I really want to know?

K+MgSO4, BSN · Nov 6, 2015

On the flip side of this is the pt that worries that 3 days of oxycontin will turn them into an addict.

I tell them that the majority of people will be fine, my bigger worry is pneumonia which is going to be a lot less fun than 3 days of oxycontin. Its about talking to the pt and explaining pain management to them that helps the most.

A lot of nurses worry irrationally about making pt into addicts. I send them on a pain round with our acute pain team to open thier minds....it really asssits with reality.

CristyGerald · Nov 9, 2015

When nurses don't care how much pain a patient is in, it sounds to me like they've stopped seeing patients as people and are stuck in the day-to-day grind. They're thinking they know how it should work, and the patient is complaining too much. That's why it's great when you've been on both sides, the patient side and the nurse side. Although, if you're luck and haven't experienced pain as a patient, that doesn't mean others don't experience pain. It's a great idea to have nurses observe the acute pain team. Compassion seminars and professional development in the area of patient communication are other areas to work on. Nurses need a break too and need to continue developing their abilities to communicate with patients, hear them and help them.

Libby1987 · Nov 9, 2015

I had surgery for a tibial fracture. IV MS didn't touch it. I was literally coming undone from no relief. My nurse, who didn't seem to be running around, had no reaction. I imagine she thought I just had poor pain tolerance.

I finally said you have to do SOMETHING!

She did call my surgeon at that point, got orders for PO meds and 2 Percocet later I was human again, and a very easy relatively independent patient thereafter.

I don't know if she stopped worshiping at the morphine alter after that but hopefully she learned something.

I don't know what makes nurses operate like that. Lack of knowledge maybe. Or lack of personal experience. Maybe it's a lack of ownership. They see the patient as belonging to the hospital that they're stuck with as an assignment versus seeing the patient as their charge and protecting them like a mother bear.

**NickiLaughs, ADN, BSN, RN** · Nov 9, 2015

My dad was a drug addict for 30 years. He was finally recovering but you can imagine the pain control nightmare. He electrocuted himself working on his boat when his titanium ring came in contact with the battery. He was in a burn unit for his hand. Dilaudid didn't touch him....ironically toradol was the only effective pain medication. Go figure. There's so much we still don't know about pharmacobiology.

I've never declared the desire to instantly rehab pts, if they have pain I address it.

I only get frustrated on two accounts, when the physician won't give me other pain med options and refuses to talk to the patient. Then I look like the bad guy and I usually have to keep pressing the doc.

The other issue is when the patient knows I'm attempting to address it, but something far more urgent is going on and they keep pressing the call light. Yes pain control is important, but my STEMI/stroke/septic pt has far greater time sensitivity for a positive outcome. Once I stabilize this patient, I will get to you.

TheGooch · Nov 9, 2015

I'm the one that said that about my experience while hospitalized after surgery. And I almost hated to post it because people get so defensive here regarding the issue.

In my case I am not a drug seeker-I had major surgery on my spine and was in severe pain before the surgery. I had several visits to one of the local ERs for acute pain and was treated quite badly by the people I saw even though I had no previous visits where I had received a prescription for narcotic pain meds.

What I said was true-I had pain after the surgery and when I asked my nurse for pain meds she told me I wasn't due for it and offered no suggestion on how to deal with it while I waited. This was on anortho/spine unit and the nurses were supposed to know how to deal with patients like me.

Before this happened to me I never took any type of narcotic pain meds for anything. I was prescribed them when I had my 3 previous surgeries and for dental work over the years but I never took them. I was never at the ER asking for meds for any type of pain I had. For example., I had a huge bleeding ulcer in the early 90's and I didn't take any type of pain meds during the 3 months before I diagnosed with it.

Now I have lower back pain and instead of going the traditional route I decided to try the medical marijuana which works. Narcotic pain meds do nothing for pain IMO except to make me constipated so the local ER won't be seeing me any time soon for my lower back pain.

That's why I get irritated when I see some one ask how they can be a "perfect patient" so they don't cause the nursing staff any problems. If you're hospitalized you shouldn't worry about that. That's the last thing on my mind when I am sick. You're the sick one and you shouldn't be expected to make their jobs easier by trying to be a "good patient". The nurses are getting paid to take care of you which they ought to remember instead of labeling a sick patient who advocates for their selves as difficult and a drug seeker.

nynursey_ · Nov 9, 2015

I s'pose I'll bite and be mildly controversial.

Pain, as we're taught, is subjective. But there's an objective element that needs to be utilized for safety purposes, as well. For example, I had a patient this week (known opiate abuser--but I glaze past that in my H&P because frankly, I don't write the orders and I am not one to withhold a pain medication simply because someone is an opiate abuser) who consistently complained of 10/10 pain. Per her account "it's like being ripped open 10x a day." OK; painful. I get it. She requested her PRN pain medication; IV Morphine. 6mg. q3hr. Again, I didn't question it ... her tolerance is quite high. She's regularly on our unit for similar chief complaints with no organic cause. I have requested both pain management C/S' and psychiatry--anything to help this patient who seemingly gets no relief from multiple modalities (patient with allergy to NSAIDs, Lyrica, Tramadol, ASA, Tylenol, and Percocet). I have no problem advocating for whatever assists the patient in achieving an acceptable level of pain.

