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

Nurses Relations

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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 isn't my place to judge someone's pain. It is what they say it is. Therefore, if the medication is ordered and its safe to give it, I will. I do begin with less potent drugs and I try to stay with them but that isn't always possible.

I had a cancer patient who was having some pretty bad pain, if one judged by his behavior. He only had one percocet ordered to control this pain, besides IV morphine. He had been complaining to the nurses and doctors that his pain wasn't being controlled with the perc. He couldn't sleep, etc. So, finally, I decided to bump him up to 1 mg of morphine. Afterward, he was able to rest and that was that.

Well, the oncoming nurse, who is known for her snippiness, didn't like it. She asked me if I REALLY thought it was a GOOD idea to be giving this patient MORPHINE.

Yes, I do think it was a good idea. He was having a miserable time beforehand and had relief afterward. Perhaps she would have liked for me to call her at home in the middle of the night to get her take on the situation?

This is just one example but the rest are pretty similar.

I don't understand some nurses' attitudes regarding pain control. Some act as if it the drug will come from their personal stash or something.

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I had a lot of experience with medical professionals taking on the role as the pain medicine gatekeeper. It's not worth it to me. If someone is hurting, and has given me verbal and nonverbal cues, I'm going to treat it.

Just like you, as long as their vitals are okay enough, it's okay with me. I have told some patients I didn't feel comfortable giving morphine with their BP being so low, but lets see what else we can do until it comes up a little more.

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As long as you handed over an adequately breathing, easily arousable patient with an acceptable blood pressure then you should not worry.

Now if your patient was floppy, difficult to awaken and ready for some Narcan, that is a problem.

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OP you did the right thing. I don't care whether the patient is lying or not about their pain. If they report pain and have an order for meds then I'm giving it as long as it is safe to do so. Pain is SUBJECTIVE!!!!!

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Specializes in Intermediate care.

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.

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Specializes in Intermediate care.

i guess i should add i think you did the right thing. He sounds like he trule was in pain, and i would have done the same exact thing. I sometimes think nurses just get to used to patients taking advantage of the system and it negativley affects the patients who are truley in pain and need the medications. I just have a difficult time dealing with the ones who are drug seekers.

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Some people really are in oain and do not put on a show about it and cry and scream. I know i become usually very quite . I do not especially care if their pain is fake as long as they are reasonable about it and not yelling and screaming and threatening until they get dilaudid .

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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.

I'm assuming you don't suffer from chronic pain..you should educate yourself on how a pt typically acts in this situation

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Specializes in Oncology; medical specialty website.

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

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Oncology pain is nothing to screw with.

I used to **** off the upper management by giving my patients dilaudid (when ordered, of course) because a lot of them knew that was the only thing that adequately controlled their pain and that in order to stay in control, they needed the dilaudid even at a 4/10 pain. Management would get in a tizzy over over-medicating patients (never happened) and try to take it out on my immediate supervisor. "Oh, JCAHO won't like this! You're going to have to reeducate your nurses!" Yeah, sure.

All the while, the patient dying of bone cancer was resting peacefully.

I sleep well at night.

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Specializes in Family practice, emergency.

"I do begin with less potent drugs and I try to stay with them but that isn't always possible."

It sounds like you are responsibly treating your patient. Don't let the cranky nurse get to you.

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Specializes in Acute Care, Rehab, Palliative.

I know what you mean. I have a patient with hydromorphone contin 18mg for long a long acting pain med and Dilaudid for breakthrough.One nurse that I works with will insist that faking it and gives her Tylenol.Sometimes she will rate it as a 4-5/10 and I will use the Tylenol but if she is obviously in a great deal of pain I will give her the Dilaudid. Then I have to listen the other nurse telling me she only needs Tylenol and that's all I should ever give her. I would never judge what another person chooses to give their patient so I don't appreciate her telling me what to do.

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