Hey so your post about pain management as a bedside nurse is so important to my own nursing practice that I've considered printing it out so I can have it to hand all the time. So thanks for that. Also, how do you deal with assignments that are busy enough that pain management is harder than it should be? I'm coming up on two years as a nurse and I feel like I take it personally when I am too busy to adequately manage my patients pain. I'm also coming from a newly unionized hospital where the ratios are still horrendous (I do 1:10 on med surg) and I'm hoping once we can enforce our staffing grids it'll be better but idk I'm burning out and I love my job so much and I really respect your nursing philosophy? I guess. Sorry for the word vomit it's been a crazy shift.
I've been trying to think of how to answer this since I got it. It's just such a horrendous ratio. With ten patients a shift, that's like six minutes an hour for each in a fantasy world where there's no charting and everything is exactly where you need it to be. I feel like I don't have great insight into this because the most med surg patients I've had assigned is five. Ten patients to one nurse is just a raw deal for everyone. Like christ no wonder you feel like you're burning out! I'll give you what thoughts I have and hopefully other people can chime in if they have suggestions. But that's such a hard patient load.
When I've been super swamped, I've found that's when being really explicit about your thinking with the patient helps. Like if I have to dash into a room and then dash back out, I'll make sure the board is updated with the next medication time and that the patient knows when the medication is going to kick in. I'll also provide call light parameters. I have a lot of success telling people, "the med should be doing something by 5:30. If I haven't checked in with you by then, and the pain is unchanged or barely changed, hit your call light and we'll try the next step. Also hit your call light if you feel any sudden change, like now you're nauseated or you have a headache or the type of pain changes or something just feels very wrong. Is there anything you need before I step out of the room?"
I like to be explicit about when to call me because I think there's two directions call light usage can go wrong: someone calls all the time, or someone never calls. With someone who calls all the time, I find that telling them when I'll be back and that I want them to call me if I'm not takes away some of that anxiety that can causes some people to call frequently. Often those patients are afraid that if they aren't on the call light, they're gonna get ignored.
For the other type of patient, the one that doesn't call, I want to make explicit that it's GOOD AND NORMAL TO CALL YOUR NURSE WHEN YOU HAVE SYMPTOMS. We've all had that patient at the end of shift who goes, "btw the gnawing pain in my leg is now a 10/10" and you're like "what gnawing pain sir?? you've literally never mentioned it before now?? I don't have any meds for that lemme page super quick????" These patients can get into pain crises easily because they don't ask for help until something is unbearable. In addition to pain crisis bad, it takes a lot more time to deal with something unbearable than it does to deal with something uncomfortable.
On that note, are you spending your very limited time efficiently? To me, that actually means spend more time talking with patients, at least up front. Manage expectations, make sure people know what to expect. Having conversations with patients that are like, "You just had surgery, it's not gonna happen that we get you completely painless. We want to get you to a manageable pain level that allows you to do whatever it is you most want to do this shift." (For me on nights, that's usually sleeping at least a little, but sometimes the realistic goal you make together is that you will feel at some point better than you feel right now.) "You have this medication scheduled, and you have this one available every X hours when your pain is severe. Is there anything you know that helps you deal with pain?"
Also establish if patients want to be woken up for certain prn medications or if they're sleeping, to let them sleep. With some patients, I will advise them to get woken up for pain medication because I know that they're going to need consistent control to avoid a crisis. (Crises take so much time!)
When I'm crunched for time, I'm fond of bringing in an ice pack and being like "if it works, great, if it doesn't, just take it off, either way here it is." Sometimes I'll do the same with a warm blanket. If I know my patient needs to take pills, I'll bring a cup of water with me into the room. If there's a basic prn like melatonin or tylenol that I think they might want, I'll pull them in advance. If the patient doesn't want them, I return them next time I'm in the med room. (Obviously, don't do this with controlled substances. It's super easy to forget to return them, and not returning opioids is one of those whoopsies people get fired over.)
