r/nursing • u/zedodee • 1d ago
Rant Got fired from my first patient
Couple days ago I had five patients, two of which needed q2h pain meds. One of them understood they weren't the only patient, the other didn't.
They started out by giving staff a rules and expectations sheet. The first rule literally stated they were primarily only there for pain control.
So when I was in there closer to the 2.5h mark, the family member called me out and reminded me of rule 1.
On day two, I gave them roxanol (1h) dilauded (2h) dilaudid (2h) roxanol and the family member was still not happy because roxanol #2 should've been given 4h after the first roxanol, not five.
Just venting. Fucking asshole.
248
u/Individual_Track_865 RN - ICU 🍕 1d ago
Lord I do not know what I would do if a patient tried to give me a “rules sheet” besides laugh
72
u/Jasper455 RN 🍕 1d ago
I would tell them that I will do the best I can, but that there was only one of me and 4-10 pts with similar expectations and possibly greater needs at times.
34
11
4
u/WhereMyMidgeeAt 1d ago
Not my patient but someone else’s brought a white board and had rules on it.
-67
1d ago
[deleted]
74
u/AlleyCat6669 RN - ER 🍕 1d ago
Then you need a private duty nurse. That’s the only way to guarantee you get your pain meds on the dot. As a nurse, you should know that’s an unrealistic expectation.
57
u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. 1d ago
Okay, princess. The rest of us will be getting on with nursing.
31
22
u/BadBrains16 1d ago edited 1d ago
The physicians I work with would love to hear your ideas about a “written birth plan.”
9
u/Superb_Narwhal6101 RN - OB/GYN 🍕 1d ago
They’d bring it in a binder with laminated pages and a picture of them and their partner with their dog on the front. (True story from labor and delivery.) 🤣🤣🤣
4
-9
1d ago
[deleted]
23
u/LiquidGnome RN - PCU/IMC 🍕 1d ago
You seem to like patients dictating their own plan for their disease processes. I'd love to see someone try to manage their CHF exacerbation. Oh wait, they can't and that's why they're in the hospital.
Patients have bodily autonomy. The vast majority are also laymen who don't know much at all about medical science.
16
u/Individual_Track_865 RN - ICU 🍕 1d ago
Patient rights are things like having an interpreter and to know why you were billed for something, or only using restraints when needed. Iif you haven’t been bedside in an acute care hospital post Covid … well
(and we all know what a birth plan is, the rule is always that the more detailed the plan the greater the chance crap will hit the fan 😆, also a labouring mum wanting ice isn’t the same as a floor/unit patient trying to micromanage nursing)
8
u/Superb_Narwhal6101 RN - OB/GYN 🍕 1d ago
I swear, more often than not, the more detailed the plan, the more likely we’re ending up in the OR by the end of the shift.
17
11
0
u/PeteLangosta Spanish nurse / Midwife resident :karma: 1d ago
Dunno what's up with all the downvotes, I might not be getting your point, but yeah, the birth plan is something we encourage people to do because there's always preferences and, many times during labour, we don't have the time and have to act fast and swiftly. Therefore, knowing things beforehand makes things easier. We always remark the fact that things in the birth plan have a chance of going through the window in matter of seconds.
4
u/SmilingCurmudgeon BSN, RN 🍕 1d ago edited 1d ago
The way the post is juxtaposed is baffling to the point where it's not clear what they're trying to say but it is clear that they have nothing to say. She had a birth plan, it was rightfully jettisoned sometime during the course of "64 hours of labor and emergency section", and that somehow means we're bad nurses if we're a minute past the time a PRN is available. It's an egotistical irrelevant anecdote finished with self-aggrandizement. This is not the sub to watch a nurse jerk herself off. Try gonewildscrubs for that.
I'm still reeling from this person's posts. They honestly believe that we don't teach our CHFers. They find it more likely that they're the only nurse actually doing their job than patients being noncompliant. No way they're a nurse.
