Years ago, I was working med-surg at a VA after working psych for my entire career up to that time (the VA really hired me for psych, but offered me a med-surg position because their policy was to hire onto the med-surg units and promote from within -- so I took the job on the med-surg unit and worked five months before a psych position came open. It was wonderful experience, and I enjoyed it). We had a man one time who was "et up" with cancer (as we say here in Appalachia
), terminal, and experiencing lots of pain. We were keeping him comfortable with lots of MS, which meant that he was pretty out of it all of the time. One lovely afternoon, his family came in to visit and were v. upset that he couldn't sit up in bed and make perky conversation with them. They got hold of the resident and gave him h*** about "over-sedating" their loved one, and he wrote an order for 2 mg of Narcan. I had never given Narcan before, so, in addition to looking it up, I checked with our (wonderful) NM before I went to give it. She said, oh no, you don't want to give him that much Narcan -- just put about 1/2 a mg into his arm and wait to see what happens.
I followed her advice, slowly slid about 1/2 a mg into his arm, and the man sat up in bed, screaming in pain, like I'd just slammed a door on his fingers. I
was pretty impressed! I sure as heck didn't give him any more, and the family was back at the resident immediately, complaining that he was in pain. So we socked him with a bunch more MS and he slipped back into pain-free, peaceful semi-consciousness.
It was not uncommon on that unit (covered by lots of residents) for our NM to approach the residents about particular orders and tell them that no nurse on our unit was willing to administer (whatever crazy order they had written), and, if they really wanted the patient to have that med, they'd have to administer it themselves ... It always
turned out that, if they were going to have to press the plunger on the syringe themselves, they had second thoughts and changed or cancelled the order ...