Decision making takes time. Walking to go get stuff takes time. I want to save the time it takes to assess if the patient needs those things and then walk off to fetch them by just having the things already. If your tightest resource is time, be liberal with resources you can spare. If you're stuck with a patient, do you have anyone you can delegate a prn med pass to? Do you know how to do the absolute minimum charting you need to? Do you have flushes and alcohol wipes and whatever other most common things you need? And since you can't hoard time, if you've got some to spare, ask yourself if there is anything you can do now that will save you time later. If you have five free minutes now and an incontinent patient, getting them up to the bathroom now can save you from taking the time for incontinence care and a bed change later on when they've also sundowned and decide they hate everything but most of all you.
So much of this answer I realize is investing as much time upfront as you can, which I realize is so hard when you are so busy. It sucks immensely that prepping takes much less time than not being prepared does when you don't always have time to prep. Plus when you invest that time to pain plan with patients and do small preventative interventions, I think it also provides some psychological comfort that helps with pain. You're letting them know you're invested and you care and you have a plan, even if you don't have all the time you'd like. That can mean better pain control, which can mean needing to spend less time in that room overall, meaning you can save six whole minutes at some point and maybe even, if we're feeling crazy, get a chance to indulge in that greatest of indulgences: just a real leisurely on-shift piss.
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Hey guess what it's more Good Ganondorf content!
@silvercaptain24 <3
The party had long since finished. Link had been escorted back to his room and left in peace. With food in his stomach and some water, he felt his strength returning. His body trembled as he stood tentatively, alone in his room, but he managed to stay on his feet nonetheless.
Stepping quietly to the door, Link put an ear to it. There had to be guards outside, but he hadn't seen any when Nabooru had brought him back here.
This entire situation was making less sense, but he wasn't going to stick around long enough to parse it all out. Nabooru had claimed Ganondorf was holding him hostage to keep him safe. Ganondorf himself had tried to make himself look like he wasn't the villain, like the entirety of Hyrule hadn't been ripped apart at the seams because of his corruption and desire for power, like he hadn't torn the Triforce from Link and Zelda in battle while his army slaughtered their men.
It didn't make sense. What game was the monster playing? Link would have to figure it out when he made it back to his own people. Zelda and his army were waiting for him. The queen was no doubt trying to get a rescue operation together, and Link didn't want to risk anyone's lives over himself, not when he could find his own way out. He wasn't some helpless fool, he could handle this, and he would get the Triforce pieces back that the queen so desperately guarded.
He'd seen the crazed look in Zelda's eyes when they'd lost the Triforce the first time. He didn't want to see that again.
There was no other way out of this room than to use the door. It felt stupidly simple and reckless. He had to open it quickly, to catch the guards by surprise, wherever they were stationed. He needed some kind of weapon. He'd managed to sneak a knife in from dinner, slipping it into his boot, but he wasn't sure how useful it would be. He gripped it firmly in his hand and took a steadying breath.
It was now or never.
Link threw the door open, quickly taking in his surroundings, and saw... nothing.
No one... was there.
Well, he couldn't stop to think about it. The noise he'd just made would attract attention.
Trying to remember the path Nabooru had led him through to get outside, Link ran quickly, ignoring the chill that sank into his bones as he moved. When had it gotten so cold? His fingers felt like they were getting numb already as they gripped the knife.
The hallway opened up to a larger room. He remembered that. This was where--
A hand grabbed him by the back of his tunic and yanked harshly, sending him to the floor with a yell. Link kicked blindly, eyes focusing on his target.
It was Ghirahim.
Snarling, Link rolled to get away and swiped with the knife to create distance. Ghirahim caught his arm by the wrist, watching him with a sadistic smile.
"I figured you wouldn't sit still for long, sky child," he purred.
Something in Link roared in response, and he let out a battle cry as gripped the demon's arm with his free hand, bringing all his weight down to drag Ghirahim to the ground. The demon gasped a little at the increased weight he was holding, but he caught the hero by the shirt instead of letting them both fall.
Link spat in his face next, and that worked brilliantly, making the demon hiss and pull away immediately. Free from his grasp, Link began to run, knowing this was not a fight he was going to win with a knife. He heard a snap and Ghirahim appeared in front of him.
