Approriate PCA use

[Alphabet soup nurse]

I would like some advice on a situation I encountered:

I happened to be in charge on a med-surg floor and another nurse had called me to help her with family being upset about MD. Background: Pt had advanced dementia--could not eat due to swallowing difficulties, was alert but little verbal responses and disoriented--- newly developed generalized edema and respiratory congestion. Pt was not comfort care but had poor prognosis. Family did NOT want comfort care measures. The MD and clinical coordinator were called and met with the family. The family kicked out the MD and just talked with the clinical coordinator who suggested a PCA pump, suction at the bedside and O2 sat monitoring. The nurse caring for the pt provided ordered Roxanol for pain, set up suction at the bedside and O2 sat monitoring, but felt PCA was inappropriate as pt was mostly in and out of sleep, and could not use PCA button due to confusion/disorientation.

Family became IRRATE that the promised PCA was not set up even though pt was asleep at this point and stated MD "was an idiot and will only have a job at McDonald's when I am done with him" The Clinical coordinator was called and upset with nursing staff and MD that the PCA was not set up stating "this is going to hurt our patient satisfaction and our numbers and we have to think about our surveys" and demanded that nursing staff and her family PUSH THE PCA! Stating the family "will see that we are trying instead of nursing giving meds because the family will not know what we are giving when we come give pain meds and forget that we gave them"

I questioned the decision/appropriateness of PCA and stated nurses/family could not press PCA for the pt and told the nurse to document what the coordinator had said and to call the MD to the floor to discuss with the nurse and coordinator. At the point my shift was over and I had already stayed an extra 20 minutes to make sure that all was going to happen. Well, the next day the pt was on a PCA. I told the manager I thought it was very inappropriate and the pt could not elaborate pain/was confused/disoriented/and lethargic and could not press the button herself and coordinator told staff to do it and let family.

What do other nurses think? I am out of line to question this?

[Alphabet soup nurse]

Thanks everyone for your input. Believe it or not this is only my second year of nursing and I am an ADN. There was NO training on how to be in charge and as charge I still have 4-5 pts of my own on days. It is scary! The hospital I work only seems to care about Pt satisfaction and the bottom line and it can be very frustrating to try and do the right thing with little experience to draw from and a lack of support from management.

[KelRN215, BSN, RN]

Does no one else's hospital use NURSE controlled analgesia? We do it all the time in pediatrics. A child too young or too cognitively impaired to push the button still needs adequate pain control. So the PCA becomes an NCA. I don't really see how this is different from the OP's situation.

Officially parents are not allowed to push the button but not saying I've never see that happen.

[loriangel14, RN]

I work on a palliative floor. Staff and families push the PCA button all the time. How would our comfort measures only patients get any pain control if we couldn't push it for them

[TheCommuter, BSN, RN]

Before you leave the room, say something positive about the primary RN, like how smart s/he is or how caring s/he is.

I agree with this technique...it is referred to as 'elevating' the oncoming nurse. Reassure the family by saying, "Nancy is an excellent, sharp nurse and the patient will be in capable hands for the remainder of the shift."

Elevating your colleagues in front of anxious families really goes a long way to appease their angst.