You make the decisions on YOUR shift and I'll make the decisions on MINE - page 4

by CrazierThanYou

7,235 Views | 49 Comments

Here lately, I've had a couple of situations where the oncoming nurse didn't agree with choices I made on my shift regarding patient care. Usually, it is regarding pain medication. In nursing school, I was taught that it... Read More


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    I think this has been an interesting and enlightening discussion. I know I can't control how people "milk/abuse" the system. It would burn me out to a crisp trying to right all the wrongs of the healthcare machine. At least as a nurse in acute care, you know exactly who is receiving the pain medicine, and that it's not being sold to some little middle schooler at a party.

    What I've learned, even more, is how wildly different someone can exhibit pain. When I'm in a lot of pain, I get turn very inward, and cry quietly in private. At least that's how I was in labor. I didn't scream or wildly sob, I would get embarrassed when the nurse would come in and try to hold it in as much as I could. But thank goodness, the nurse didn't have any preconceived notions about pain, and I got an epidural and was just peachy afterwards. I had a nursing student in the room when I was getting the epidural placed, and she asked "Are you even in any pain?" because my lack of visual cues. Haha! No I'm just paying for the epidural for *kicks* and giggles.
    sharpeimom and tewdles like this.
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    Quote from samadams8

    umcrn, I hope you are doing well, and I so sorry that you had to endure any of that. It's a peeve of mine. Not everyone is drug-seeking--especially if they don't have a history, and if there is a real potential for some serious health issue/s. Both my parents were seriously under-treated for pain when in the hospital with serious issues. You don't want to get all crazy like Shirley MacLaine in Terms of Endearment; but the idea of your loved one, a friend, or really any patient suffering needlessly is hard to take.
    I'm great! Been back at work for over a year now. Really, all I needed that night in the ER was 10 mg of decadron...worked like a charm. I had my tumor removed a week later and haven't had a headache since! One of the biggest problems I faced at the time when I was seeking treatment for my "migraines" was that I had just moved to a new state and had a new primary care doc who didn't know me and didn't know that I had no past medical history and that for me to be in her office 3 times in 3 months complaining of headaches was NOT normal for me. I was 24 years old, healthy and had no other issues. I believed her for months that I just had "migraines" and dealt with them, even though she wouldn't even give me a prescription for anything (I went through A LOT of excedrin), it wasn't until the other symptoms started popping up that I researched and found a neurologist on my own and even he confessed that he didn't think anything else was wrong with me until I told him of my other symptoms (which were flashing lights in my vision, tunnel vision and blackouts in my vision). I am thankful every day that I found that neurologist. Had I not found him and continued on my own thinking I had "migraines" I likely would have wound up in the ER with seizures or wouldn't have made it to the ER at all (my tumor was 5x6cm and my surgeon said it definitely would have killed me if left to grow).

    I work in a pedi cardiac icu so except for the rare adult we get there are not many drug seekers, however we have our fair share of kiddos who have had more narcs in their short lives than the average drug seeker in an adult hospital, and keeping them comfortable is a huge challenge some days, especially when the docs don't want to keep prescribing for them.
    Janey496, sharpeimom, and tewdles like this.
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    For pts that have cancer, they get whatever is ordered. I don't know why nurses think that limiting pain medication in cancer pts is a good thing. The only time it should be backed off is when you are trying to get them mobilized after surgery. Oncology and anesthesia order specific pain management regimens and that should be followed. There are entire courses that are dedicated to pain management of cancer pts. Nurses that try to stay under that regimen usually have never had cancer. I understand the frustration with drug seekers, but cancer is an automatic pass.
    tewdles, sapphire18, samadams8, and 2 others like this.
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    I've only read the OP but I want to say that some nurses won't give morphine due to their own prejudices. I've had to have prn morphine doses for people about to pass routine because the other nurse wouldn't give the shots ever, even with r/r of over 45. It's disgusting to have to find patients trying to gasp for breath when the report nurse told me nothing's wrong. At this one place I worked, when I would come on I wouldn't go to report right away, but check the patients who I knew would be needing the morphine relief. If you can't give morphine and be sensible about it don't be a nurse. The OP is talking about cancer patients for Christ's sake not drug seekers; people who need the relief. It's not just cancer either, there are multiple diseases that cause pain and then there's even a natural death that can require morphine assistance...we like to call it comfort measures.

    You know who you are...and I'll call you on it every single time.

