Made to look like an idiot. (rant)

[MarcusKspn]

Hi everyone,

bad day at work again. Maybe I'm just asking for it, lol. This is a rant but I also have some questions for you. I wanna know what you would have done. You guys should know by know that I work at a nursing home, I was working 10-6 sunday night. I had a patient that has a very extensive GI/Abdominal Hx. Colon cancer, had part of his colon removed, paralytic illeus, Hx of obstruction. He also has back pain a lot, takes Darvocet N-100 for the back pain. Never has complained to me about any abdominal pain whatsoever. Well, at about 0200 in the morning he es screaming out in pain, has Right Upper quadrant pain. He is moaning, extremely restless, rates 10/10. I have never seen him so misserable. Now my med-nurse asked me if she should go ahead and give the Darvocet to him. Every place, hospital, and especially ER I have ever worked at says not to give Narcotics for abdominal pain, they mask the pain, and if it gets worse it will be harder to catch. Thats what I was thought in Nursing school too. At this point with the distress that man was going through, a transfer to the hospital was not out of the question in my mind. So here I am, its 0200 in the morning, I have a patient with a very complicated GI Hx, only a narcotic to give (doesn't even have an order for Tylenon). I decided to call the Doctor, did not feel comfortable giving a narcotic that was ordered for a different kind of pain in this situation. If he tells me to give it I'm fine with it, but I wanted him to be aware of the situation. He is very rude to me on the phone, told me to give the DCN, and send him to his office in the morning.

Well I come in to work at 10 yesterday, and I look through his chart to see what his doctor said, and on his progress note is this written "Nurse called last night about patient in pain, affraid to give pain meds. Told nurse to give pain meds if patient is hurting" and under his new orders, in big fat letters "GIVE PAIN MED IF PATIENT IN PAIN". Now that just majorly pissed me off, it is not that I was sitting here scared to give a DCN. I just thought that most places have a policy against giving Narcs for abd pain. And I just wanted him to be aware of the situation, since his patient has such a complicated Hx. Anyway, here is my questions:

1. What would you have done?

2. Was I wrong regarding the policy of narcs r/t abd pain?

3. Am i just to carefull or what?

I know I have only been an LPN for a little over 4 months, so I'm still learning every day. Should I have handled it differently. I think that doctor is just pissed off because I called him at 0200 in the morning. He is the same doctor that has called my administrator saying he might as well work in the building if we keep on calling him so much.

[rn-jane]

You were be a good nurse, the doctor was a jerk! If doctors don't like being woke up at 2 am in the am then they should not have become doctors.

If it isn't it should be in the hypocratic oath or was it the hypocrit oath.

kidding aside always chart in your notes.If there are problems we have a nurse-doctor confidential form that we give to our manager about situations with docs that are questionable.

Sometimes there are situations you have to be forceful with doctors and almost plead for their case.

[ktwlpn, LPN]

Originally posted by MarcusKspn

Hi everyone,

bad day at work again. Maybe I'm just asking for it, lol. This is a rant but I also have some questions for you. I wanna know what you would have done. You guys should know by know that I work at a nursing home, I was working 10-6 sunday night. I had a patient that has a very extensive GI/Abdominal Hx. Colon cancer, had part of his colon removed, paralytic illeus, Hx of obstruction. He also has back pain a lot, takes Darvocet N-100 for the back pain. Never has complained to me about any abdominal pain whatsoever. Well, at about 0200 in the morning he es screaming out in pain, has Right Upper quadrant pain. He is moaning, extremely restless, rates 10/10. I have never seen him so misserable. Now my med-nurse asked me if she should go ahead and give the Darvocet to him. Every place, hospital, and especially ER I have ever worked at says not to give Narcotics for abdominal pain, they mask the pain, and if it gets worse it will be harder to catch. Thats what I was thought in Nursing school too. At this point with the distress that man was going through, a transfer to the hospital was not out of the question in my mind. So here I am, its 0200 in the morning, I have a patient with a very complicated GI Hx, only a narcotic to give (doesn't even have an order for Tylenon). I decided to call the Doctor, did not feel comfortable giving a narcotic that was ordered for a different kind of pain in this situation. If he tells me to give it I'm fine with it, but I wanted him to be aware of the situation. He is very rude to me on the phone, told me to give the DCN, and send him to his office in the morning.

Well I come in to work at 10 yesterday, and I look through his chart to see what his doctor said, and on his progress note is this written "Nurse called last night about patient in pain, affraid to give pain meds. Told nurse to give pain meds if patient is hurting" and under his new orders, in big fat letters "GIVE PAIN MED IF PATIENT IN PAIN". Now that just majorly pissed me off, it is not that I was sitting here scared to give a DCN. I just thought that most places have a policy against giving Narcs for abd pain. And I just wanted him to be aware of the situation, since his patient has such a complicated Hx. Anyway, here is my questions:

1. What would you have done?

2. Was I wrong regarding the policy of narcs r/t abd pain?

3. Am i just to carefull or what?

I know I have only been an LPN for a little over 4 months, so I'm still learning every day. Should I have handled it differently. I think that doctor is just pissed off because I called him at 0200 in the morning. He is the same doctor that has called my administrator saying he might as well work in the building if we keep on calling him so much.

How about an update-how is the resident,Marcus?

[MarcusKspn]

Hello,

thanks for your replies. Quick update, patient was allright, no further problems with abd pain so far. But I would rather have called the doc over nothing, than something major happening. I had all his paper ready to ship, even had the report for the ambulance written out. If he would have worsened any I would have had no second thought about shipping him to the ER. No action from the DON or administrator concerning his childish note. No pat on the back either, except from my co-workers. I did to a complete work-up before calling the doc, giving him his Symptoms, onset, location, patient description, VS, last BM, and everything else I could think of, and I also told the doc that the reason I was concerned about giving the DCN-100, d/t abd Hx. So thanks everyone for replying.

Hope everyone had a nice Christmass.

[PMHNP10]

Originally posted by MarcusKspn

No action from the DON or administrator concerning his childish note. No pat on the back either, except from my co-workers.

Unfortunately management often forgets how far a small individual "thank you" or "job well done" can go. It is great your co-workers did recognize your efforts, but most importantly, know that your patient is the most grateful, although he has no idea what you went through to help him as best as you can.