okay, this could be a stupid question/story, but my degree is not in nursing - i start this summer
so, when i was in the hospital after a c-section (with my 2nd child) and my son was in NICU - i was prescribed to lortabs (2 every four hours). since i was staying in the hospital, i didn't have to go out and get a prescription - the nurse brought it to me...while i was there.
when i had my first child, i was released from the hospital the next day after my c-section - went to the pharmacy, and took MAYBE 5 or 6 pills once i was home. the rest stayed in my med. cabinet.
but with my 2nd child being in NICU and me being stuck at the hospital without being able to breastfeed, hold him, and do all the things new mothers usually do - i was a nervous wreck and stir crazy - wanting to walk to see him, wanting to walk to the ice machine, wanting to put on make up, wanting to go develop pictures - wanting to do ANYTHING besides sit in the hospital bed without my baby!
point being - since i was doing so much running around, i actually needed the pain meds this time. so, after about 6-7 hours without, i asked the nurse if i could have some and she was nice and brought them to me. i suspected that she'd bring me some 4-5 hours later. when she didn't, i asked again. she brought them to me. i asked if they could just bring them to me when they had the chance (around the time i was prescribed) because i would be needing them and i didn't want to bother them - and she said no, and that i had to ask for them. i felt like a drug addict begging for meds every 4-5 hours! i hated it. and after a few times of asking, i felt like THEY were treating me like one!
why do you have to ASK for pain meds in the hospital when they're prescribed after surgery? i'm sure there's a reason - it just made no sense at the time.
wrong according to you! who is not even a nurse yet (or a nursing student).
as you can see from all these posts, we nurses practice differently on certain situations. but that does not make the other opinions wrong.
you have to walk a mile in our shoes to really know what's going on.
"there has been a lot of interesting information/opinions shared imo - even if they are wrong." :)
since when do you need a degree in nursing to have the opinion that someone's opinion is wrong. furthermore, many nurses who are nurses "yet" disagree with the minority group of "nurse ratchets."
i may not be a nurse (yet) but i am an educated person, more educated than many, and have plenty of life experience, again more than many.
life experience and common sense were enough to tell me the situation was uncalled for, but if that wasn't enough - it has been confirmed here.
"there has been a lot of interesting information/opinions shared imo - even if they are wrong." :)
since when do you need a degree in nursing to have the opinion that someone's opinion is wrong. furthermore, many nurses who are nurses "yet" disagree with the minority group of "nurse ratchets."
i may not be a nurse (yet) but i am an educated person, more educated than many, and have plenty of life experience, again more than many.
life experience and common sense were enough to tell me the situation was uncalled for, but if that wasn't enough - it has been confirmed here.
because we are talking about nursing actions and judgments. it's like me telling the engineer how to build skyscrapers.
"there has been a lot of interesting information/opinions shared imo - even if they are wrong." :)
since when do you need a degree in nursing to have the opinion that someone's opinion is wrong. furthermore, many nurses who are nurses "yet" disagree with the minority group of "nurse ratchets."
i may not be a nurse (yet) but i am an educated person, more educated than many, and have plenty of life experience, again more than many.
life experience and common sense were enough to tell me the situation was uncalled for, but if that wasn't enough - it has been confirmed here.
being educated doesn't mean you know it all!!! especially if it's not your area of study/expertise!!!
you know...opinions are like butt holes, everyone's got one. doesn't make them all right.
finish school, get your license and work for sometime then come share your strategy of pain management:p
you just reinforced what most people on this thread are saying. you have to use your nursing judgment! you can choose to give the prn pain meds around the clock or you can choose to offer it q 4 hours. it really depends on the situation, floor, and what kind of patients you have. and yes we already established that assessments and reassessments are done.
(the post being referred to is 210).
sort of. by "most people", i'm guessing you mean the group that disagreed with this statement: "it was probably ordered as needed but the nurse should have followed your request and brought them every 4 hours. there is no reason why the nurse couldn't have followed your request.", since the response to that which said "your answer is completely wrong." got 27 kudos.
when asked why the answer was wrong, the response "because it is a prn med, meaning the patient needs to ask for it. if my patient needs it every 4 hours, i will call the md and have the order change to a standing order. problem solved!" got another 10 kudos.
the purpose the statement in post 210 is to establish pain management legal protocol and goals. as evidenced above, many nurses feel that there is some sort of practice or protocol conflict with offering/giving prn pain meds "regularly, around the clock", when that is actually a legitimate choice.
after stating that prn's can be given routinely and around the clock with just a prn order, they then address the issue of establishing when we should make that choice (assuming no contraindications): "in many acute pain situations, such as post-operative or post-trauma, medications ordered q4h prn (every four hours as needed), for example, should be given (or at least offered) q4h (every four hours) routinely for the first 24-48 hours to keep ahead of the patient’s pain."
the op's main complaint was that she was not offered the prn q 4hrs initially, and then when she requested that be done, she was told no and that she would have to ask for each dose, which many posters appeared to agree with based on some general prohibition against giving/offering them regularly, although at least according to the state of california bon this appears to not only be incorrect, but that's actually what we "should" be doing for patients that include post-op patients (and the op).