    Can you tell this is a pet peeve of mine...
    sharpeimom, uRNmyway, MLB4, and 5 others like this.
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    Quote from umcRN
    I'm great! Been back at work for over a year now. Really, all I needed that night in the ER was 10 mg of decadron...worked like a charm. I had my tumor removed a week later and haven't had a headache since! One of the biggest problems I faced at the time when I was seeking treatment for my "migraines" was that I had just moved to a new state and had a new primary care doc who didn't know me and didn't know that I had no past medical history and that for me to be in her office 3 times in 3 months complaining of headaches was NOT normal for me. I was 24 years old, healthy and had no other issues. I believed her for months that I just had "migraines" and dealt with them, even though she wouldn't even give me a prescription for anything (I went through A LOT of excedrin), it wasn't until the other symptoms started popping up that I researched and found a neurologist on my own and even he confessed that he didn't think anything else was wrong with me until I told him of my other symptoms (which were flashing lights in my vision, tunnel vision and blackouts in my vision). I am thankful every day that I found that neurologist. Had I not found him and continued on my own thinking I had "migraines" I likely would have wound up in the ER with seizures or wouldn't have made it to the ER at all (my tumor was 5x6cm and my surgeon said it definitely would have killed me if left to grow).

    I work in a pedi cardiac icu so except for the rare adult we get there are not many drug seekers, however we have our fair share of kiddos who have had more narcs in their short lives than the average drug seeker in an adult hospital, and keeping them comfortable is a huge challenge some days, especially when the docs don't want to keep prescribing for them.

    Wow, so, so glad you are doing well. I love peds cardiac ICU! Well, except the politics. . .ugh.

    Thank you for weighing in on this topic. Your input is appreciated and is powerfully true!

    I know exactly what you mean re: peds cardiac ICU. How many babies do we end up having on methadone? I don't even know. Of course, not the ones that are straight-forward and staged repairs w/o complications. But there are plenty of complicated kids and situations, and it does happen more than we would like. But you have to take care of first things first.

    Again, really, thank you for sharing your story. That must have been quite scary for you.
    umcRN and sapphire18 like this.
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    Quote from tyvin
    I've only read the OP but I want to say that some nurses won't give morphine due to their own prejudices. I've had to have prn morphine doses for people about to pass routine because the other nurse wouldn't give the shots ever, even with r/r of over 45. It's disgusting to have to find patients trying to gasp for breath when the report nurse told me nothing's wrong. At this one place I worked, when I would come on I wouldn't go to report right away, but check the patients who I knew would be needing the morphine relief. If you can't give morphine and be sensible about it don't be a nurse. The OP is talking about cancer patients for Christ's sake not drug seekers; people who need the relief. It's not just cancer either, there are multiple diseases that cause pain and then there's even a natural death that can require morphine assistance...we like to call it comfort measures.

    You know who you are...and I'll call you on it every single time.

    Can you tell this is a pet peeve of mine...

    Thank God I haven't had to work with a lot of nurses that feel this way. That would so frustrate the life out of me. I'd end up opening my mouth and. . . lol

    Do you think maybe some of these nurses that have resistance to administer pain medication might have had addiction issues or something; b/c otherwise, call me an idiot, but I don't understand why you wouldn't want to relieve someone's pain and suffering. And I say that, and I'm not big on people have epidurals and so forth; but I'm not going to get in their way or help facilitate it if they want it. I just think, in many cases when in labor, you are shortchanging yourself and at times even the baby. Personally I think it's only a very, very small percentage of people that couldn't get through labor w/o and epidural, if they were in good physical shape, exercise-wise, prior to labor. That was what helped me. Uping my exercise and being in shape for the delivery. And my labors weren't easy. I'm so glad I got to have a least one the old fashioned way. And the recovery was a zillion times better than having a C-section. Course that is a whole other topic, but since pain in light of labor was brought up. Just saying, this to me is the only real exception to not being all out for pain administration. But even then, it's up to the mom to make the decision, not me. It's her labor after all.

    For cancer patients, burn patients, direct post-op patients, patients with acute onset of certain conditions--even people with real and severe migraines. . .patients like those. . . well, to give IV pain meds is a total no brainer. I say if you have ever had a real migraine or headache so bad that your BP is 180/110 or you just can't see and/or you are vomiting your guts up, or if you were ever a surgical patients--like abdominal surgery or the like--unless you have ever really had pain that truly was 8-10/10, you really can't appreciate what these people are going through. Who the heck am I to tell someone that their pain is BS?! I don't have the right to even think it, IMHO, unless the patient is a known drug-seeker--and even then, you worry about the one time it may be real with them.

