Was I wrong? - page 6

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   LoveMyRNlife
    My thoughts reading while reading this thread were pain meds q 2 hours is hard to do at times with multiple patients and I would have welcomed the PCA for my patient and myself. You gave that patient better pain control instead of constantly chasing it, and thus allowing you more time to care for your other patients. MDs where I work start out with "normal" doses of pain medication but if a patients admits to drug abuse ( having a high tolerance for opioids) they will adjust meds to meet their needs for pain control.
    I would have personally thanked you for caring for my patient and getting the PCA pump. We pledge to take care of everyone equally even if we don't like it.
    You did the right thing!
  2. by   NRSKarenRN
    Thanks for being a patient advocate, your actions were appropriate to acheive adequate pain control. I've cared for hundreds of patients with Sickle Cell Disease.... they are admitted often for pain management and hydration, many with vaso-occlusive disease causing cell and bone death, which many nurses don't understand. Following article informative of this disease.

    Sickle patients best managed by Hematologist. Having a pain management + care plan for handling acute crisis as part of patients medical record is best practice these days.

    American Academy Family Physicians.
    Approach to the vaso-occlusive crisis in adults with sickle cell disease
    ...the vaso-occlusive crisis, or sickle cell crisis, is initiated and sustained by interactions among sickle cells, endothelial cells and plasma constituents.1 vaso-occlusion is responsible for a wide variety of clinical complications of sickle cell disease, including pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.

    a vaso-occlusive crisis is initiated and sustained by the interaction among sickle cells, endothelial cells and plasma constituents. clinical complications include pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.

    acute pain in patients with sickle cell disease is caused by ischemic tissue injury resulting from the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. chronic pain occurs because of the destruction of bones, joints and visceral organs as a result of recurrent crises. the effect of unpredictable recurrences of acute crises on chronic pain creates a unique pain syndrome.2,3

    acute bone pain from microvascular occlusion is a common reason for emergency department visits and hospitalizations in patients with sickle cell disease.4 obstruction of blood flow results in regional hypoxemia and acidosis, creating a recurrent pattern of further sickling, tissue injury and pain. the severe pain is believed to be caused by increased intramedullary pressure, especially within the juxta-articular areas of long bones, secondary to an acute inflammatory response to vascular necrosis of the bone marrow by sickled eythrocytes.5 the pain may also occur because of involvement of the periosteum or periarticular soft tissue of the joints.

    the approach to pain control must include measures to treat acute pain crises, prevent future vaso-occlusive crises and manage the long-term sequelae of chronic pain that can result from multiple recurrent bony infarction....
    Last edit by NRSKarenRN on Feb 13 : Reason: spelling
  3. by   Lexi McDonough
    You did nothing wrong. Regardless of whether or not you are covering part ofsomeone's shift, once you take report and the patient is handed off to you, you are supposed to provide whatever care you think is best (provided of course you are engaging in evidence based practice and not doing anything against policy).

    If this were me, I would report the incident. Even if you did do something wrong, her response was very inappropriate and surely against your organizations code of conduct. Also, just because you suspect a patient is a drug seeker and even if you know they are an addict, you still assess and treat their pain the same way. Considering he fact that addiction is now a diagnoseable disease, she is doubly wrong.

    IMO from what you said, your coworker is not a good nurse and may actually be harming patients by improperly addressing real pain. Even if you are one of those people who think addiciton is not a disease and addicts should not get narcotics, you should realize that you arent going to cure their addiction during this admission and giving them the meds isnt going to make things worse, it might actually make things better because what if (and this happens relatively often) they sign out AMA because they arent getting enough drugs and instead go and do something illegal or dangerous? Regardless of you views on addiction, you have to admit that getting pharmaceutical quality medication while being monitored in a hospital setting is safe better/safe for the patient and everyone else than having them do something dangerous/illegal (i.e. mug someone for drug money) and use street drugs that are not only sterile, but could contain any number of harmful even deadly additives. Even from a financial perspective it costs a lot less to give and admitted patient pain meds than treat them for hep C or other drug use related disease later on.

    Sorry to rant, In short, your coworker was wrong and you did everything right. Even if we ignore the whole addiction is a disease thing she still behaved inappropriately in front of a co-worker and you treated you patient according to how the ANA, state BON, and most medical professionals would consider correct.
  4. by   Lexi McDonough
    Exactly. The patient was her responsibility and when you are responsible for a patient, you are required by ethics, the law, and hospital policy to treat them as best as you can and the fact that you are covering for someone doesn't change a thing.
  5. by   3ringnursing
    She was actually YOUR patient at the time when you made the call for a med change request.