Also, I haven't seen this mentioned yet, sometimes nurses deliberately start spacing out pain medications because they're trying to make sure you don't become too tolerate of the medication or become overly sedated.
Patients don't realize this, maybe, but every time your nurse comes into the room he or she is watching out for certain things. They're listening to make sure your speech isn't slurred, they're asking you questions and seeing how alert you are, they're looking at your pupils.
For all we know the OP was slurring her speech and wobbling, we don't have both sides of the story here. Also from her story, I can easily infer that she may of been taking the pain medicine for anxiety instead of pain. That's not good, maybe the nurse should of asked the doctor to get her a supplemental anxiety medication order.
sort of. by "most people", i'm guessing you mean the group that disagreed with this statement: "it was probably ordered as needed but the nurse should have followed your request and brought them every 4 hours. there is no reason why the nurse couldn't have followed your request.", since the response to that which said "your answer is completely wrong." got 27 kudos.
when asked why the answer was wrong, the response "because it is a prn med, meaning the patient needs to ask for it. if my patient needs it every 4 hours, i will call the md and have the order change to a standing order. problem solved!" got another 10 kudos.
the purpose the statement in post 210 is to establish pain management legal protocol and goals. as evidenced above, many nurses feel that there is some sort of practice or protocol conflict with offering/giving prn pain meds "regularly, around the clock", when that is actually a legitimate choice.
after stating that prn's can be given routinely and around the clock with just a prn order, they then address the issue of establishing when we should make that choice (assuming no contraindications): "in many acute pain situations, such as post-operative or post-trauma, medications ordered q4h prn (every four hours as needed), for example, should be given (or at least offered) q4h (every four hours) routinely for the first 24-48 hours to keep ahead of the patient’s pain."
the op's main complaint was that she was not offered the prn q 4hrs initially, and then when she requested that be done, she was told no and that she would have to ask for each dose, which many posters appeared to agree with based on some general prohibition against giving/offering them regularly, although at least according to the state of california bon this appears to not only be incorrect, but that's actually what we "should" be doing for patients that include post-op patients (and the op).
did you mean to say incorrect or correct? nevermind! i re-read, sorry!
once again, just to clarify, i didn't request "bring me medication every 4 hours around the clock." rather, when i asked, "can you just bring them to me?" i had no idea how often i "could" receive them and by the time i was asking, 4 hours had well passed with no questions about my pain or offers for medication - which is why i was in the dark. it was after i flat out asked (after some beating around the bush) i was told i could have them every four hours, and even then, i wouldn't expect them "around the clock" assuming around the clock means when sleeping as well. i have said this many times, but the way it played out was after a couple times of having to ask (and no questions being asked of me about pain/assessments being done) i asked while the nurse was standing there, handing me the meds, "can you bring them next time i can have some?" at which point i was told "no, you have to ask for them." i think the next logical question for someone who is not a drug seeker and who does not want to disturb the nurse without reason would be, "how often can i have them?"
i just find it funny that all over this forum, nurses are complaining about patients who push their call lights when they're busy, and patients who are asking for meds "every 15 minutes" but when someone asks them to bring them when they can have them, and is told that isn't possible bc they have to ask, and then is asked when it's "okay to ask" they are also ridiculed also.
someone who isn't asking for medication for the sole purpose of not wanting to "bother" the nurse and having enough respect to assume she's busy and they can ask for meds next time she (or he) comes around is going to be a person that has gone well past the point of the meds working and is in pain by the time they ask.
I'm really trying to learn from your input and the input of other people in this thread. You've mentioned multiple times about not wanting to bother the nurse, I'd like to address that if I may.
The nurse is a professional and part of her job is to give out medications. Some of those medications are "as needed" so if you need those medications you should ask for them.
Right or wrong I've noticed that some nurses assume that if a patient is a "walky talky" ie can walk and talk that they should be able to voice any complaints. Some nurses think asking "do you need anything" addresses everything from needing help with adl's, pain assessment, bathroom issues, etc. They assume that because you can walk and talk if you needed something you'd speak up.
However my own limited (5 years) experience in a hospital setting says otherwise. Some patients won't ask for things specifically so you need to ask them more direct questions.
"On a scale from one to ten how would you rate your pain right now?" "Does it hurt when you pee?" "Do you have any questions you'd like me to remind you to ask your doctor?"
