Was I wrong? - page 3

Bear with me for this is going to be a little long. I was covering part of a shift for a co-worker on my scheduled day off. The shift was 7am-730pm and I was working 9 to 3:30 for her on the regular... Read More

  1. by   thoughtful21
    Oh, wow – that other nurse was so wrong! Every nurse should understand that sickle cell crises are extremely painful. And the crises happen frequently and unexpectedly, especially for a young girl who is going through adolescence. This other nurse is being judgmental and isn't treating the patient right. It sounds like she doesn't understand the patho of sickle cell anemia at all...maybe she needs to read up on it.
    Here's an awesome case study that proves our point. It talks nurses undertreating adolescents for sickle cell pain.
    Medscape: Medscape Access
    Managing Pain in Teenagers With Sickle Cell Disease by Cynthia Fletcher, PhD, RN


    Last edit by thoughtful21 on Feb 9 : Reason: added the name of the article
  2. by   RainMom
    Quote from dimari
    You did the right thing but her behavior makes me think that maybe your co-worker is the addict and has been stealing the patient's morphine for herself (I've witnessed this in previous hospital jobs I've held). She might be furious that the PCA won't require her to get narcs every 1-2 hrs. Just a thought.
    That didn't even occur to me but sounds totally plausible given her strong negative reaction to the PCA order. Things that make you go hmmm....
  3. by   Munch
    Quote from dimari
    You did the right thing but her behavior makes me think that maybe your co-worker is the addict and has been stealing the patient's morphine for herself (I've witnessed this in previous hospital jobs I've held). She might be furious that the PCA won't require her to get narcs every 1-2 hrs. Just a thought.
    You know that really is a very good point. A case of let me point my finger at this patient before the fingers are pointed at me. I was also wondering why she didn't try to get the order changed. Q2hr dosing is a lot and takes up a lot of time. We get regular med-surg overflow patients all the time and anyone with dosing that frequently gets a PCA for the most part especially sicklers as we know they have huge amounts of constant pain. It really makes me think too because when I have her that one time fentanyl dose of 50mcg she said she was feeling a bit better where as the morphine 6mgs didn't touch her. 50mcgs of fentanyl is roughly equivalent to 6 of morphine. Makes me think she was skimming some of that morphine for herself that's why the patient reported zero relief. She obviously wasn't being difficult otherwise she would have said the fentanyl did nothing as well. Of course this is all speculation but it sure makes me wonder now.
  4. by   Munch
    Quote from thoughtful21
    Oh, wow – that other nurse was so wrong! Every nurse should understand that sickle cell crises are extremely painful. And the crises happen frequently and unexpectedly, especially for a young girl who is going through adolescence. This other nurse is being judgmental and isn't treating the patient right. It sounds like she doesn't understand the patho of sickle cell anemia at all...maybe she needs to read up on it.
    Here's an awesome case study that proves our point. It talks nurses undertreating adolescents for sickle cell pain.
    Medscape: Medscape Access
    Managing Pain in Teenagers With Sickle Cell Disease by Cynthia Fletcher, PhD, RN


    Thanks for the article I am definitely going to check it out. Being an inner-city hospital with a huge amount of SCC patients I get young people on my floor all the time with the disease. Luckily the doctors have experience with these patients so they usually get the doses of meds they need. If not a phone call is all that is needed and the docs adjust the meds. They usually throw in a long acting opiate and some kind of benzo and benadryl to help them relax and sleep. Sometimes anxiety can make pain worse and a dose of ativan or valium can really be a great adjuvant to the opiates.
  5. by   Sujan
    Not sure what state you are practicing in, but here in Oregon we have a state mandated requirement that nurses MUST treat patients pain and believe what the patients say about their pain. Nurses allowing personal bias to infuence their view and treatment of a patient's pain is so wrong. We are to listen and treat and in many cases ADVOCATE with the MD for better pain control. There is also much to learn regarding the addict patient and their different needs for pain relief. The addicted patient may already have chronic pain management that is ongoing, and now be suffering with acute pain which requires a different approach for relief. The sickle cell patient will most likely already be taking something for chronic pain. YOU did that patient a favor as your "friend" obviously does not have much of a critical thought in her brain. My guess is that she was upset that it was YOU and not her who made this patient feel better. You made the right choice doing what you did and unfortunately your friend is clueless and immature in her nursing judgment.

    Sujan, MSN, RN
  6. by   Here.I.Stand
    If I had my capillaries occluded, I imagine I would be seeking drugs too. BECAUSE THAT HURTS!!!!!