1
1d ago
[deleted]
2
u/SmilingCurmudgeon BSN, RN 🍕 1d ago
You're being questioned because your assertions are ridiculous to the point of delusion. Click the same button you clicked to join to leave. Pretty please.
3
u/Key-Pickle5609 RN - ICU 🍕 1d ago
Ok I need to know what the deleted comments were lol
5
u/SmilingCurmudgeon BSN, RN 🍕 22h ago edited 22h ago
You can't prioritize if you can't give a pain PRN the exact minute the patient is eligible, and she'd know after 35 years as an LPN. There was also some irrelevant anecdote about her birth plan and how it was rightfully disregarded after 64 hours of "emergency labor and section", so evidently she did understand the concept of plans and schedules having to be flexible in a hurry but her martyr complex wouldn't allow her to extrapolate that to how a nurse with 4+ other patients may not be available in the 60 second window between when a PRN is "due" and when it is "late".
Going off of memory here so some of the details might be fuzzy. But here's the good part: they made good on their word and left in a huff because of the "negativity" they received in response.
1
2
83
u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. 1d ago
I would have loved to be a charge in that situation, hand back that sheet and remind that family "H" stands for hospital, not hotel.
47
u/Superb_Narwhal6101 RN - OB/GYN 🍕 1d ago
Yeah I’ve been “fired” for not having q4h PRN Oxy ready and at the patients bedside at the exact 4 hour mark, around the clock. A few times actually, and these were postpartum patients. Like ready to go home the next day, refusing Motrin “bc that’s not going to do anything.” You can never make all your patients happy. Don’t be hard on yourself. Some people are just miserable humans.
58
u/anonymouslady8946 RN - OB/GYN 🍕 1d ago
At our hospital they can’t have oxy if they are refusing Tylenol and Motrin 🥰
23
u/Superb_Narwhal6101 RN - OB/GYN 🍕 1d ago
No one listens when we say Motrin every 6 hours is going to help more than anything! This is a great policy.
27
u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. 1d ago
Patients do not seem to grasp that NSAIDs are so good for sore, inflammatory pain like...minor tears after childbirth! Also that opiates will constipate further.
-14
u/Unique_Regular9442 Nursing Student 🍕 1d ago
Okay but motrin wont do diddly squat for moms who had c sections. At least not for the first few days
19
u/Interesting_Birdo RN - Oncology 🍕 1d ago
It might not be enough but it will definitely help, and reduce the amount of narcotics needed significantly. Ditto Tylenol.
-14
u/Unique_Regular9442 Nursing Student 🍕 1d ago
From a momma who had a c section, definitely did not help. Granted i spent alot of time waking around from my unit to the nicu. I’m lucky to have a treatment team who was very understanding and did give me a hard time in managing my pain. Also i wasn’t refusing pain meds either. I usually took the motrin and Tylenol. But it wasn’t helpful for me so usually they would offer oxy
13
u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. 1d ago
Your experience is not everyone's, friend.
0
u/Unique_Regular9442 Nursing Student 🍕 1d ago
True true.
6
u/LiquidGnome RN - PCU/IMC 🍕 1d ago
We treat our trauma surgical patients with a multi-modal pain regimen. They get tylenol, a muscle relaxer, gabapentin, and oxy as needed. It seems slightly different in OB, but the idea is the same. Use multiple meds for pain. OTC meds alone may not work for everyone after a C-section. However, APAP does work in conjunction with an opiate. Percocet is oxy/APAP. Lortab is hydro/APAP. Ultracet is tramadol/APAP.
3
u/LiquidGnome RN - PCU/IMC 🍕 1d ago
We treat our trauma surgical patients with a multi-modal pain regimen. They get tylenol, a muscle relaxer, gabapentin, and oxy as needed. It seems slightly different in OB, but the idea is the same. Use multiple meds for pain. OTC meds alone may not work for everyone after a C-section. However, APAP does work in conjunction with an opiate. Percocet is oxy/APAP. Lortab is hydro/APAP. Ultracet is tramadol/APAP.
