[lmessajumper]

Unfortunately I find that most nurses are not managing their patient's pain appropriately. Recent comments I have heard during report:
1. She hurt all night but I only had Tylenol ordered. It didn't do any good. (Please note that RN did not call MD to report pt's unrelieved pain)
2. He kept call for pain meds every hour. I kept telling him he could only get it every 4 hours. (Also did not call MD)
3. She didn't sleep at all last night. I was giving the maximum dose but I was worried about her getting too sleepy.
4. He kept rating his pain from 8 to 10, but he tested positive for marijuana in the ER so I figure he is just drug-seeking so I didn't call the doctor.

This is the majority of attitudes I am finding all over the country.

Please remember:
PAIN IS THE 5TH VITAL SIGN!

YOUR PATIENT'S PAIN IS WHAT THEY SAY IT IS.

JUST BECAUSE YOUR PT IS SLEEPING DOESN'T MEAN THEY AREN'T IN PAIN

I respond to these nurses in different ways according to the situation. I try to be casual and non-critical. I try to approach it with a sense of humor and irreverence.

I joking remind them that we do not work on an alcohol or drug dependency unit so my priority is not getting this guy off drugs, let the rehab nurses worry about that. Besides, you won't have to worry too much about oversedating him, he probably has a high tolerance. Also, just because you are an addict, doesn't mean that you aren't in pain. Some pt's are addicts because "we" made them so! Poor woman has terrible chronic back pain and the meds we have to offer are usually pathetically uneffective and just for good measure, she has become dependent on them and she can't get anymore because she is dependent and her back pain is worse.

When I get report about a "drug seeker" that has been calling "every four hours because he knows it is time to get another pill", or "I'll look in and he is sleeping but 10 minutes later he is calling for pain meds", I realize that this patient will probably be distrustful, angry, anxious, tired and/or hopeless and I will need to address these issues head on. If it is ordered, I usually walk into the room with the pain med saying that I know they have been hurting all night but I will not stop until we get this under control. I will be in here with your meds as soon as they can be given again. If your pain is not gone in an hour, call me and I will call the doctor and let her know. I do not want you to be in pain today, it slows healing, increases you blood pressure and keeps you from participating in your recovery. Don't worry, I will take care of this. I then review the pain scale and get a description of their pain: Where? What does it feel like, stabbing, aching, burning, etc? Does the medicine help? How soon has it been coming back? If they are still in pain when I reassess in 30-60 minutes (depending on the med), and I have no other meds or comfort measures to try, I will always call the doctor to let them know. Please be your patient's advocate when you speak to the doctor. Many doctors are not comfortable treating pain or are too cautious. If what they order doesn't work, call them back again! You are all that patient has to count on.

When appropriate as far as the patient's comfort and consciousness level, I will then try to get as much info as possible about their pain. Does it come and go or is it all the time? Does anything you do make it worse or better? What do you do at home for pain? Are you having problems with constipation? How is it affecting your lifestyle, work, family, friends? I review deep breathing and relaxation exercises and I try reassure them that I am on their side and that I want them to call me for anything. They may test me by calling frequently or being quick to accuse or distrusting my assurances. I just keep them informed of what I am doing on their behalf and treat them respectfully and try not to be judgemental about anyone's history or lifestyle.

It may sound simplistic, but I always think "what if this was my husband or Mom or sister"? How would I want them to be treated? If we all approach every patient with this thought, we can all go to bed every night knowing that someone's life was better that day because of us.

[EricEnfermero]

Originally Posted by lmessajumper

This is the majority of attitudes I am finding all over the country.

Ouch! (no pun intended)

[rninme]

I'm not going to take offense at your generalization....
Maybe the people of your unit need a refresher course on pain management. I don't think that all nurses do not manage pain effectively....I for one, am a pitbul when it comes to fighting with doctors for effective pain medications for my patients. Maybe a little re-education is in order for your co-workers. Good luck.

[KellieNurse06]

sorry but I see the op's point............and I agree. The op is NOT saying ALL nurses or the mojority of nurses are like this............just what they have experienced..............let's not be picky on exactness! lol!
Also......I have noticed similar stuff myself with my own child......non verbal so lots of people assume there is no pain... and then you get the old "how do you know".ummmm.....because I do....
Also not to change the subject.........ALWAYS tell your patient what you are doing whether verbal or not................
I can't tell you how many times with my child they just come in the room and start doing stuff without so much as a hello..............and it's because she can't talk..........so the kid is laying there scared and shaking and no one says as much as one word.............gets my butt...........I always tell every patient what I am doing regardless of who/what.........it's kind of like second nature to me..........
But yes the pain thing definetly and the speaking to as well...........always put yourself or your loved one in their place & how you would respond..............