RN won't give pain meds - page 2

by Laught3r 16,729 Views | 29 Comments

I am an LPN in a small facility. Many docs here order Morphine IV to be given to their pts. My problem is that as an LPN I cannot give IV push meds. When my pts ask for pain med for a pain level of 5/5 I have to ask the RN to... Read More


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    I don't know that the RN should just accept your assessment. You are a new nurse and she, presumably is more experienced. Not trying to be ugly, just stating my view, for what it's worth. It can be a bad thing to not assess a patient for ourselves. You wouldn't necessarily take the work of an aide or family member, would you? You'd do your own assessment.

    I applaud you caring about your patients and I think the RN is wrong to go by merely seeing that the pt is lying there with closed eyes. Maybe the patient is meditating or praying or just trying to hang on until the med comes. Appearances can be quite deceiving.

    Perhaps you could speak frankly to her, perhaps not. Maybe she is lazy, slothful, fearful, whatever. Maybe she sincerely believes what she is telling you. Hard to say. Can your manager help?

    You might want to go to RN school so you can do your own pushes and not have to wait on RN's to do them.
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    Quote from litbitblack
    I went to RN school specifically for that reason. I had a pt that was crying in pain, first the doctors didn't believe she was in pain and ordered tylenol until her labs came back showing pancreatitis(ive had that and it is horribly painful)well i finally fought long enuf with them and they ordered iv pain med. THe rn to give it had it in her hand and was standing in the hallway talking to a nurse from another floor while i was standing outside my pts door trying to console the pt and hurry the nurse up. SHe waited an additional 15 min for her pain med. I was ****** and the very next day started registering to take my basics so I knew that i could give my pts the care they needed without having to wait. THat rn needs a pain management class.
    I was thinking along these lines when I read your post. One of several good reasons to become an RN. Even if the RN in question were to get off her behind and assess the patient herself, that is extra time wasted when you could have already administered the med as you saw fit.
    Last edit by caliotter3 on Apr 19, '09
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    I am outraged that an RN would hold back on adminstering pain meds for any patient. If she/he has any questions in regards to the patients SELF assessment for pain level, instead of simply staring in a doorway, the RN ought to be doing his/her own assessment by actually talking to the patient.
    I say this as someone who has been a nurse since 1982, who has had more than my fair share of illness and pain, have watched family members die, and feel that taking care of any patient should be like taking care of one of mine. I find that the biggest issue today in pain management is the disconnect that many health care "professionals" demonstrate partially because they are afraid of addiction issues(not usually a problem for short term acute pain care), or because the meds that the docs order don't cover the patients pain adaquately, and instead of asking the doc to increase the dose, or switch to something more potent, simply answer the patient with the old standby, "Doctor ordered this medication and you can have it in another _____ minutes." and that's supposed to help?
    Another problem, of course, is if someone comes into the hospital, in acute pain with some acute condition that they've suffered with before, and tell the nurse that X medication is the best pain medication for that condition. Instantly the mental bars go up- "OOOOOooooooOOOOO, WE know ALL about drug seekers", even if the patient is simply trying to expidite things.
    And worst of all, working in a university teaching center, is the fact that many of our health care professionals and students are young enough that they have never been ill enough to be in a hospital. They have NO idea how much pre-op and post-op pain hurts, or how nasty it is to have an NG tube shoved down your nose/throat...They are pretty much idiots were that's concerned. I once was working near a couple of medi students who were talking about a patient and the three of them were having a jocular talk about just "dropping a tube", as if it were no big deal. I turned and asked them, "Have any of you ever been ill enough to have a tube dropped?" No. No. And No. I said, "Well, perhaps you ought to try dropping a tube yourself and see how much fun that is." The three of them vanished....
    Sorry, got carried away about the topic of pain medication and the lack of understanding on the part of oh so many health care "professionals" about how to treat it, professionally.
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    I agree about the University aspect with you, I know that not all places are like this but many are. I worked NICU for many years and when I first started we had a surgeon that everyone was scared to ask things of, he was famous for saying that premature infants of this or that age don't feel pain as their neurologic systems were not mature yet. Well, that is bullcrap...anyone who has worked with them has seen them grimace, cry, and get very agitated with VS changes with only minimally painful procedures...much less post op. I would call him whenever I had a baby of his and harrass him until he gave me orders for fentanyl or versed. I also gave him every piece of literature I could come up with regarding the fact that infants do feel pain. He would then throw them away and cuss at me but I just let it roll off my back...I had orders for my babes. He did it just so I would let him get sleep and not because he came to my way of thinking. The only way I didnt loose my job was because the NICU attending agreed with the nurses and not the surgeon...the surgeon had no pull in our unit but I did pray that none of my actual kids ever needed surgery. I could see him coming in their room and going oh yeah I know your Mom....this wont hurt a bit. Stick to your guns and keep on being a patient advocate; it could be your family member in that bed someday.
    sharpeimom, Heogog53, and Vito Andolini like this.
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    Quote from caliotter3
    I was thinking along these lines when I read your post. One of several good reasons to become an RN. Even if the RN in question were to get off her behind and assess the patient herself, that is extra time wasted when you could have already administered the med as you saw fit.
    Do you really expect the RN to give the med with absolutely no assessing by her of the patient?
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    That is one thing that infuriates me, when a nurse feels that the patient does not need their pain med. We were taught that you always address pain, no matter what you believe. I always made pain issues, a priority. If someone would ask for pain med while I was doing a routine med pass. I would pause my med pass, give their pain med, and then continue where I left off. I was a pt. many times. I will never forget the time that I was in severe pain and was admitted to the hospital for pain control. I was ordered Dilaudid IV, however, I was in hospital for six hours before I got anything for pain med. But, I was smart enough to anticipate it, and medicated myself with percocet(prescribed by my dr. before she wanted to admit for pain control) before I was admitted. I know for a fact that my orders were faxed before I was even at the hospital.
    I think some nurses believe they have too much power when it comes to pain meds. If a pt. asks for pain med, the nurse should give it, regardless of their opinion.
    Heogog53 likes this.
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    Yes, yes, and yes. I have had a couple of surgeries and a few acute illnesses that required tubes and the like - I never knew that type of pain existed (post-op), and was in horrible misery for days because meds were under-prescribed. In a small town, docs are so afraid of being accused of "over-prescribing" that they opt to "play it safe" and under-prescribe. Ridiculous. I will always advocate for my patients, because as we know, pain is subjective - how can you tell someone THEY don't have pain when they say they do? Ludicrous.