    Those people that have a history of addiction and who are managing to stay in recovery usually ask for a non-narcotic kind of pain relief for legitimate things in the ICU or ED. In fact, we have had some folks in the ICU that really needed narcotic, IV pain mgt, even though they have a hx of addiction. It sucks, b/c you don't know what kind of cascade will take over in their lives afterwards; but sometimes you have focus on the acute or critical, and then deal with the other sequalae later. For the person that wants to stay in recovery, well, it's a big deal; but what are you going to do. You hope to get t he right people on board to help them with this after the acute or critical phase of the other prominent illness is past. It does sadden me though, b/c I have seen what this will do to people that have the illness of addiction--and their famlies. It's kind of a no-win situation that they have to get support with and fight their way through. Usually, however, if their pain isn't compromising them, in the past, we have given them non-narcotics first and tried other things. You have a lot of kids out there that have been on oxy's for a long time. . .they finally get off, and then they end up in the hospital for something, and they then get percocets, etc. I have had to have talks with them about them thinking about their choices. I tell them that I can't tell them what their pain is; but they know what they went through to get clean, how hard it was, even with using methadone or suboxone. Is the pain bad enough that you would put yourself at risk to go through that again, and would you be as success next time, as you were last time? It's a tough situation to me in if you have an addiction problem. We've gotten so used to the scourge of drug abuse and addiction, we've forgotten how absolutely horrible it is to individuals, families, and society. I know a young girl right now that is pregnant and addicted to snorting heroine. I've cried at home and prayed for this kid all week long. I can only imagine about the ultimate health of the baby, and I worry that someone will find this girl dead on the street.

    But if she came in with severe trauma, burns, whatever, we'd put her at risk in terms of survival, at least I believe so, in the critical phase of her physical recovery. So we would have to give her strong pain meds. I hate what drug addiction does to people. It makes me so angry.
    uRNmyway, umcRN, and tewdles like this.
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    Ah yes, I agree - you should make your nursing decisions based on your judgement at the time... if no one is harmed, you made the right decision based on what was in front of you right at that moment.

    As nurses we're too critical of each others practice at times... lets cut each other some slack once in a while!



    Laura
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    Quote from brithoover
    I'm assuming you don't suffer from chronic pain..you should educate yourself on how a pt typically acts in this situation
    And her understanding of pain and pain management.....
    mc3
    sharpeimom and SoldierNurse22 like this.
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    Quote from Jenni811
    i just don't like when patients take advantage of the system. 90% of them rate their back pain a 10/10. Majority of the tim ei want to be like "well if you would listen to me and get off you're arse and move a bt maybe you wouldn't be so cramped up and constipated" When someone tells me their pain is a 10/10 im thinking burn patients, or a woman in labor. Not someone who is comfortably enjoying a glass of choolate milk and a cheeseburger snuck in by family. i once had a patient who rated his pain an 8/10, was in for back pain. The guy would SCREAM out in pain when it would come on. He was so considerate, he asked me to shut the door so the others couldn't hear him scream. I gave that guy everything under the sun that i could. i fought for certain pain medications.

    Its the patients who do not act like that and rate their pain a 10/10 and tell me "im doing nothing to control their pain" I know pain is what the patient says it is...but come on, lets get real here people. So whatever, I guess im "one of those nurses." I'll control your pain if it is there, but if you are laughing, eating cheeseburgers, visiting on the phone, texting, sitting on facebook then no i'm not going to control you for a 10/10 pain.
    So, you take it upon yourself to "fix" the system, even though you have an MD order, just so people don't "take advantage of it"? At the expense of someone else's pain? Really???? mc3
    tewdles, sharpeimom, MLB4, and 2 others like this.
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    OMG! Seriously?! I suppose you don't give money to the homeless because you prejudge that they might buy drugs instead of food, thus leaving them homeless AND miserable. If a doctor orders pain medication and the patient asks for it, if the patient's vitals and cognition permit, then GIVE IT! They are NOT going to become addicted to it in the short amount of time they are in the hospital. When I see a nurse judge a patient so harshly It seems as though they are jealous that the patient can have pain medication and they can't. What other medication causes such contempt from nurses? And for what reason? Because they are afraid the patient might undeservingly "get high"? Do us all a favor and stop playing God.
    Last edit by eric3 on Mar 28, '13
    MLB4 and SoldierNurse22 like this.


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