I'm a new grad and I'm about 2 months into orientation on a med-surg unit. Sometimes I get patients with histories of painful conditions such as cancer or sickle cell anemia, with a doctor's order for a narcotic pain medication PRN Q4H, Q6H, etc. Sometimes the patients don't report any pain so I leave it at that, but sometimes the patients report pain "always" and want their medication Q4H or Q6H around the clock. So on my shift, I reassess the pain throughout the day, ask "are you having any pain" at the Q4H mark, and if they say yes with a number rating of 4+ I ask if they feel they need the pain medication. If they say yes, I give it, but have noticed on MAR's a few times that other nurses are giving narcs less frequently. Could I get in trouble for giving too many narcs if a pattern develops? Another nurse told me not to give them unless the patient asks for it without me suggesting. But if the patient has cancer and pain is a 10, should I ask them explicitly if they want the med? Maybe they forgot what's on their MAR? Yet another nurse said the patient would "get high" with the ordered Percocet 2 tablets Q4H for pain. High? The patient's vitals are fine and he's up and walking around (now that his pain is controlled), he doesn't look "high" to me. Again, I am never giving more than the order, and this is by far not every patient with a narcotic order. Maybe the patient just happened to have pain on that particular day? I'm day shift, so it makes more sense they'd feel pain and ask for it while awake than on night shift. I just want to make sure I'm doing the right thing and walking that fine line between 'leaving patients in pain' and 'drug pusher' (either of which could get me in trouble).