    Oh, and I absolutely agree that the RN should do an assessment. whether or not she's busy, doesn't matter - she is there to help patients, period. i'm going for my RN and would not give a med to someone unless i had assessed them - i wouldn't go solely off another nurse's report. we are responsible for ourselves and our patients.
    Last edit by CharleeJo.RN on Jul 21, '09 : Reason: needed to add something
    SuesquatchRN likes this.
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    ill give you my 2 cents on what you wrote



    when my pts ask for pain med for a pain level of 5/5 i have to ask the rn to give the med for me.
    sometimes they will go and look in the room and if the pts is lying there with their eyes closed waiting for someone to come in and give them relief.


    as people commonly do when they're in pain, its all they can do. i mean i suffer from migraine and its all i can do to lie still with my eyes closed ....the pain is still there



    they will come back and say i am not giving them anything because they are sleep and don't give them anything if they can sleep. (they are not asleep because they call fifteen minutes laterasking for pain med.)


    im a nurse by the way, but id like to say what sort of idiot nurse would behave in this manner. they displayed no critical thinking at all. was it above their level of inter-ma-lectual functioning to consider, maybe they are awake with their eyes closed or to go over and see if they're awake. sometimes my colleagues make me mad





    if the doc ordered 1-3mg of morphine q2h prn. and my pt has just come from surgery and i ask if they can give the pt that i am taking care of 2mg for the breakthrough and then hopefully in three hours when they get their first scheduled po med it will cover them. they will tell me well just wait until they get their po, they just woke up they can't be in that much pain.

