I don't know if anyone else will understand my problem or not.
In our LTC facility, we have some patients on PRN Vicodin or Percocet. We have one nurse who trys her darndest to get these things dc'd - she will say that 'they don't need that!'
I understand the problems of addiction, but my thought is - if they're toward the end of their life, why shouldn't they have pain relief?! Tylenol just doesn't do it for some of them.
And (don't hate me) but so what if they DO become addicted? It's not like they'll be standing on the street corner trying to buy it illegally. We have one old guy who asks for a Vicodin every nite at bedtime - that's the only time he takes it - he's unable to move around on his own because of an old hip fracture.
I don't believe in handing it out like candy, but don't they have the same right to pain relief that a hospital pt. has?
I have to tell you guys, since I posted my opinion on admin of analgesics I have had a complete 180 degree turnaround in my attitude! When I flush this one Rsd feeding tube Q night she asks for "something for pain". I've been giving her PRN lortab. Well, one of my aides told me 2 d ago that my RN supervisor told her she thought I was taking the lortab for myself cuz I'm the only one giving it to her! I can't believe she told my aide this (I'm the aides supe at night)! Why she didn't confront me directly I've no clue. I want to confront the RN about this but the aide is begging me not to cause trouble. This is my last wk there (I'm moving 3000 mls away) and doesn't want trouble w/ this lady after I leave. I will no longer hand out PRN's unless I have to. I hate to become hard but if this is the result of being compassionate then I can't afford it. I am new nurse this has really rattled me. What do I do? Let it go?
This is my last wk there (I'm moving 3000 mls away) and doesn't want trouble w/ this lady after I leave. I will no longer hand out PRN's unless I have to. I hate to become hard but if this is the result of being compassionate then I can't afford it. I am new nurse this has really rattled me. What do I do? Let it go?
You follow the good training you were giving in nursing school and you do a pain assessment and you chart it. Where do you hurt? What is the pain like? You rate it on a 10 point scale. You ask how frequently the resident experiences the pain. You then chart the effectiveness of the pain medication. If she is slumbering peacefully 30 minutes later then you chart "sleeping with no visible signs of pain, no restlessness, no grimacing, no moaning or calling out."
Stand tall and follow good nursing practice. Do not let other's poor practice standards reduce your own. What you cannot afford to do is compromise your integrity as a nurse.
Thx for the support! I REALLY hate to become hard, hate to change my basic personality, do things against the grain. Maybe I can find a compromise. This particular pt is a stroke pt w/ limited verbal ability (I think). She usu goes to sleep after I give her the lortab. I only see her at night. What I've been doing is having an aide stand w/ me at the med cart and go into Q pt's room that I must give any kind of narc to. I'm trying to protect myself here. Come to find out the last 2 nurses on this unit actually got caught w/ pt drugs on them so this RN is overly suspicious. I'll do what I need to do to protect my license, my livelihood, after all I have children to feed. I need my job. I'm only there for 1 one more wk. Incidently I've only been w/ this company for 5 wks. My husband lost his job my 1s there so we are moving back up north. I'm scared to be a good nurse at this facility when it comes to admin pain meds. I can't afford this trouble or doubt. I don't need this hassle. I gave out PRN's at my 1st job up north w/ no problems. Maybe it will be different at my next job and I can be the kind of nurse I want to be. Good idea to document Q thing re:pain meds. I will start doing that. I will be the only nurse there who does that also!
Specializes in Gerontology, Med surg, Home Health.
"Stand tall and follow good nursing practice. Do not let other's poor practice standards reduce your own. What you cannot afford to do is compromise your integrity as a nurse."
Couldn't have said it better myself. If YOU know what you are doing is the right thing for your patient and you are following protocol, don't let someone who is misinformed or misdirected or miswhatever change the way you do things...especially when it comes to pain control. I think most residents at a facility are way undermedicated when it comes to pain. The docs think nothing of prescribing 3 nasal sprays for a stuffy nose but tell you to give someone with crippling osteoarthritis one tylenol every 8 hours....barbaric.
I agree. I KNOW pt's at LTC's are undermedicated. I KNOW I'm not guilty of anything but it doesn't make me feel any better. I am very uncomfortable working there now. I wish she (my RN supe) would confront me directly and just ask! Jeez! Why tell God knows how many people yet not give me a chance to defend myself! Poor supe skills. Has anyone else ever had this problem?
Specializes in home health, neuro, palliative care.