1
1
u/SnowyEclipse01 🏳️⚧️🚑 Paramagician 23h ago
IV APAP is proven when used in a multimodal pain regiment post surgery and traumatic injury to reduce the need for redosing of opioid pain medication.
Ibuprofen and Toradol are also shown to do the same, and are highly effective in musculoskeletal pain as both monotherapy and adjunctive therapy.
1
u/pinkpumpkinapple 13h ago
you’re projecting your personal experience onto nurses who have observed hundreds-thousands of experiences
4
u/DinosaurNurse RN 🍕 1d ago
My oldest daughter just had a c section and took only tylenol. She's a nurse's daughter. 😂
2
3
u/Superb_Narwhal6101 RN - OB/GYN 🍕 1d ago
Not really. Alternating Tylenol and Motrin around the clock is usually very effective, with the Oxy for breakthrough pain PRN. Just taking Oxy every 4 hours without even bothering with Motrin and Tylenol is going to constipate you, and then make you feel like hot garbage when they all of a sudden take you off of it in 4-5 days. It makes little to no sense not to even bother with Motrin and Tylenol. Just because they’re over the counter, people assume “they don’t do anything.” And that’s nonsense.
3
u/DinosaurNurse RN 🍕 1d ago
My 5 kids are 28-36, and I refused anything BUT Ibuprofen, even with my c-sectin, after their births. At least it DOES actually "do something." It doesn't JUST alleviate pain.
6
u/Goatmama1981 RN - PCU 1d ago
That is SUCH a good idea. So common-sense. I also wish they would let us give 5mg oxy and then the other 5mg in an hour if needed. I think our current policy is stupid because if the person's on the fence they'll usually take the higher dose even if they don't really want to. 😕
3
u/anonymouslady8946 RN - OB/GYN 🍕 1d ago
We’re allowed to give the other half in an hour too!
3
u/Goatmama1981 RN - PCU 1d ago
🥲 I love hearing about people who work at places where the rules make sense!
3
2
u/Tilted_scale MSN, RN 1d ago
I’d sure love to not be deathly allergic to Motrin from experience, because I’ve seen the effects in post c/s patients. Alas for me it was “please just Percocet. Not oxy. I need the Tylenol multiplier, but not a ETT or cric from Motrin.” ☹️
3
u/anonymouslady8946 RN - OB/GYN 🍕 1d ago
Allergies not included I should add. Plenty of people can’t take Tylenol/motrin for legit reasons
2
u/Tilted_scale MSN, RN 1d ago
Oh I never questioned it! I knew what you meant. Just totally wanted to be a jealous nurse for a minute. I’m just glad my reaction to Tylenol is not instant death.
67
u/IggyD003 BSN, ICU, Neuro ICU, NeuroSpine, PreOp/PACU, CP Coordinator, CnC 1d ago
Not a bad way to get fired from a parent. They didn’t freak out and cause a scene. They didn’t scream for the manager.
Remember you will never make every patient 100% happy, though our badge buddies say RN (refreshments and narcotics) we’re there to keep them safe and make sure they survive the hospitalization.
33
u/Hexonxonxx13 1d ago
Rules and expectations? Ha! The first time I was fired from a patient for crap like this, I was crushed. Now I’m like “thank you!!” Same with patients threatening to leave AMA. I used to educate them and say oh please don’t leave. Now, I’m like great, let’s take your IV out! People!!
16
u/Ciao_Bella__ RN - Telemetry 🍕 1d ago
I had a patient one time that was demanding something stupid, wish I could remember what. But anyway, he was threatening to leave AMA so naturally we have to call the provider and let them know. The provider comes down, goes into the room to see patient, then comes to me and says - I’m not putting up with his crap, I’m discharging him. Security came up and escorted him and his girlfriend out the door. I have never been so relieved to not a have patient before that I told the charge nurse that even though I just admitted a patient, I would be happy to take the next admit!
6
u/Hexonxonxx13 1d ago
That is amazing!! Our hospital doesn’t support staff like that at all. The abuse we put up with is insane. But yes, I’m with you, I too would have been just fine with another admit if it meant not having to deal with that!
