Is my NM whack or is it just me?

Nurses General Nursing

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I work on a busy orthopedic floor. We receive a lot of post-op patients. I work the night shift. The other night I medicated a patient of mine times 1 for some pain she having. After that, she was sleeping like a baby. Her VS were stable and there were no other indicators that she was in pain, such as grminicing, etc. Flash forward. The Ortho doc comes in and the patient tells the doc that she had been in pain all night. So that following night I get called into my NM office and she asked me why is he upset, and I explained what I just explained to you. Then she said something so utterly retarded I didn't know what to say. She actually told me from now on I am supposed to awaken the patients every few hours and inquire if they would like pain medicine or not. WHY ON EARTH WOULD I WAKE A PATIENT UP, ESPECIALLY WHEN THEY LOOK COMFORTABLE, IF THEY WANT MORE PAIN MEDICINE? Is it just me or does this sound ridiculous to anyone?

Specializes in Advanced Practice, surgery.

Could I just defend our patients for a little bit again please. Yes they are capable of asking and letting us know when they are in pain, but from my personal experience recently I didn't. Not because I expected the nurses to know that I needed something but for a few reasons.

Firstly I didn't know if my analgesia was due and I didn't want to appear too needy by asking if it wasn't, I had no concept of time passing so 5 minutes seemed like hours especially when I was hurting.

Secondly I didn't want to bother the nurses, they were busy enough and there were sicker patients than me that needed their attention, I didn't want to take them away from someone who may have needed the nurses more than me.

Thirdly, I didn't want to seem like a drug seeker, I know this sounds silly but because I wasn't aware of time I didn't want to be asking for analgesia if I'd only had it an hour ago.

Lastly, even though I am sure I wasn't in pain all night it felt like it because the period of time I was in pain seemed like so much longer than the time I was comfortable.

Pain does strange things to people, it can change the way they act and it makes you miserable.

I like the idea of asking the patient how they want their analgesia needs met during the night

Patients have the right to be completely free of pain..........the 6th right to medication.

Although it may not be board sanctioned in every state, it is being lobbied by many.

So, in many facilities and hospitals its now required to ask pts if they are in pain on a scheduled basis. Have even had this written as an order on the MAR. Not to be accused of shirking my duties, I dutifully awaken pts on a regular basis and ask "Are you having any pain? On a scale from 1-10, how would you rate your pain?" And, according to their answer, provide the pain meds just as ordered and document everything about the episode, including the cursing out I received for waking him/her up in the first place! Then, its usually the pt giving the MD the reaming out for having such a rediculous order as to wake them up in the middle of the night to ask if they're in pain. You'd be surprised how quickly that order is changed to ........"while awake".

i agree with you about pcas, but. the pca decisions are made above my pay grade: it takes a provider to order one and a management team to commit to using them and buy the machines, tubings, cassettes, etc. in the first place.

you should recommend that they get them and use them. pcas are money makers for hospitals, big money makers. they are proven to reduce hospital stays and get patients out of the hospital sooner, which makes more money for the hospital. we rarely have patient stays of >24 hours due to well controlled pain with use of pcas. patients not using pcas have more pain and longer stays, which reduces reimbursement due to contractual lump payments.

Specializes in Management, Emergency, Psych, Med Surg.

She just does not want to deal with the problem. First of all as the manager I would tell the physician that I would investigate and I would have gone into the room with the MAR and would have reviewed what medications the patient had received. I would determine if she had called for meds and did not get them, the nursing record to see what the patient was doing when she made rounds on her patients and then discuss any issues with the nurse if needed. I would also educate the patient about pain control. To require a nurse to wake a patient up to see if they are in pain is stupid. Just ignore it.

The answer would be YES...BTW, most hospitals require a follow up to determine pain med effectiveness...some require you to ask the patient their current pain level on a scale of 1-10 within an hour of medicating. If your hospital does not, I would do it as my own personal nursing practice. And document their response. Finally, it irks me that this patient wouldn't call out for pain med if he/she were in pain. Most patients are skilled at using that call button.

IMHO sleeping in a hospital should be solid evidence that this patient was very likely not in pain "all night". :eek: LOL

...don't be so sure of yourself. as someone who can't take most pain meds i know that sometimes sleep is my only haven. i am allergic to opiates, i've went into convulsive, projectile vomiting fits everytime one was tried on me. i developed ulcerative gastritis a few years ago and my gi doc told me "absolutely no nsaids", for someone with arthritic knees i thought i would surely die. i tried children's motrin suspension once, thinking how bad could that hurt me, a child's dose no less, and i couldn't eat for three days afterward. i also suffer from the occaisional migraine, and boy are those fun. unless i want to sit in the er for several hours just to get a shot of toradol i have to put an ice pack on my head and go to sleep. and, i'm usually down for at least 2 days. so, i am well aware of the solace of sleep to ignore the pain. the three days spent in the hospital for ug and 'mild pancreatitis' (who were they kidding, there's no such thing), had to be the worst pain i ever felt in my life. the nurses there were kind enough to offer me a heat pack to place on my abdomen to relieve some of the pain. and, some of them even woke me up in the night and asked if i wanted another when they got my vs. it was greatly appreciated.

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