That being said ...

"Why didn't you wake me? My pain meds are DUE NOW."

"I'm going to die. Please give me my Morphine early. I am going to die." Upon entering the patient's room, patient is sound asleep, appears comfortable ... no distress. No change in vitals.

"I need an early dose .." Patient's eyes are lidded, half-closed, and patient is legitimately drooling on self. Same patient wakes 5 minutes later, throws water pitcher into the hallway, demands to see Nursing Supervisor, and angrily calls me a disgusting whore, among other things. RR is 10 when asleep. BP is low. SpO2 hovering around 90% on RA.

Patient wakes. Asks me for her 2mg Dilaudid PO, which the physician ordered to hold her over during periods of IV breakthrough pain.

No. No. And no. Not safe. Not under any circumstance. We need a new plan.

And what does the patient call me? Prejudiced against recovering drug addicts and tells the ANM that I have "NOT MANAGED MY PAIN ADEQUATELY."

This may be a rare breed ... but if you work in certain types of hospitals, this is more the norm than not.

Examine these types of patients and then ask yourself your question again. You may be able to answer it more than you realize.

TheGooch · Nov 9, 2015

I s'pose I'll bite and be mildly controversial.

Pain, as we're taught, is subjective. But there's an objective element that needs to be utilized for safety purposes, as well. For example, I had a patient this week (known opiate abuser--but I glaze past that in my H&P because frankly, I don't write the orders and I am not one to withhold a pain medication simply because someone is an opiate abuser) who consistently complained of 10/10 pain. Per her account "it's like being ripped open 10x a day." OK; painful. I get it. She requested her PRN pain medication; IV Morphine. 6mg. q3hr. Again, I didn't question it ... her tolerance is quite high. She's regularly on our unit for similar chief complaints with no organic cause. I have requested both pain management C/S' and psychiatry--anything to help this patient who seemingly gets no relief from multiple modalities (patient with allergy to NSAIDs, Lyrica, Tramadol, ASA, Tylenol, and Percocet). I have no problem advocating for whatever assists the patient in achieving an acceptable level of pain.

That being said ...

"Why didn't you wake me? My pain meds are DUE NOW."
"I'm going to die. Please give me my Morphine early. I am going to die." Upon entering the patient's room, patient is sound asleep, appears comfortable ... no distress. No change in vitals.

"I need an early dose .." Patient's eyes are lidded, half-closed, and patient is legitimately drooling on self. Same patient wakes 5 minutes later, throws water pitcher into the hallway, demands to see Nursing Supervisor, and angrily calls me a disgusting whore, among other things. RR is 10 when asleep. BP is low. SpO2 hovering around 90% on RA.

Patient wakes. Asks me for her 2mg Dilaudid PO, which the physician ordered to hold her over during periods of IV breakthrough pain.

No. No. And no. Not safe. Not under any circumstance. We need a new plan.

And what does the patient call me? Prejudiced against recovering drug addicts and tells the ANM that I have "NOT MANAGED MY PAIN ADEQUATELY."

This may be a rare breed ... but if you work in certain types of hospitals, this is more the norm than not.

Examine these types of patients and then ask yourself your question again. You may be able to answer it more than you realize.

Not everyone is like that though. You only have 1.5 years of experience and you're already jaded. Sad.

nynursey_ · Nov 9, 2015

Not everyone is like that though. You only have 1.5 years of experience and you're already jaded. Sad.

I haven't indicated that I believe all patients are. What I said was that there are specific instances where utilizing your clinical judgment to question "pain is what the patient says it is" is appropriate. I am not jaded. To the contrary; I'm more often than not the nurse that gets extremely involved in trying to manage pain, even in those patients who are calling me every name from A to Z.

I appreciate your sarcastic, off the cuff judgment, however.

mmc51264, BSN, MSN, RN · Nov 10, 2015

Acute on chronic pain is extremely difficult to deal with. They hurt, they have a trauma of some sort so they hurt more. They take enough meds to, literally, knock a horse down, and we are frontline to try and keep them happy I had one on 19 mL of Ketamine an hour. That is 3 times what we would normally give and this pt was still asking for meds every hour. I have them ask me when they can have IV meds when I am handing them 20-30mg of oxy. I try my best to keep them safe and happy. Not easy Usually a trauma experience is not the time to be concerned about their "habit" get them through the worst part and let the docs and pain team deal with after discharge.

toomuchbaloney · Nov 10, 2015

So if the patient says their pain is 10/10 and you dont agree, what are you going to document?

If pain is not what the patient says it is, how will you measure it?

Do all people respond to noxious or pleasant stimulation in the same way?

Have you ever experienced intolerable, excruciating pain?

jc24oh · Nov 11, 2015

If a patient says their pain is 10/10 and they are sleeping when I return to the room with pain medication, or some other observable trait I will put that in a comment on a pain assessment especially if I decided to delay pain medication due to nursing judgement for sedation/vitals. I have also written progress notes when patients routinely have 10/10 pain that never gets better no matter what I'm doing or what other medications I get ordered, etc. Since clearly we all need a new plan. I admit that these situations do frustrate me, mainly because I want to help and I feel helpless....but that's about me, not the patient, and I know that and handle it appropriately.