7
u/Goatmama1981 RN - PCU 1d ago
I get a kind of sick enjoyment from seeing the shocked pikachu face when I'm like "cool, let's get you out of here!" And don't beg them to stay!
5
u/Hexonxonxx13 1d ago
Oh it’s the best!! And they always change their tune when they realize you aren’t playing their game!
5
u/DinosaurNurse RN 🍕 1d ago edited 1d ago
Years ago I had a hospital patient elope, right after admission. I got reprimanded because he left with his I.V... pretty sure it was solely his reason for admission, if you know what I mean...
3
26
u/cobrachickenwing RN 🍕 1d ago
" giving staff a rules and expectations sheet ". That is when we give them the pamphlet regarding patient code of conduct. And escalate to a behavior contract if they didn't get the hint. Third strike is when security is called to trespass them and forcibly remove them.
29
u/_Alternate_Throwaway RN - ER 🍕 1d ago
Got fired for being a male nurse and telling my male patient that I had several injections for him to address his issue and that due to the number of injections and amount of medicine at least one of them must be given in a large muscle like the glute, hip, or thigh. He immediately yelled "I ain't no f** and I ain't down with that gay shit!" and then demanded I leave the room and get him another nurse because I was trying to turn him gay by putting things in his ass.
Dumbfounded I quietly left and told another more experienced nurse (I was a new grad at the time) and she went in and told him the exact thing I did. When he responded the same way she happily pointed towards the door and told him "We have medicine to take care of you but if you don't want it you're welcome to leave!" He jumped off the bed and ran out of the unit screaming insults and wild accusations at all of us.
12
u/Aupps RN 🍕 1d ago
Just remember that those who scream homophobic slurs are usually hiding homosexual feelings.
3
u/kauniskissa 1d ago
I don't get this sentiment because it insinuates that it is usually gay men who perpetuate homophobia and hides the fact that vast majority of homophobic/gendered violence comes from straight men.
Like, do men scream misogynistic slurs because they're hiding their feminist feelings?
22
u/boyz_for_now RN 🍕 1d ago
What did they need pain management for? The second they handed me a rules sheet I would have laughed.
7
u/zedodee 1d ago
Joint replacement that left them bed bound for several months
22
u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. 1d ago
No, they refused PT after joint replacement because, "I just had surgery!!!!"
2
13
u/cats-n-cafe Jack-of-All-Trades RN 1d ago
Honestly, I’ve only been fired by 2 patients….and the feelings were mutual…..
I wish I had been fired from many more who didn’t fire me.
26
u/rieeechard 1d ago
I got fired from a patient bc i didn't believe him when he said someone had used his toothbrush because it smelled like toothpaste(single occupancy rooms). Got him a new one and was told I'm either incompetent or an idiot and he wanted another nurse. I still don't understand it.
4
u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. 1d ago
I'd be worried about you if you did.
11
u/angelfishfan87 ED Tech 1d ago
Honestly if a patient is giving me rules, I would shut that shit down. It's hosp, not a hotel or in home care. They can talk to my manager if they've got problems. They are not the only person I am caring for, and the need to 'give orders/rules' is proof they don't fully understand that and it's going to be a problem by default.
I would have fired that patient before they had a chance to fire me. There is no pleasing a pt like that.
11
u/gasolinerainbowz 1d ago
they would put comfort care patients legit actively dying on med surg floors.... and lucky me would get these patients... 6 patients. TPN, giving blood products, hep drips, restraints, pre/post op, dialysis calling for patients to go down, and on top of that a room full of family with a dying patient and orders for IV ativan, morphine every 30 min and they expect it every 30 min!!! like I want to be doing right by that patient to keep them comfortable but I cant possibly do that while caring for the other high acuity patients. like please fire me because your loved one doesnt belong in the hospital on hospice where we dont specialize in that 1 on 1, and fuck the management for making them and the nurse suffer mentally for not being able to care for them the way they need while dying.