"Now, now," Ghirahim said, brushing some white hair out of his face. "I have strict orders to keep you here."
"Over my dead body," Link snarled.
"Oh, I wish," Ghirahim replied. "You see, that has been a point of contention lately. My master wishes you alive and it is so dreadfully taxing on me. But I trust his judgment. He has a way to address the true matter. And then your little vassal can be safe and sound while I deal with you."
"What the hell are you talking about?" Link snapped, eyes searching for another escape route as he spoke. The demon lord certainly loved to talk, so if Link could use that to his advantage, he would.
"It's amazing how dense you can be," Ghirahim grumbled. "Honestly, an entire war fought for you and you don't even understand it. Cia may have fallen in love with you, but she desires your vassal. Nevertheless, this has always been about eliminating you. My master understands that. It will be my highest honor to serve in that capacity for him, to be the one to deliver the killing blow. I cannot wait for that momentous occasion."
"You're out of your mind," Link replied. Another hallway was just to the left, and if he ran fast enough... "I am the Hero. I don't know what you're talking about with vassals. I serve the queen as a--"
"THIS ISN'T ABOUT THE QUEEN!" Ghirahim screamed, face contorted in rage. "This is about you, sky child, about revenge, about eliminating the one threat in my master's way! Her Grace isn't here, and her descendant doesn't have a fraction of that power, the Triforce is all my master needs now, and I will finally be able to kill you!"
The conversation was about to end and Link knew it. He tore off in the direction of the other hallway, managing to round the corner when he heard a snap again. He was prepared this time, grabbing the nearest pot and throwing it just as diamonds materialized in front of him. Ghirahim grunted as it made impact as soon as he appeared, shattering into countless pieces while Link quickly backtracked and went a different way.
By the grace of the goddesses, that had given the captain enough time to at least outmaneuver the demon lord, who wasn't sure which part of the compound Link had ended up by now. He was grateful for it, his heart racing and pounding in his ears as he rushed to find an exit. Fighting Ghirahim in the heat of battle felt far more... controlled than this. Here he felt like prey, and Ghirahim's rage and power over him was...
He wasn't going to say he was scared. He wouldn't.
Link felt a breeze and it gave him hope. That had to mean he was close to the outdoors. But where were all the Gerudo?
A door was up ahead, sand trickling in from beneath it, a promise of freedom and safety. Link threw it open with relief.
And ran right into Ganondorf.
Gasping, Link scrambled backwards, losing his footing and his balance as he fell unceremoniously to the ground. He continued to scoot away, trying to find a way around the towering figure. The man was enormous - it could give Link the advantage of scurrying around him if he was fast enough, but the world was spinning and--
"I figured you might try this," Ganondorf sighed.
Okay. Okay, fine. So they were talking. That would give him time to catch his breath. All these fools and their monologues - and people said Link was arrogant. At least he didn't usually give his enemies time to formulate a plan while they were actively standing in front of him.
"Your strength is returning," Ganondorf noted, walking towards him. "But that doesn't mean you're ready for a fight."
Well, Link might as well try to get some answers while he was here. "Where's the Triforce, you monster?"
"Where it needs to be," Ganondorf answered simply, closing the door behind him, much to Link's dismay. He stared at Link for an uncomfortably long time, making the captain squirm.
"Nabooru said you want me alive. Tell me why," he demanded, trying to make the man talk again.
Ganondorf was silent for a moment longer and then shook his head. "You're not in a state to accept my words."
"Try me," Link goaded. He had to admit, at this point he was curious. And it bought him more time to figure out what the heck his next step would be.
"I know your type, Hero," Ganondorf said, tacking on the title as if it were a curse. "You follow the queen like a puppy that doesn't know any better. Your heart is filled with a sense of duty, a desire to help and do good, and it is fixed on that woman. You'll do whatever Zelda tells you."
Link bristled but bit his tongue. Whatever slander Ganondorf was about to say didn't interest him, but the man hadn't made a point yet.