Tammy,
I really hope that one person's flippant remarks are not going to cause you to abandon what is best for your patients. It is our job as nurses to be advocates for our patients. I do understand your anxiety, though, and I hope your new job is a more supportive one.
At this particular job I'll be very cautious and rein my natural instincts to be kind in re: pain med admin, I'll play it by ear at the next job. Thank God I only have one wk left there! If I was going to stay there I would march her (my RN supe) to the DON and get this settled. Maybe she didn't say it and the CNA who told me about did? This has certainly rattled me and caused me to doubt what a good nurse does. I know we are advocates but at what price???
I personally would wonder why the aide is so adamant about you not asking the RN about it. I agree with so much that has been said here and one can never overemphasize the need to DOCUMENT DOCUMENT DOCUMENT!!
Maybe you could say something to the RN quietly. You're leaving anyway so maybe say hey is there any advice you could give about my performance or in areas where I could improve... I dunno.. something along those lines.
Thank you all for your replies. I'm glad I'm not the only one that feels as I do.
We count everything from Xanax to morphine - I agree that if a med hasn't been taken in a couple of months, that it should be dc'd, but if they are taking it regularly, then they should be allowed to keep it. Altho I do feel that they should be assessed more often, and it should be charted WHY they need it.
The LPN that dc's all these drugs has worked in this same LTC for many years, and has never worked in a hospital. I feel like it's kind of a power thing with her. She will only give Tylenol - then when I get there at nite, they ring for something else, because the tylenol hasn't helped.
OTOH - the last nite that I worked, 20cc of one ladies prescription cough syrup 'disappeared'! The lady doesn't take it often, and when she does, the dose is only 2.5cc. This concerned me, and I pointed it out to the DON who doesn't seem concerned.
We d/c unused pain meds too and our DON is the only person who has the authority to destroy d/c'd meds with the facility supervisor as witness. What gets me fired up is a doc who d/c's pain meds that ARE being used on a regular basis. Had a pt once who's pain assessment was always in the 8-10 range with Lortab taking it down to maybe a 3 and Ultram only taking it to a 5-6. The doc decided that the pt couldn't possibly be in that much pain and d/c'd the Lortab and Ultram and left us with nothing but Tylenol q6h. This is also the same doc who told me that the liver problems I have (non-alcohol steratohepatitis) can't possibly cause pain either. Hmmmmm guess who is no longer my doc.. lol. The pt has asked repeatedly to see the doc face to face but all the doc does is come in, review the chart... which btw has qshift pain assessments and documentation of pain meds and effectiveness... and then quick as a flash is gone from the unit. The doc even admitted once to our DON that she didn't like her job... ok that's fine, but why take it out on patients who are dependent on her for care?? I just don't get it.
An oncologist told me that anyone who has pain CAN'T be addicted to medication. What indicates "addiction", in his words, was the person without pain taking a narcotic for the euphoria it generates.
I've tried to keep this in mind over the years I've worked in LTC. It has proven beneficial to some, I know.
Back in the Game - we had a few of those at the hospital where I worked - we used to fantasize about them coming in for surgery, then only giving them Tylenol q8!
In the post-anesthesia unit where I last worked, most of the surgeons were great about pain meds, but we had one old doc who would always order 1 Darvocet q4!! I would give it, then call him every time to tell him it WASN'T WORKING! Then he'd order morphine.
I've never had a problem calling any doc, anytime, when their patient needed something important!! If they weren't happy about it, too bad! It's our job to be advocates - the few who didn't like it were a little more appropriate the next time, because they knew they'd get a call if they weren't.
1st edition
66 Posts
I have to tell you guys, since I posted my opinion on admin of analgesics I have had a complete 180 degree turnaround in my attitude! When I flush this one Rsd feeding tube Q night she asks for "something for pain". I've been giving her PRN lortab. Well, one of my aides told me 2 d ago that my RN supervisor told her she thought I was taking the lortab for myself cuz I'm the only one giving it to her! I can't believe she told my aide this (I'm the aides supe at night)! Why she didn't confront me directly I've no clue. I want to confront the RN about this but the aide is begging me not to cause trouble. This is my last wk there (I'm moving 3000 mls away) and doesn't want trouble w/ this lady after I leave. I will no longer hand out PRN's unless I have to. I hate to become hard but if this is the result of being compassionate then I can't afford it. I am new nurse this has really rattled me. What do I do? Let it go?