Sometimes nurses forget that being in a hospital is stressful for patients and things will slip their mind. Or they don't want to be a bother.
If the nurse was at my hospital and was doing things by the books they would of done the following:
Assessed pain using a 1-10 scale if possible, medicate if indicated.
One hour later reassess pain using a 1-10.
Around time pain medication is due again, reassess pain on 1-10.
One hour later, reassess pain.
It's been said before, and will be said again, you can't say for sure that you'll need pain meds in x amount of hours.
Another issue I think some nurses face is that they're reluctant to do a pain assessment because they think that will encourage their patient to take pain medication that they otherwise may not have taken. Some believe that "if it hurts enough they'll ask". I can see that side of things too. Some patients will keep sucking down meds until you need to narcan them. Some patients will take so much meds they'll give themselves an ileus. You can't just pretend those things don't exist.
Also, I haven't seen this mentioned yet, sometimes nurses deliberately start spacing out pain medications because they're trying to make sure you don't become too tolerate of the medication or become overly sedated.
Patients don't realize this, maybe, but every time your nurse comes into the room he or she is watching out for certain things. They're listening to make sure your speech isn't slurred, they're asking you questions and seeing how alert you are, they're looking at your pupils.
For all we know the OP was slurring her speech and wobbling, we don't have both sides of the story here. Also from her story, I can easily infer that she may of been taking the pain medicine for anxiety instead of pain. That's not good, maybe the nurse should of asked the doctor to get her a supplemental anxiety medication order.
I agree and that makes sense. However, after reflecting on the situation (and as I mentioned earlier) I was flat out asked if I did drugs while I was pregnant because they couldn't figure out what was wrong with my child. This may or may not have been an influence on the nurse's actions - just as an outsider might say "maybe she was slurring her speech, etc." It's an assumption and a possibility.
I know if I were told "Patient A's child is in NICU and they don't know what's wrong - they haven't ruled out drug abuse," that would probably have some influence on my opinion of that patient in GENERAL - but especially when it came to giving them narcotics. This is the reason I agree with previous posters who have stated basically that "it doesn't matter who they are or what they do, their pain should be controlled while in our care." I personally would feel like a POS if I ASSumed this about a patient only to find out the suspicion was completely wrong. This may or may not have been the case with the nurse, but I find it odd that in the very same hospital, I was treated COMPLETELY different when I had my first, healthy child that I was caring for and breastfeeding and all was well.
As a sidenote - this particular nurse (after our weird/tense banter about the meds) was sitting at the nurse's station when I went to see my child and was turned away because it was shift change. My husband stood there and we were talking (just talking quietly) and I started crying/sobbing/hugging him and for the first time EVER she showed some compassion and came over to console me. For the record, I didn't break down because it was shift change and I was turned away. I just happened to lose it (for the first and only time) at that moment. I haven't mentioned this before, but I was VERY uncomfortable with the way the NICU nurses treated me as well. This whole discussion has me reflecting and thinking it's very possible they assumed my child's problems were a result of drug use. I will just never forget when the specialist asked me that question/the way he said it. I would think that's something that would be confirmed or ruled out by the time they call in a specialist, but I could be wrong. Any thoughts on this are welcome.
I'm very easy to get along with. I hate going to the doctor, and I hate going to the dentist. The first time I went to the dentist I was 25 years old - that's how afraid I was (never had a cavity, btw). I rely on my nurses to ease my fears and appreciate them very much. I show them I appreciate them with "thank you's" cards, taking pictures (of them), and even flowers. I must've apologized a million times for vomiting after surgery and expressed my horror to the nurse who had to help me put on my weird underwear. I'm not a "holier than thou" type person who thinks I'm the only person a nurse has to care for. In fact, I've always gotten a letter in the mail (the ones most people throw away) asking how my experience was, and I've always made a point to write down names of my nurses (or CNA's or housekeepers for that matter) so I can reply and praise them. I've done this when I've taken my children to the hospital - it's just the kind of person I am. If there's a comment box, and a nurse has been nice, I'm filling out a card. In fact, I went on Pizza Hut's website just last night to send a NICE comment about the manager. Point being - I'm not inconsiderate, I don't think I'm the only person alive, and I do understand policies. On the same token, I am not an idiot and I know when someone is being hateful. Take it or leave it.
I'm really trying to learn from your input and the input of other people in this thread. You've mentioned multiple times about not wanting to bother the nurse, I'd like to address that if I may.
The nurse is a professional and part of her job is to give out medications. Some of those medications are "as needed" so if you need those medications you should ask for them.
Right or wrong I've noticed that some nurses assume that if a patient is a "walky talky" ie can walk and talk that they should be able to voice any complaints. Some nurses think asking "do you need anything" addresses everything from needing help with adl's, pain assessment, bathroom issues, etc. They assume that because you can walk and talk if you needed something you'd speak up.
