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

tewdles, RN · Mar 27, 2013

There are studies that show that cancer patients with pain are frequently undertreated precisely because of the type of behavior you described...health care professionals that are ignorant about appropriate pain management protocols.

Thank you for treating your patient and not your own biases about opiates (as too many professionals do).

MomRN0913 · Mar 28, 2013

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 orifice 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.

There is a difference in acute pain and chronic pain as one said. Just because you are not screaming out in pain doesn't mean you don't need pain meds. People who have chronic pain are taught and learned many things for pain control. Such as to ask for pain meds BEFORE the pain becomes uncontrollable. Also, to use techniques such as distraction, such as facebook, eating foods they enjoy or laughing with family members to try to keep their mind off pain.

I handle 10/10 pain differently then others. I don't scream, I don't yell, I'll joke around, I'll carry on a conversation to distract. I did that during labor. I did that with my gallbladder attack in the ER when I was definitely in a 10/10 pain. It's the way I handle it. You wouldn't know my pain is so bad until you looked at my vitals .

Just remind me to scream if I ever want my pain meds from you.

umcRN, BSN, RN · Mar 28, 2013

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 orifice 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.

A year and a half ago I walked into an ER with a known brain tumor (diagnosed by MRI and the initial doc I saw thought it was too complex for his system to treat so he sent me to the closest large neuro center). I'd been having 10/10 headaches for MONTHS, nothing touched them. Part of this is my fault, I thought I was over reacting, that it "couldn't hurt that much" so I did not do a good job expressing the severity of the pain when I saw my primary, my dentist, my ophthalmologist - I was trying to see anyone to help me with the pain, but I didn't scream loudly enough apparently for anyone to take me seriously. Every time I would get a headache I would vomit from the increased ICP and pain. In the ER I waited 10 hours to get anything for pain. Every time someone asked I said it was 8 or 10/10, I vomited multiple times, and no one came to me with anything. Yes, when I wasn't puking my brains out, I was trying to distract myself with a game on my phone or talking to my friend who came with me. I guess I didn't look to be in enough pain to warrant any meds. :no: Pain is subjective and people shouldn't have to get to the point od screaming and crying before their pain is managed.

eatmysoxRN, ASN, RN · Mar 28, 2013

It's the ones who really do overrate pain that ruin it for others. I know that pain is subjective but seriously. If you set an alarm on your phone to wake up and start screaming in pain then you just want pain meds. I know it's handled netter before it gets bad, but your stomach hurts because you've been getting IV narcs for 4 days for abdominal pain and you're constipated now. Your scans and EGD and UGI and blood work is clear. You're only in pain every 4 hours. Please stop.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

Roseyposey · Mar 28, 2013

I feel sorry for that poor cancer patient who has such a crappy pain management regimen.

Really???? They criticized you for that??? I have given the iv Morphine while the patient is taking the po Percocet. Of course, pain management is my passion, so I am probably over zealous. If someone has cancer pain, they should be treated!!! If someone is tolerant to meds, then the "norms" are out the window! One or two milligrams of morphine for a chronic pain patient or a cancer patient who has been on opioids is like injecting normal saline. If we don't want to create patients who are tolerant to opioids, then we should prescribe the darn things. Someone who is already on MS Contin is not going to get pain relief from a couple milligrams of Morphine or 0.5 mg of Dilaudid. You know what? We are not here to wean people off of pain meds! If they can tolerate it, and they need it, I give it. Of course, I do not work "the floor" anymore, so my view point may be a little off.

allnurses Guide · Mar 28, 2013

There are studies that show that cancer patients with pain are frequently undertreated precisely because of the type of behavior you described...health care professionals that are ignorant about appropriate pain management protocols.
Thank you for treating your patient and not your own biases about opiates (as too many professionals do).

As a hospice nurse, I agree wholeheartedly with you.

1 or 2 mg of Morphine is NOTHING when used against cancer pain.

I've been a nurse for over 15 years and I am appalled when this attitude towards opiates and pain still exists.

Your place of work OP needs to do an inservice with a pain management physician and nurse and re-educate that nurse you work with. I suggest you talk to the "powers-that-be" and get something going about this.

We've got people on Morphine and Dilaudid pumps getting meds continuously with available boluses every 8 minutes or 10 minutes or 15 minutes.

Lay people are scared of Morphine but there is NO reason that nurses need to be anymore . . . .that's seriously wrong.

edmia, BSN, RN · Mar 28, 2013

You did the right thing. You listened to your patient and you medicated his pain. Awesome job! Thank you!

What the other nurse thinks about it is nothing to you. If she is so appalled at how other nurses medicate, then she should sign up for 24/7 coverage. I'd call her a name that's not allowed on AN.

This is one of my pet peeves and I find it highly unethical for any medical professional to play G-d and decide that they know how much pain someone is in. I don't care if they look like junkies, we are not going to detox them during this hospitalization and their pain is still in need of control. Withdrawal is not the answer. And with cancer pain? Please, give them all of it. They are dying, do you really think they care if they're hooked on the pain med? C'mon! It is ridiculous when a nurse thinks she knows better than her patient. It's a paternalistic attitude that has absolutely no place in professional practice.

umcRN, BSN, RN · Mar 28, 2013

As a hospice nurse, I agree wholeheartedly with you.
1 or 2 mg of Morphine is NOTHING when used against cancer pain.
I've been a nurse for over 15 years and I am appalled when this attitude towards opiates and pain still exists.
Your place of work OP needs to do an inservice with a pain management physician and nurse and re-educate that nurse you work with. I suggest you talk to the "powers-that-be" and get something going about this.
We've got people on Morphine and Dilaudid pumps getting meds continuously with available boluses every 8 minutes or 10 minutes or 15 minutes.
Lay people are scared of Morphine but there is NO reason that nurses need to be anymore . . . .that's seriously wrong.