4
u/drive_to_madagascar 1d ago
My hospital does this and it is the literal worst. We have a mixed tele, medical, and hospice floor and take 5-6 patients. And it’s just impossible to give q15 min meds to keep them comfy. The only way this is even close to doable is if they get a continuous drip or a pca and we had to fight tooth and nail for that.
2
u/Glamaramadringdong RN 🍕 1d ago
I had that in a nursing home with 25+ patients. Half of them trying to fall every 10 minutes. Family would expect me to be giving every possible PRN as often as possible on the dot. Even when the patient is obviously comfortable and is basically contented jello. We had to have some real honest talks about workloads and expectations. That I would do my best but it was not realistic for me to be in their room every 20 or 30 minutes.
Luckily our hospice house has started taking these patients when beds open up.
1
u/pinkpumpkinapple 13h ago
same, it’s the worst!!! they give me hospice patients on top of my acute surgical patients in a 6-10 patient assignment that have had big surgeries like whipples and require a ton of time, and give me zero training on hospice and how to interact with the family. like whyyyyyyy
9
u/Remarkable-Moose-409 1d ago
I would ask the patient & family if the physician had seen their written, self directed, plan of care. If not, I’d offer to scan a copy into their medical record & request a care meeting with the physician ASAP. Do this in a caring way.
8
u/Willwrestle4food BSN, RN 🍕 1d ago
I had a patient fire me about a month ago. I've been a nurse for a while so it's not the first time but it is rare. This was a particularly difficult patient and she also liked to play games and had unrealistic expectations. Her particular power play was to hit the call minutes after I'd rounded with petty requests. About 90 minutes into my shift she gave me a very mean spirited lecture about how long she had to wait. To which I explained that she was one of five patients and if she insisted on hitting her light so frequently she would occasionally have to wait a bit. She was outraged and insisted on firing me and speaking to the charge nurse. New nurse was assigned and picked up a very pleasant post op watchman in her place. Best firing ever. She even requested me back about 3 hours later after her new nurse was even less attentive and accommodating than I was. Sometimes being fired isn't really the punishment they think it is.
6
u/Humble-Speaker-8268 1d ago
I’d give them our own list of rules and reasonable expectations, but we have a manager that has our back so not taking that for granted.
6
6
u/Murky_Indication_442 1d ago
Wait, what!? They gave the staff a rules and expectations sheet? Haha 🤣 I wouldn’t have taken it, I would have said, “I understand it’s difficult to be in a situation where you have to rely on other people for things you are used to doing yourself, and I understand you are concerned about pain control. I can assure you we already have policies in place and follow the standards regarding pain management.”
3
3
u/fuzzyberiah RN - Med/Surg 🍕 1d ago
As is almost always the case, the nurse is not the one who suffers from being “fired” by a patient.
3
u/BathroomSmooth1937 1d ago
If they need pain meds that much and that often then the doctor is not doing their job in prescribing an adequate amount of pain meds appropriate for clinical situation (ie a terminal cancerr patient) or acknowledging a patient with an pain med dependency, discharging them with a referral.to a pain clinic for management.
3
2
u/New-Chapter-1861 BSN, RN 💉🏥 1d ago
Good riddance to them lol its not your fault. Be happy you don’t have to deal with them. Ive had patients tell me to wake them out of a dead sleep for PRNs, I dont think so buddy lol
2
u/Fun-Marsupial-2547 RN - OR 🍕 1d ago
I get some kind of sick joy out of being fired by patients. Like I didn’t want to hang out with you either!!! I did have one patient I swore was going to fire me or something bc I refused to give her more “calm me down” meds but she asked my charge if I could be her nurse when she tried to check back in after leaving AMA
2
u/LadyGreyIcedTea RN - Pediatrics 🍕 1d ago
Sounds like you'll have a more peaceful shift not caring for this person.
One of my former colleagues (now deceased) used to always say that the patients who fire you are the ones you don't want to be taking care of in the first place.
2
u/ragdollxkitn Case Manager 🍕 1d ago
I got fired once as a CM. Mostly because some patients are unrealistic in their expectations and don’t like to hear the truth.