However my own limited (5 years) experience in a hospital setting says otherwise. Some patients won't ask for things specifically so you need to ask them more direct questions.
"On a scale from one to ten how would you rate your pain right now?" "Does it hurt when you pee?" "Do you have any questions you'd like me to remind you to ask your doctor?"
Sometimes nurses forget that being in a hospital is stressful for patients and things will slip their mind. Or they don't want to be a bother.
If the nurse was at my hospital and was doing things by the books they would of done the following:
Assessed pain using a 1-10 scale if possible, medicate if indicated.
One hour later reassess pain using a 1-10.
Around time pain medication is due again, reassess pain on 1-10.
One hour later, reassess pain.
It's been said before, and will be said again, you can't say for sure that you'll need pain meds in x amount of hours.
Another issue I think some nurses face is that they're reluctant to do a pain assessment because they think that will encourage their patient to take pain medication that they otherwise may not have taken. Some believe that "if it hurts enough they'll ask". I can see that side of things too. Some patients will keep sucking down meds until you need to narcan them. Some patients will take so much meds they'll give themselves an ileus. You can't just pretend those things don't exist.
:::sigh:: i hope i'll not say this again. if you have significant pain and are more active than the average c-section patient, i DO think it's safe to assume you'll need pain meds again within 24-48 hours post op (not knowing the "magic number" is 4 hours) when you ask if they can be brought without asking, and not knowing that you have to ask.
you said this is typical where you work:
Assessed pain using a 1-10 scale if possible, medicate if indicated.
One hour later reassess pain using a 1-10.
Around time pain medication is due again, reassess pain on 1-10.
One hour later, reassess pain.
see, this wasn't done. if 'around the time pain medication was due again' had been assessed, it would have never been an issue because i could've said i was in pain and been offered or asked for meds.
furthermore, after i was told i had to ask (and before i was told, but was given them when i asked) i was never assessed an hour after taking them.
because we are talking about nursing actions and judgments. it's like me telling the engineer how to build skyscrapers.
if 75% (or even more - that's being generous) of the engineers agreed with your opinion rather than their fellow enginners - i'd think those engineers might need to re-assess their strategy - jmo. :)
:::sigh:: i hope i'll not say this again. if you have significant pain and are more active than the average c-section patient, i DO think it's safe to assume you'll need pain meds again within 24-48 hours post op (not knowing the "magic number" is 4 hours) when you ask if they can be brought without asking, and not knowing that you have to ask.
you said this is typical where you work:
Assessed pain using a 1-10 scale if possible, medicate if indicated.
One hour later reassess pain using a 1-10.
Around time pain medication is due again, reassess pain on 1-10.
One hour later, reassess pain.
see, this wasn't done. if 'around the time pain medication was due again' had been assessed, it would have never been an issue because i could've said i was in pain and been offered or asked for meds.
furthermore, after i was told i had to ask (and before i was told, but was given them when i asked) i was never assessed an hour after taking them.
Let me say that I'm sorry you had a bad experience with pain control during your hospital stay. I know that pain control is one of those things that can put a negative light on the care a patient receives, even if everything else is superb.
(Not a nurse yet) but I think if I had a patient with your situation I would have done the assessments, and I probably would of brought the meds with me in my pocket assuming that you'd need them. As long as you didn't start showing any signs or symptoms of over sedation or overdose, I would of keep giving you the meds.
If you started to show signs of having too much pain medication in your system I would have told you what those sings were and explained to you why I think giving you pain medication would be dangerous at this time.
I think communication can help a lot in these kind of situations.
Just continuing on the same thoughts of "if you were my patient" I think I would of asked for some prn anxiety meds. Did you get any anxiety meds? The things you described, pacing the halls, putting on make-up during an inappropriate time, having a child in the NICU, all scream anxiety to me. The funny thing about anxiety though is that anxious people almost ALWAYS quip back "Me anxious?!" For some reason anxious scoff at the suggestion they're anxious, but I've learned that if you rephrase the question more colloquially they're is less of a stigma attached. Like "Do you feel like your nerves are shot?" "Is your mind racing a million miles an hour?"
backatit2
368 Posts
"there has been a lot of interesting information/opinions shared imo - even if they are wrong." :)
since when do you need a degree in nursing to have the opinion that someone's opinion is wrong. furthermore, many nurses who are nurses "yet" disagree with the minority group of "nurse ratchets."
i may not be a nurse (yet) but i am an educated person, more educated than many, and have plenty of life experience, again more than many.
life experience and common sense were enough to tell me the situation was uncalled for, but if that wasn't enough - it has been confirmed here.