100% agree with you.

I also had to chuckle at this a little, my patient today was two years old, TWO. He is a cardiac kiddo and has had FOUR open heart surgeries in his little life and countless other small surgeries and procedures. He was intubated and sedated but he still required 1.3mg per HOUR drip of versed, o.4mg per hour of dilaudid and required breakthrough doses of 70mcg of fentanyl with an additional 1.3mg of versed every few hours. On top of that he was getting round the clock methadone and ativan. Those drugs could have easily knocked me down for days but he was still fighting! Trying to get his restraints off, trying to get out of his bed, just plain ticked (and it makes me happy that he has that fighting spirit because he needs it to get through what he's got going on right now). But it just goes to show that its all relative to the patient and pain/comfort management must be individualized. To those with chronic pain and especially chronic narcotic use, they are going to require much higher than the "normal" doses that our drug guides tell us to use.

Bobjohnny · Mar 28, 2013

Just a little background I work on Med/Surg-Tele unit which at my hospital is designated to get all of patients receiving inpatient chemo. We by far use the most pain meds of any floor in the entire hospital, and nearly as much as rest of the hospital combined. If you exclude OR, PACU & ED we use more than the other 5 floors combined. We're a 30 bed unit and the hospital has 186 beds, just to put it in perscpective.

I have had the Cervical CA patient's who are getting 3mg of Dilaudid every 6 minutes with a 55mg 2 hours lockout on a PCA, because we can't set the settings any higher. But I have also had the patient that has a uretal stent that rates their pain 10/10 and I proceed to give them their ordered 1mg Dilaudid IVP. As I'm pushing said medication into the most proximal site with fluids running at 100ml/hr the patient looks at me and states "Would you like me to rate my pain now?" I of course reply "Yes." She answers with "It's a 0 now. Thanks!" and proceeds to smile and wink at me.

Don't get me wrong I will never deny a patient pain meddication. But it certainly can be frustrating. There are times that I feel like a legal drug dealer. But I won't hold pain medicine, I've even asked for patients to get more pain medication when I personally don't believe they are experiencing any pain.

We as nurses have to set aside our biases and remember who comes first. I'm glad to see this isn't something that only nurses I know have diffulty with.

Guest343211 · Mar 28, 2013

A year and a half ago I walked into an ER with a known brain tumor (diagnosed by MRI and the initial doc I saw thought it was too complex for his system to treat so he sent me to the closest large neuro center). I'd been having 10/10 headaches for MONTHS, nothing touched them. Part of this is my fault, I thought I was over reacting, that it "couldn't hurt that much" so I did not do a good job expressing the severity of the pain when I saw my primary, my dentist, my ophthalmologist - I was trying to see anyone to help me with the pain, but I didn't scream loudly enough apparently for anyone to take me seriously. Every time I would get a headache I would vomit from the increased ICP and pain. In the ER I waited 10 hours to get anything for pain. Every time someone asked I said it was 8 or 10/10, I vomited multiple times, and no one came to me with anything. Yes, when I wasn't puking my brains out, I was trying to distract myself with a game on my phone or talking to my friend who came with me. I guess I didn't look to be in enough pain to warrant any meds. Pain is subjective and people shouldn't have to get to the point od screaming and crying before their pain is managed.

OMG, really, this is so true. I know there are drug seekers, but that is not what was described by the OP, and I think we have to be really careful with making judgments about other people's pain. I had some tough labor, but I was not crazied out, and I was stubborn enough to not want to scream and yell and scare other moms that were laboring. The contractions were measured as off the wall, but they were something I could deal with and still stay focused. OTOH, I have had vascular headaches/migraines that brought my BP to increadibly dangerous levels, and nurses and doctors still ignored it, b/c I was NOT screaming in their faces.

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 don't believe any nurse or physician should allow other patients to "ruin it for others." Patient A's pain and their ability to deal with it may be worlds apart from Patient B. It shouldn't even come into consideration IMO. You assess and re-assess and evaluate based on all the data and the whole picture. But there;s another person above that is right also when he or she suggests that the pt's pain was not being properly managed in the first place--ithat is, n terms of a pain -mgt regime.

All you need is to be wrong one time in terms of under-treating serious pain. It's not worth it to me to take on the role of judge and jury. And usually those that are trying to get over end up showing their cards in time.

Penelope_Pitstop, BSN, RN · Mar 28, 2013

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 orifice 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 what do you tell these patients? "Sorry, you don't look like you're in pain, so you aren't getting anything for it?"

There are people who milk the system. Doing what you do won't fix the system, though. Besides, there will *always* be a faker. It isn't worth your time to figure out who that faker is. Give the meds if ordered, and move along with taking care of sick people.

dirtyhippiegirl, BSN, RN · Mar 28, 2013

Someone freaking out over you giving 1 mg iv morphine? Think I've been working in burn for too long...

/routinely gives 300 mcg of fent, 4 of versed for minor dressing

changes

//we make a lot of narc addicts on my unit

///not my place to judge