"You don't see the mess you're in," Ganondorf continued, shaking his head. "You don't understand. I'm trying to protect you, Link."
Link blinked. Then he blinked again. Nabooru had said as much, but hearing it from him... well. She had said keep him safe. He'd interpreted it as keep him alive. "Protect me from what?"
"Everything," Ganondorf muttered in a low time, voice rumbling in his chest. He bent forward, as if to grab Link, and the captain took that as his cue.
Link bolted, rushing to the left to get out of the reach of the man as he tried to run around him, using his small size to his advantage. He reached the door and immediately realized his mistake.
It was locked.
The ground vanished beneath him, and Link felt his stomach lurch as he was held in the air by one of his arms. The strain of having his entire body weight pulled into his shoulder joint made him grit his teeth. Then his world twirled as he was tossed against the man, his back to Ganondorf's chest, held in place by an arm wrapped around his torso.
"Let me go!" he yelled, kicking his legs as much as possible.
"I told you that you were not ready for this conversation," Ganondorf said, almost chidingly. "I'm taking you back to your room so you can rest."
"You think I'll be ready for a conversation that isn't true?" Link snapped. "You're holding me hostage for a reason, stop lying to me!"
Ganondorf said nothing, walking down the hallway with Link his helpless prisoner dangling in his grip. His waist and stomach ached from the hold, though at least pressed against someone else warmed him enough that he wasn't shivering and numb. His body was screaming at him at this point, wounds he hadn't even realized existed suddenly flaring up. He supposed the battle that had gotten him captured had left more marks than he'd realized.
That didn't matter. Escaping mattered.
Link felt so utterly helpless and he hated it. He'd never felt so out of control in his life. When he was plopped back on the bed and left alone to his own musings, he curled into a ball, suddenly shivering again.
He felt so, so alone. And suddenly, with the thought of Ghirahim's twisted, demented, enraged face, with the thought of how easily Ganondorf just manhandled him, he felt...
He wasn't going to say it. He wasn't going to say it.
Damn it all, he was scared. And he hated it.
He was the bearer of the Triforce of Courage and he was scared.
Burying his face into his knees, Link hugged himself and cursed himself at the same time. The tears fell silently at first before little hiccups started to accompany them. He was too tired for this. The only mercy the goddesses provided was that he was alone. He didn't want anyone to see him like this.
His body felt impossibly heavy. The room felt like it was closing in. He was exhausted. His head hurt. His stomach ached from how he'd been held. Something on his back seared like fire. His knees were bothering him. He was freezing. He felt so unbelievably overwhelmed. He felt so unbelievably unsafe.
He'd always been the one to save the day. He'd been invincible with the Master Sword, though he'd learned that having others to help him was equally as important. But he had no Master Sword here. No friends. No hope of anything.
In the darkness and cold of the night, his fears consumed him, and he gave into despair. Link cried, so desperately alone. He just wanted to feel safe.
Warmth enveloped him, and he sank into it willingly, his hiccups turning into sobs. Something ran soothingly along his back, soft cloth was pressed against his face, and he found himself clinging to it desperately like a lifeline.
He needed to get himself together. He didn't care. No one was here anyway.
Then what's... why am I...?
He was too tired to process it anymore. All he knew was he felt safe.
"You'll be okay, child."
The voice was deep and gentle, whispered into his hair. Gentle pressure pressed him against whatever softness was in front of him. He heard a heartbeat.
A heartbeat. Pressure. Words. This was... he wasn't alone.
Hiccupping, Link opened his eyes, hands still clinging for dear life to patterned cloth in front of him, red hair spilling into his face as it slid over the person's shoulders.
A deep voice. A man's voice. A man wearing Gerudo--
What the hell.
Alarms rang in Link's mind as he put the pieces together. This couldn't be right this couldn't be right--
"You're safe," the voice said gently, continuing to run a hand along his back.
Link was so lost and confused and hurt and why the hell didn't anything make sense what was happening--
"I'll fix this," Ganondorf promised, and Link gave up entirely, falling apart.
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