2
u/Yellowize RN - Hospice 🍕 1d ago
Roxanol q2hrs. Couldn’t they do that at home for themselves? Obviously they are capable of managing time and can make a list of demands. They are fully capable to manage their own medication needs.
2
u/SkurrSkurrBurrBurr LPN 🍕 1d ago
Jesus christ. I have 30 patients on day shift (7a-3pm, however, i’m usually there til at least 5 because i can’t leave work without doing everything properly…), and i can tell you, any time any one of them complain about me coming in with meds late, i say “I’m sorry, but the patient next door fell and hit his head on the door and was bleeding out, unfortunately that took precedence over being here 30 minutes earlier. I’m sure if it was your head bleeding out on the ground, you’d hope for the same treatment. I have no option but to treat the most emergent/critical situations first. I’m sure if that was you on the ground, you’d hope for the same.“ I simply list whatever crazy shit happened in the past couple of hours that caused a delay in my appearance with their meds, & they have no choice but to suck it up.
Entitled patients act this way because we kiss up to them, and let them. They are NOT paying your salary. Your job is paying you. & they are paying you to keep ALL of your residents safe and out of harm’s way. Do you really think your supervisors would prefer you get everyone their medications on time if that means that you have six falls a day that you leave them to deal with? No! Do you think they’d rather you not complete anything of actual medical importance, simply because room 3 is asking for yet another oxy every four hours? She had one four hours ago, if she has to wait 30 minutes or an hour more, it isn’t going to kill her. If she can wait 4 hours, she can wait 5 or 6. 95% of the time, i don’t even take a 30 minute break, and I’m usually at least two hours late on my 8 hour shift. That means i’m working ten hours without a thirty minute break, without so much as a bite to eat, because I’m trying to get thirty people their meds and treatments on time. Thirty people who are comfortable laying in a bed, getting medicated for anything & everything that they could possibly desire. Meanwhile I don’t even have time for a bite of a sandwich or chips. & I’m fine with that, I love working as a nurse. But what I am not fine with, is being disrespected & treated with disrespect, because I got to you 30 minutes later than the nurse yesterday did. Guess what? Every day is a different day, and different events happen. So sometimes, emergencies push things back. As a nurse, we are required to triage - to pick which events require the most immediate interventions, & which events can wait a little while longer.
The absolute disrespect people act with nowadays is absolutely disgusting. & they excpect us to suck up to them and treat them like god’s gift to this unit? fuck that. You treat me like shit, that’s your choice. I’m still going to get you your medication whenever I am able to. The most important and most critical situations simply have to be taken care of first. That’s the way it has to be.
1
u/TronLoot-TrueBeing RN - ICU 🍕 1d ago
If they want 1:1 treatment they are gonna have to upgrade to the deluxe package.
1
u/ImNotObama ED Tech 1d ago
Not a nurse, but ED paramedic. I’ve been fired by two patients. First one I missed an IV on a pediatric patient who was in the ED for vomiting x3 days. Patient stated that the missed IV didn’t hurt but parent wasn’t happy and said they didn’t want me in their room and to send in somebody “who knows what they’re doing”. Nobody ended up getting an IV on the patient and they left AMA.
Second one was I had just come on shift and was going to unhook a patient from the monitor so they could use the restroom. AxO 4/4 GCS 15 walkie talkie female patient here for abdominal pain. They said they didn’t feel comfortable with a male unhooking them and showing them the restroom. This patient was still fully clothed. Simply told them that was their right and went and found one of the female nurses to lend a hand
1
u/whereis_ermito RN - Oncology 🍕 12h ago
every time i’ve been fired by a patient has been a relief. because often they’re looking for their own control and power trip. more often than not you’ll be better off, because now they’re someone else’s problem
480
u/LizardofDeath RN - ICU 🍕 1d ago
A secret they don’t tell you is when you get fired from a patient it’s usually a huge win for you as the nurse bc you don’t have to deal with them anymore