Anna Flaxis, ASN 19,998 Views
Joined Oct 15, '10.
Posts: 2,813 (67% Liked)
You're being thrown under the bus.
Meh, if you can't beat 'em, join 'em.
"Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."
Cardizem gtt on a regular med surg floor???[emoji15]
I was just curious how others handled this type of situation.
^^ Ugh, Ambien comes to mind...
Hmmmm, I don't know....maybe a complete overhaul of the health care system?
Is it normal to think I'm doing something wrong is all the other RNs are offering to help? I don't mind people helping when it's time sensitive or critical, but if it isn't I kind of like to do it myself because that's the only way I'll get faster/more experience--by doing it! But last night all the other RNs offered all the time to help (when they were free!) Granted, they each had an orientee who was doing most of the patient care but I kind of felt like they were judging me because (in my own mind) I wasn't moving fast enough.
Thank you for elaborating. This is very helpful.
Pancreatitis can be one of the more painful conditions, requiring astronomical doses of opioids just to make the discomfort tolerable. This patient may have even benefitted from a PCA (Patient Controlled Analgesia).
It sounds to me like your unit/facility could benefit from implementing an Acute Pain Protocol of some sort. This way, the doctor could just order the protocol, which gives the nurses a lot of flexibility within a set of parameters to figure out what works best for the patient. It's a win-win. The doctors will receive fewer pain related pages, the nurses will have more tools in their toolbox, and the patients' need for pain control will be addressed. Do you have a unit based practice council, or could you bring this up to your manager for consideration?
As far as dealing with the (understandably upset) family members, I have a basic spiel that works well for me. First, I offer reassurance that controlling the patient's pain is important to me, and that I will do everything I am able. I explain that I cannot give medications without a doctor's order, and that I am making it a priority to obtain that order. I explain that these are very powerful medications, and that for the patient's safety, I have to be careful not to give too much, because I don't want to kill them. I explain that often, it takes more than one dose to get an acceptable result, and that we have to work together to figure out how much of what drug is going to work without harming the patient. I let them know that some conditions are so painful that it is not possible to eliminate the pain completely- that I could give them enough Dilaudid (or Morphine or Fentanyl or whatever) to kill an elephant and they still might have some pain, and that the goal is to get the pain to a level that they can tolerate- not to eliminate it completely. I might ask "If we could cut your pain in half, would that be an acceptable result for you?", and I make a plan together with the patient and their concerned family to do that. Since I work in the ER, the doctor is right there and so I don't have to page and wait for a response, but I have worked inpatient in the past, and I would explain this to the patient and family: "I am going to page the doctor to find out what else we can try, and it's going to take a little time for him/her to return my call and give me the orders. I can't give you anything until that happens, but I can offer _____________ (warm compress, ice pack, dim the lights, whatever) while you wait".
If they *still* follow me out of the room and shoot daggers at me, well then, I tried. But usually, when I make myself their ally and ask for them to participate in the plan like we're a team, they calm right down. They're just concerned for their family member, as they should be.
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