Was I wrong? - page 4

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   Meriwhen
    Guess what? Once YOU assumed care of the patient, she became YOUR patient. You advocated for your patient. The resident agreed with your recommendations. He/she is the one that put in the order and made it happen.

    And IMO, it's not your place--or your coworker's place--to decide whether or not a patient really is in pain but is instead drug seeking. Pain is whatever the patient says it is. Doesn't matter if the person is opiate-naive or the biggest drug addict on the block. Your role is to convey the patient's condition to the resident, who will then make the call as to what, if anything, to provide for pain relief. And unless the patient's condition contraindicates giving ordered pain medication (i.e., allergies, her respirations are 6/min), then there's no reason the pain medication should be held from her.

    You weren't wrong.
  2. by   ProperlySeasoned
    You gave patient centered care, that is what is important. And if I was in pain from a sickle cell crisis, I would be a "med seeker" too!
  3. by   ALRLPN
    just another controlling nurse...wanting thing her way..i can't stand having to work with ppl like that, they have poor skills when it comes to working as a team..which only makes life easier for everyone
  4. by   twinsmom788
    Your co worker is an addict. I have investigated so many of these cases, it was very obvious from your first sentence. It's a good thing you came along that day. Best wishes to you.
  5. by   HermioneG
    I just want to echo what everyone else said and say great job. If I or any of my loved ones was ever in pain or needed help, I would feel so fortunate if they had a nurse like you. And in our profession, I can't really think of any higher compliment. You were your patient's advocate and 100% did the right thing. I'm sure that your (YOUR.. NOT your coworker's) patient is very thankful for it, and don't let your coworker's reaction make you question yourself for even a second.

    PS maybe I'm a weirdo but I'm kind of worried about this nurse taking care of this patient again? I don't know how things work on in-patient units (I'm from ER) but can she get the doctor to d/c the PCA pump? Can we be certain the patient's pain will continue to be controlled once she reassumes responsibility? Is her bias against this patient going to cause her to let the patient suffer with inadequate pain control? Or is this patient covered now that the PCA pulp had been initiated?
  6. by   Munch
    Quote from HermioneG
    I just want to echo what everyone else said and say great job. If I or any of my loved ones was ever in pain or needed help, I would feel so fortunate if they had a nurse like you. And in our profession, I can't really think of any higher compliment. You were your patient's advocate and 100% did the right thing. I'm sure that your (YOUR.. NOT your coworker's) patient is very thankful for it, and don't let your coworker's reaction make you question yourself for even a second.

    PS maybe I'm a weirdo but I'm kind of worried about this nurse taking care of this patient again? I don't know how things work on in-patient units (I'm from ER) but can she get the doctor to d/c the PCA pump? Can we be certain the patient's pain will continue to be controlled once she reassumes responsibility? Is her bias against this patient going to cause her to let the patient suffer with inadequate pain control? Or is this patient covered now that the PCA pulp had been initiated?
    The nurse can call the doctor and try to get the order for the PCA discontinued. I dont think he would do that because after I started the PCA I was on the phone with him a few times giving him her status and I told him that the only side effect she was having was pain relief! It really was night and day with this patient she was flat on her back clenching the rails on the bed with the lights off and she didn't touch her breakfast tray before the fentanyl IVP and PCA. I checked on her frequently and after the PCA she was out of bed in the chair watching TV pretty much the rest of the time I was there and she even ate a little bit of soup for lunch. I told the resident all of this and he and the attending were happy with this and they were going to make a note in her records if she is admitted next time that fentanyl is what should be tried first. So with such good results the doctor should not d/c the PCA until she is able to get relief from PO meds. It was my day off but I'm going in to work in a few hours actually(darn insomnia) and I'm going to check on the patient assuming she is still there and I'm getting with my manager as well as the resident to explain what happened. I don't want anyone in the future to suffer needlessly either.
  7. by   angeloublue22
    I hate to say this but I worked with a nurse that did almost this exact thing and it turned out she was diverting pain meds. She didn't want a client on a PCA because then she wouldn't have easy access to pain meds. Also, a red flag was the morphine wasn't working. That's probably a lot to assume, but this story sounded too familiar. Did you ask that patient if she was receiving her morphine Q 4?
  8. by   elijahvegas
    The labs will tell you if shes in real crisis. What was her retic count ?
  9. by   NurseBlaq
    Quote from twinsmom788
    Your co worker is an addict. I have investigated so many of these cases, it was very obvious from your first sentence. It's a good thing you came along that day. Best wishes to you.
    My thoughts exactly. I've worked with addict nurses and the nurse's response was overkill for such a simple order change unless the PCA prevents her from signing out morphine. The patient was hurting because she was probably diverting it and giving the poor woman saline. She needs more than remedial education, she needs to be in a diversion program with the state board of nursing and prevention of administering narcotics until she completes the program.
  10. by   Munch
    Quote from NurseBlaq
    My thoughts exactly. I've worked with addict nurses and the nurse's response was overkill for such a simple order change unless the PCA prevents her from signing out morphine. The patient was hurting because she was probably diverting it and giving the poor woman saline. She needs more than remedial education, she needs to be in a diversion program with the state board of nursing and prevention of administering narcotics until she completes the program.
    Yeah I am definitely in agreement. She really did overreact. The thing is I don't have any hard evidence and making an accusation like that with little to no proof can really have damaging consequences to her career if for some reason she isn't diverting I don't know her I don't work with her normally so I don't know her well enough I was just doing her a favor by covering for her that day.

    I did get to talk to my manager about what happened and I did check on the patient before my shift started and she still did have the PCA and my friend who works on that floor said that the patient was doing good and is going to be discharged soon.
  11. by   samwaddell365
    I would have done the same thing as you. I'm sorry for your friend's attitude to the situation, however, you took the report and accepted legal responsibility for the patient, that makes you the patients nurse at that time and your judgment goes. Sickle Cell Anemia is an extremely painful disease and it can be easy for nurses to become jaded and make assumptions, however, we have to remember that we can not feel what is going on inside someone's body. Sickle cell patients are frequent flyers to the hospital, however, I tend to think that is because they frequently go into crisis. Ultimately though my opinion doesn't matter. Fact is you made a nursing judgment that was for the benefit of your pt, and you helped relieve their pain, there is no basis for being angry about that.
  12. by   NurseBlaq
    Quote from Munch
    Yeah I am definitely in agreement. She really did overreact. The thing is I don't have any hard evidence and making an accusation like that with little to no proof can really have damaging consequences to her career if for some reason she isn't diverting I don't know her I don't work with her normally so I don't know her well enough I was just doing her a favor by covering for her that day.

    I did get to talk to my manager about what happened and I did check on the patient before my shift started and she still did have the PCA and my friend who works on that floor said that the patient was doing good and is going to be discharged soon.
    Agreed and understood. Just be sure to watch closely and don't pick up any more shifts for her. I would also be mindful of this behavior in the future. From my experience this isn't a one time thing, a pattern will become more noticeable now that you've become aware.
  13. by   beckysue920
    After reading the 50 (plus?) comments, I can't help but wonder how the original nurse covering this patient, treated her (the patient) when she resumed her shift. I guess we will never know.

    As Munch stated, the patient was going to be discharged soon, thank God for the excellent care you gave her and the fact that she can go home.

    This does indicate a possible diversion issue, may that "nurse" get her comeuppance.

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