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March 15, 2017

Q&A With Nurse B: Day Nurse Left My Patient In Pain!

Welcome to Q&A with Nurse Beth Boynton, RN, MS. 

In this 10-part weekly series, we'll be navigating common conflicts in nursing and healthcare with an eye towards shared accountability and co-creative solutions. 

Submit your conflict to keith@nursemail.org.

The Situation

Dear Beth,

My name is Jasmine and I work the night shift on an Oncology Unit. 

I am upset about a situation involving a patient’s pain issue that wasn’t addressed in a timely manner. 

Mrs. Jones was admitted with Stage IV lymphoma. She was having increased back pain at home, but had not mentioned this to the ER staff. I had documented this in my notes and expressed concerns to the day nurse, Linda, when I reported out to her.

The next night, the evening nurse, Richard, said he was unaware of any breakthrough pain. Evidently, he had not received proper notes from Linda.

Mrs. Jones had also been started on two new antibiotics but no new pain meds. He explained that the patient had been sleeping much of the shift so he wasn’t sure pain was such a big concern. 

I then went to find Mrs. Jones crying softly and telling me, “It hurts to move.” I was seething inside, thinking how lazy the day nurse was. Thankfully, the hospitalist ordered some PRN morphine right away.

I couldn’t stop thinking about Mrs. Jones having to suffer unnecessarily. When Linda arrived the next morning, I was angry and confronted her, but Linda told me to lighten up.

How do I address this in a professional manner?

Signed, 

No Unnecessary Pain

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The Solution

Dear Jasmine,

I can understand your frustration. I can’t help but wonder if another conversation with Linda might be helpful. Let’s discuss next steps you that will lead to better care and a more trusting relationship. 

The Work

I have a close friend who is an Oncology Certified RN. I admire her ability to cope with the heartache that accompanies this specialty. 

Real or anticipated loss of patients feels overwhelming to her. The same might be happening to you and Linda. One or both of you might be impatient with each other given the demands of your work; an article on “compassion fatigue” Compassion Fatigue in Oncology Nursing: A Witness to Suffering is an excellent resource in this regard. 

Conflict between nurses working different shifts is not uncommon. Each nurse views their shift as the most demanding. In reality, all shifts are demanding. 

The patient care, nurse-patient ratios, administrative work, and supervision vary by specialty. But everyone is being challenged to work to their maximum capacity at all times. 

Nurses working different shifts have no time to process grief or joy together. That’s a recipe for misunderstanding. 

And, you might have different clinical judgments. Step back a bit and re-approach the situation with a new curiosity and respect.  

Related: Medical Improv Activity:  Breaking Tension & Improving Communication  

Next Steps

You could consider asking Linda to have another conversation about Mrs. Jones. Present your concerns with ownership and approach the situation with an open mind. 

There is no guarantee that Linda will respond in kind, but she might; if she does, you both are likely to gain trust and respect for each other’s decision-making. If she doesn’t, you will still have a better idea of what to expect from your colleague. 

You might invite dialogue by saying something like this:

Hi Linda. can we talk about our recent conversation about Mrs. Jones’ pain management? I want to let you know where I’m coming from and get your take on it. 

Having agreed to a time and place, begin the conversation with using an “I statement” that might sound something like this:

I was worried about Mrs. Jones’ pain when I left that morning.  I had assured her that we could get her pain under control. I felt I had let her down when I went back in the next night night and she was still in pain. When you told me to “lighten up,” I felt like you were telling me that my concerns were not important. Can you help me understand what was going on during the shift?

From here, we can hope that Linda won’t be defensive. Ideally, she will share her rationale and apologize for her dismissive comment. Maybe the patient was able to sleep because she was so exhausted, found a position of comfort, or the pain was less of a problem during the day. 

Perhaps the new IV orders were taking up a lot of time or Linda had more urgent tasks that she was focused on.

If you can show Linda that you are human, you’ll help make it safe for her to do the same. From here, you can forgive yourselves and each other, and your future work together may be more rich with trust and respect. 

Next Up: 15 Highest Paying Nursing Specialties

Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture.  She is a Medical Improv Practitioner and author of Confident Voices (CreateSpace 2009) and Successful Nurse Communication (F.A. Davis 2015).  Her third book,  Medical Improv: A New Way to Improve Communication is scheduled for release in 2017. 

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