    One of the delightful types of personalities one may run into on a day to day basis in the work place - whether you are an accountant or a street sweeper, doesn't matter what profession you are in.
  6. by   Leader25
    I would have called her and put our two heads together.
  7. by   SafetyNurse1968
    Always treat the patient, not the diagnosis. Sorry this happened to you. So many people see drug addiction as a choice, instead of as a disease. If the patient had cancer, would you even question yourself? She was in pain. You did the right thing by advocating for your patient. The resident had full access to the records for this patient - the decision was ultimately made by the prescribing authority. Your colleague could possibly use some education.
  8. by   3ringnursing
    No.

    You were in the right, and by the laws of Occam's Razor, she was not {i.e., You (right) = She (wrong}.

    Any questions?
  9. by   RNMomma91
    From the moment you received report she became your patient. You did exactly what any prudent nurse would do. It's not her place to make the decision on whether she believes a patient is experiencing true pain or not. I would report her behavior to a supervisor and I would never cover for her again. I understand that dealing with drug seekers can wear on a nurse but once you become that jaded you should probably take a break from that area from a while.
  10. by   mmc51264
    All of our SS pts get a PCA. It is a horrible disease and many of them have high pain/high narcotic tolerance because of the disease. PCA meds can be better regulated than having prn meds to give. You would spend your whole day medicating one pt.
  11. by   Munch
    Quote from Lexi McDonough
    You did nothing wrong. Regardless of whether or not you are covering part ofsomeone's shift, once you take report and the patient is handed off to you, you are supposed to provide whatever care you think is best (provided of course you are engaging in evidence based practice and not doing anything against policy).

    If this were me, I would report the incident. Even if you did do something wrong, her response was very inappropriate and surely against your organizations code of conduct. Also, just because you suspect a patient is a drug seeker and even if you know they are an addict, you still assess and treat their pain the same way. Considering he fact that addiction is now a diagnoseable disease, she is doubly wrong.

    IMO from what you said, your coworker is not a good nurse and may actually be harming patients by improperly addressing real pain. Even if you are one of those people who think addiciton is not a disease and addicts should not get narcotics, you should realize that you arent going to cure their addiction during this admission and giving them the meds isnt going to make things worse, it might actually make things better because what if (and this happens relatively often) they sign out AMA because they arent getting enough drugs and instead go and do something illegal or dangerous? Regardless of you views on addiction, you have to admit that getting pharmaceutical quality medication while being monitored in a hospital setting is safe better/safe for the patient and everyone else than having them do something dangerous/illegal (i.e. mug someone for drug money) and use street drugs that are not only sterile, but could contain any number of harmful even deadly additives. Even from a financial perspective it costs a lot less to give and admitted patient pain meds than treat them for hep C or other drug use related disease later on.

    Sorry to rant, In short, your coworker was wrong and you did everything right. Even if we ignore the whole addiction is a disease thing she still behaved inappropriately in front of a co-worker and you treated you patient according to how the ANA, state BON, and most medical professionals would consider correct.
    I totally agree with what you are saying. I am a big believer in harm reduction and while I DO NOT think we should be giving every addict that walks through their doors a fix but we aren't going to cure addiction in an acute care setting. Also my hospital serves a lot of underserved people with addictions so I see the outcome the war on drugs has created(a different discussion all together). Not to mention with this patient..addiction or not she has a painful condition that requires narcotics regardless. Withholding pain meds from her is not productive. Even if she admitted she was an addict and got her into detox its counterproductive she is going to need narcotics sooner or later.
  12. by   Munch
    Quote from NRSKarenRN
    Thanks for being a patient advocate, your actions were appropiate to acheve adequate pain control. I've cared for hundreds of patients with Sickle Cell Disease.... they are admitted often for pain management and hydrationmany with vaso-occlusive disease causing cell and bone death, which many nurses don't understand. Following article informative of this disease.

    Sickle patients best managed by Hematologist. Having a pain management + care plan for handling acute crisis as part pf patients medical record is best practice these days.

    American Academy Family Physicians.
    Approach to the vaso-occlusive crisis in adults with sickle cell disease
    Thank you for that information! We see such a huge population of sickle cell patients in my hospital as well. Actually when I came on that day I was covering I found it odd the patient wasn't on a PCA. When we get med-surg overflow on my floor(which actually we mostly have more med-surg patients than Neuro patients on my floor at any given time) we get a lot of sicklers and they always come up from the ED with a PCA order. If not and they require q1hr or q2hr narcotic doses then we get a PCA ordered right away. So I was just doing what was standard on my floor by getting her a PCA.
  13. by   Jessasaurus
    I hope your coworker is never my nurse...

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