    That other nurse needs some serious remedial education.

    Excellent work, Nurse.
  7. by   audreysmagic
    To me, it sounds like a patient in real pain was properly treated. If she were an addict, she still deserves to have her pain properly treated. The other nurse's reaction sounds a lot like the "well, they're a psych patient, so their medical problems can't possibly be real" crap I see a lot from a local ER. Drives me up the wall.
  8. by   Tenebrae
    I think your co worker needs to get the hell over herself personally.

    You advocated for someone in your care who was in pain, and as a result their pain was adequately managed.

    I recall a similar situation when I was a student. Patient had arterial ulcers and as a result was in alot of pain. Also had a history of high ETOH use. I would ask my preceptor Mr Such and Such needs pain relief and the response would be "oh well hes an alcoholic". I was really lucky as a student I could say sort of act naive and get him the pain relief citing that i needed the practice.

    The difference when his pain was adequately managed, he would be sitting up in bed, reading his book, talking to his neighbour. When his pain wasnt well managed, he was basically curled up into a tiny ball and not moving

    Good on you for advocating for the patient
  9. by   Here.I.Stand
    Oh, forgot my anecdote. Early in my career I cared for a SS pt who in the hospital received 20mg IV Dilaudid q 2 hrs. Yes, you read that right. Twenty. AND 50mg IV Benadryl q 4hrs.

    It's a physiological fact that tolerance happens, and the thought of these people being subjected to that incompetence makes me extremely sad.
  10. by   vintage_RN
    I echo what everyone else has said.

    1. This nurse reported off to you, therefore the patient is now in YOUR care and YOU are responsible for them. Which means it is your judgement call on how to respond to, assess and treat said patient!

    2. Is this nurse in the patient's body? How do they know what pain the patient feels or not? I always treated pain when I worked with adults..."drug seeking" behavior or not.

    3. I think you did the right thing in advocating for your patient without judgment, and I believe this nurse should be reported.
  11. by   Daisy4RN
    Agree with others, it was your patient and your call, period! And I also would never work for her again!
  12. by   Kooky Korky
    Quote from Newgradnurse17
    I'm sure is this pt was in there all the time seeking drugs the dr would of been aware of this. Some people just like things done there way and can't handle it when things change. You said she was just a co worked on another ward, so I wouldn't worry about it. Let her find somebody else to cover her next time.

    A resident doc wouldnt necessarily know pt.
    Sicklers have evil pain, for real.

    May this suspicious witch of a nurse experience such pain in her body so she will understand.
  13. by   Munch
    Quote from Tenebrae
    I think your co worker needs to get the hell over herself personally.

    You advocated for someone in your care who was in pain, and as a result their pain was adequately managed.

    I recall a similar situation when I was a student. Patient had arterial ulcers and as a result was in alot of pain. Also had a history of high ETOH use. I would ask my preceptor Mr Such and Such needs pain relief and the response would be "oh well hes an alcoholic". I was really lucky as a student I could say sort of act naive and get him the pain relief citing that i needed the practice.

    The difference when his pain was adequately managed, he would be sitting up in bed, reading his book, talking to his neighbour. When his pain wasnt well managed, he was basically curled up into a tiny ball and not moving

    Good on you for advocating for the patient
    What is it with some nurses(and docs) that think that just because someone abuses drugs and or alcohol that 1) they can't possibly be having real pain and 2)if they really are having pain they are addicts so no addicting meds for them like they should be punished for being addicted to something.

    As far as sickle cell goes it really isn't relevant if they are addicts. They have a life long excruciating painful disease. Its almost like being worried about getting a patient in hospice addicted to narcs. With sickle cell the disease is never going away their is no cure. Some if not most will need narcotics for the rest of their lives. Being addicted isn't really relevent.

    Quote from Here.I.Stand
    Oh, forgot my anecdote. Early in my career I cared for a SS pt who in the hospital received 20mg IV Dilaudid q 2 hrs. Yes, you read that right. Twenty. AND 50mg IV Benadryl q 4hrs
    Thats another issue that comes up is the huge amounts of narcotics these SSC patients are indeed tolerant to. If they don't get the right dosages of these meds for these patients then you also have to deal with opiate withdrawal on top of the excruciating disease process sickle cell. Gosh can you imagine being in withdrawal during a crisis? I luckily can't even imagine but its something I wouldn't wish on anyone.
    Last edit by Munch on Feb 9 : Reason: Spelling

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