nurses' rights or responsibilities to pts.

[leslie :-D]

I was just reading Bunky's response under the topic of whether MD's treat chronic pain efficiently. Bunky was talking about a pt. with pancreatic ca, screaming out in pain and having her DON threaten to fire her if she dared called the doctor for more adequate pain mgmt. I just recently admitted a pt. who had a radical vulvectomy and had an order for percocet but my mgr. left a note for all nurses to only give Tylenol. In Bunky's case or my case, can nurses endanger their employment status or receive warnings if you don't listen to your superiors? Aren't we supposed to be advocating for our pts? Isn't it our right AND responsibility to uphold the ANA's code to do no harm? I know all the answers to my questions but I don't know if our superiors have a legal right to order the above statements. Any input would be most appreciated. Many thanks.

[bunky, BSN, RN]

Earle, in thinking back over that issue, when I was a new grad, I felt like I had to do as ordered by my boss, but now my thoughts are that unless the orders are unsafe or contraindicated by a condition which the physician had no prior knowledge of, I don't think that another nurse can issue such demands legally. What if I had called him? What could anyone have done to me for it? Nothing that I don't think I couldn't have fought and won, but as a new grad, I didn't have that security in my self-righteousness that you see from me today. Ha! Ha! And Earle, for God sakes, go to my "Fabulous Idea" post and put me out of my misery will ya?! Geez!

[Mary H.]

If the doctor has ordered Percocet, or any other medication, and the patient meets the criteria specified in the order (q4h prn pain), you will have more trouble defending NOT giving the medication than you would to give the medication. The only time I would not give the medication is if the patient were sufferring severe side effects or adverse drug reactions to the medication. As far as calling the doctor when they don't want to hear about it anymore, after being a night nurse for a while, I started making some of those calls anyway. Sometimes, I'm sure someone heard about it in the daytime, but at 0300, most doctors will just give you what you want so they can go back to sleep. If you are careful with your documentation about why you called, you will be able to defend the call.