Mom said no more pain meds

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    My patient has pain maybe 3 times a week. He just gets prn meds like motrin or Tylenol. Mother said no more pain meds and that he is going to have to learn to live with the pain. He gets irritable,cries and grinds his teeth. After he takes his pain med it is obvious that he is feeling better. Mom says that these meds cause liver problems etc and therefore he will no longer be receiving them. I really love this child but I don't know if I want to watch him while he is pain and to not do anything about it. I think I need a new job. This mother has so many rules which change from week to week. I think maybe I need to think about getting out of private duty period. The thought of being allowed to make an actual nursing decision myself instead of having to get Mom's permission first sounds wonderful.
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  4. 12 Comments so far...

  5. 4
    Don't you need an updated order from the doctor to discontinue something? PRN is based mostly on the nursing assessment/patient complaint not on mom's say-so.

    I have told our nurses that we are giving a PRN like Tylenol every 6 hours when my son was sick and never had them question it or withhold it.

    I would think that withholding a painkiller is tantamount to medical child abuse.
    SE_BSN_RN, systoly, Purple_Scrubs, and 1 other like this.
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    Thanks ventmommy. At this agency, we are told to do whatever Mom says to do. They don't want to lose any clients for any reason. Mom doesn't want to discontinue the prn orders because these orders are prn pain or prn temperature over 101. Mom only wants it given for high fevers. It seems cruel to not give it when he is having pain. In my charting, I chart: "Patient is irritable and crying. He is grinding his teeth. Prn pain medication not given per instructions from mother."
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    I would have been gone from this case the same day that Mom told me this. I would refuse to participate in cruel treatment of the child. It does not sound like she is amenable to instruction that it is the "overdose" of medication that harms the liver and not the "judicious use" of the same meds. You have no intention of overdosing her child but she does not find you capable of making that kind of decision. I would advise you to inform your agency about the mother's instructions in a written communication note, whether or not you leave the case. There are reasonable family members out there, but they are the exception and not the rule. Most of the time, one needs to gauge their need for a job versus how much nonhelpful interference they will tolerate. I draw the line at not addressing the patient's pain.
    Lovely_RN and Blackcat99 like this.
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    Thanks caliotter3. Yes, I feel this mother has really crossed the line this time. I worked at hospice for 2 years so I have a thing about a patient receiving adequate pain medication. My intelligence says to leave this case immediately. My heart :heartbeat when it looks into the eyes of this most precious beautiful child says I must stay forever. I am too attached to this child, that's not a good thing. One of the supervisors are coming to visit soon. I will go ahead and tell her about it but I am afraid she will say "Just do what the mother says no matter what"
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    I don't know what state you are in but I would imagine that there are limits as to what a parent can refuse to treat in your state. I know that parents can refuse treatment in futile cases but I don't know that they can refuse PAIN TREATMENT without risking a visit from social services due to the fact that not treating pain is cruel. If that is true in your state, then the agency would be complicit in the cruelty towards the child by enforcing the PARENT'S wishes instead of the medical order.

    This mom sucks and if I knew her, I would definitely have something to say.

    It's hard to not get attached to your patients. We are attached to many of our nurses.
    Blackcat99 likes this.
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    I would rethink your decision to stay with this case if you object to her demand to not treat her child for pain.
    Lovely_RN and Blackcat99 like this.
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    Document what the mom has stated. Then document that you have educated her. Then document that she has declined the meds. The parent does have the choice to decline. Then report it to your supervisor and document it. After that I would put in a call to social services. With the documentation, you have covered yourself.
    After covering for myself, I'd RUN!!!!!! You can always tell your supervisor that you are interested in floating to broaden your skills and keep them from getting rusty. Go float and when the right case and hours come along you will know what to do.
    Blackcat99 likes this.
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    I'm not a Nurse yet... but I'm no stranger to documentation. Each and every time you assess and determine that the child is in pain, and you request permission to give appropriately prescribed pain meds to the child, and the parent refuses, explore the refusal reason with the parent, educate the parent and re-offer. Document the refusal. One or two occurrences of a refusal may be justifiable by the parent... however, you're establishing a pattern... a willful pattern. As you see the pattern, report it to CPS. If they come and remove the child from that environment or parent loses custody, the agency will probably lose that client... and expect some kind of retaliation for reporting.

    If this situation is as you describe with your agency, I'd expect retaliation in some way for "losing" a client even though you're going to be doing your duty as a likely mandated reporter of child abuse.

    Yes, parents usually have the right to refuse any and all medical care of their child... but that can not rise to the level of abuse. If it does, those people who are mandated reporters must report it to the appropriate agencies.

    I can also see another reason for making the child "get used to pain" in that perhaps the pain meds are too costly for the parents now so they want to limit the usage to only those severe times and thus cut the cost down.
    Blackcat99 likes this.
  13. 0
    Thanks all for your comments. I reported to the RN clinical superviser at my agency about Mom saying no more pain meds. The supervisors words to me and I quote: " Oh I guess his mother has decided to stop spoiling her child"


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