If I'm helping one of my colleague's patients and they appear in pain, I do exactly what I would do if it were my patient--ask them for a number between 1-10, try to get them to clarify how they're feeling now compared to how they've been feeling. Ask them when they had pain med last. Ask them if they want pain med. If they do, I look them up, see what they can get. Then I let their nurse know this information: a) the patient is in pain, b) the context (they are out of bed, just got on CPM, just woke up, etc), c) numeric pain level, d) if they are due for any pain meds/what they took for their last dose. Then, if I'm available and it's appropriate, I offer to medicate the patient. Then there are moments when I am completely occupied with a patient and another nurse says to me "Mrs. Smith is in pain. She's on her CPM. She rates her pain 6/10. She last had oxycodone at noon--10 mg. She can have this again now--would you like me to medicate her?"
I'd say 90% of ortho patients are in exquisite pain post-op. Then there are those few that really can control their TKR pain on extra-strength Tylenol (and do all their PT/CPM, etc). My floor is definitely not perfect in a lot of ways, but we do work as a team when managing pain since it is such a huge part of what we do and such an important part of the rehabilitative process. Sometimes, no matter what we do, we can't get a patient's pain under control. Sometimes a patient is extremely surprised at the pain they feel the first time OOB since they were so comfortable before. We all ask about pain--if we don't, our patients will tell us about it anyway. I think some nurses--especially those new to ortho--don't pick up on some of the nuances of joint replacement pain management (ie, did the patient have an epidural, are they getting toradol around the clock, do they have a long-acting narc on board, is this a chronic pain/tolerant opiate user already, does this patient have a hx of narc-confusion or are they afraid they'll get "addicted", are they nauseas and thus refusing pain med, or are the pain medication orders inadequate for the situation, etc). They may ask for a number on the 1-10 scale, and when they get a "I'm fine", they don't ask any follow ups.
If you see one of this other nurse's patients in pain, I'd go talk to her--ask her why the patient hasn't been medicated (it's not necessarily an accusation--plenty of patients will refuse), and offer to help. If, by her response, it seems that she's not "getting it" (ie, not providing enough information to the patients so that the patient can advocate for himself better) take it as an education opportunity to help her along. (Plenty of people did this for me, believe me
) If she really seems to be neglecting her patient's pain management and doesn't show any improvement--she don't belong on ortho, and I'd let the manager know. Cause that just ain't fair for the patient!
Last point: I have learned with 2 years of ortho nursing that it is OFTEN appropriate to try to convince a patient to take a narcotic pain killer. I feel it's my responsibility to gain "informed refusal" if a patient chooses not to take pain medication. A nurse from another specialty may not be as familiar with "pushing" the pain meds. Teaching moment teaching moment teaching moment