    'psychic nursing' how the hell would this nurse know that?? i mean she didnt even speak to the patient. what an outrage! over my years as a nurse ive come across 'psychic nurses'. you know the type , you know the nurses who can say 'you dont look anxious'.....well i say; 'how does an anxious person look???' can someone with a flat affect be anxious?? the answer is yes. but you wouldn't see the anxiety on their face because they have .......a flat affect! but many of these nurses simply rely on their clinical judgement oh i mean psychic nursing abilities to determine a patients mental state



    am i being overly sensitive to this because i am a new nurse? am i assessing my pts wrong when it comes to their pain? it makes me angry that i cannot be in control fully of medicating my pts when they are in pain.am i wrong for wanting the rn to give my pt pain med when i ask or are they wrong for just assuming that my pts are not in that much pain.

    i might be a little out of line here (please correct me if i am as im not so familiar with the us levels of training i.e lpn, rn etc)
    1/ your not being sensitive you are displaying critical thinking.
    2/ if you spoke to your pat' and they claim to be in pain and have a history of being factual with you regarding their pain coupled with your observation of them whilst they are unaware you are watching them (some patients when they know you're watching will play the sick role in the hope of securing more pain medication)
    3/ if they have a condition and are therefore likely to be experiencing pain then i would give the medication
    4/ it is up to the rn and out of your hands, you dont have a say. the rn is legally obliged to behave in a legally set out manner. whilst you the lpn are not allowed to give your considerations for the dispensing of this particular medication. you have not received the respective training (correct me if im wrong!!!) the state has organised various levels of training to protect the public, you can want the best for your patient but that as an lpn and in this situation counts for nothing and if you havent received this traing then your talking form your a$$ or about what you think you know rather than what you do know
    5/ if it makes you angry etc....you know what you need to do...........go to college and become an rn or doctor or pa. i work with ppl like you who think they know better than the nurse or the doctor etc.... and you know what you might!!! its all the same though, you dont have a say, period
    6/ they are wrong for assuming ....they displayed no critical thinking and were probably more interested in their conversation or coffee. i know because ive spent 12 years with other nurses ..i know the games they pull and i know that patient care sometimes is not high on their list particulalry on a quiet evening or night duty ....




    by the way in this facility i work nights and most of the time we have on 4-7 pts and the rn usually has 0-2 since they have more paperwork the lpn's take on the larger pt load.[/quote]

    which is common, i have found in my experience the more education you have the less intense your workload ( my opinion) you my friend are $hit kikker, the go'fer or lacky etc. you dont enjoy the privileges of being able to dictate, and let me tell you nurse know how to dictate. but let me add your experience is identical to the nurse-doc relationship i.e nurse who think they know better than the doctor .............its all the same!
    Heogog53 likes this.
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    You are advocating for your patients and your assessment is valuable. The RN has NO BUSINESS contradicting your assessment based upon a NON ASSESSMENT from the doorway. I am sure that you will find some way to nice up my sentiment should you agree...but the RNs in your facility need an attitude adjustment. They are, afterall, professionally responsible for the nursing care that is delivered while they are present. It is bad enough if they are incompetent enough to choose ignorance when it comes to staff performance...it is a complete embarrassment to RNs that they might intentionally stand in the way of good nursing care! What exactly are their priorities?

    Gosh...that was a wee rant
    Heogog53 likes this.
  10. 1
    When our LPNs came to me and asked me to medicate their patients for them, I respected their knowledge of their patient. Of course I would do a quick assessment of their resp just for my own security. Kudos to you for advocating for your patients. No patient should suffer in pain needlessley, especially when there are pain meds ordered to relieve it. Next time the RN refuses, I would have to adjust her attitude, but thats just me. I would NOT put up with that at all. You are just as much a nurse as they are and they need to respect your judgement. The ONLY reason a RN should/could refuse is if she feels it would be unsafe, which is not the case here. That urks me. I know what its like to live in pain, and if you were to look at me you would never guess the amount of pain Im in. You cant always judge by facial expression, especially with patients who have chronic pain. They have had to learn to live with it and dont respond like acute pain patients. Sorry for my rant, but that just ticks me off. I would definitely address this with the manager. They are making your job hard and making your patients suffer needlessly.
    Heogog53 likes this.


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