nursing differences

[midwife2]

I am a Canadian RN in a free standing 6 bed Hospice. We have 4 full time RNs and only one of us is working at any given time. We work 12 hours shifts and only see each other at shift change. Thus, we are on our own to make judgements about narcotic dosages (within the range ordered) and sedation dosages. We are experiencing some tension amongst ourselves regarding these decisions. One of us is more likely to be liberal with the dosages that the other three. This nurse graduated 35 years ago and the other three are all new grads in their first jobs. Have any of you experienced this kind of conflict and how did you resolve it?

[Katillac, RN]

That's a good question! Ours is also a six bed unit, and we have seven part and full time nurses and a list of per diems all of whom may have slightly different approaches to medication. With us, it's all about whether we are achieving comfort with the least amount possible of undesirable side effects. And it's all driven by the plan of care as the bottom line. When we have significant conflicts, a meeting is called so that everyone can discuss the issues. The decision about how to proceed would then be made by the Primary Nurse, and in her absence or if the conflict is larger than that, the Patient Care Coordinator.

But maybe a more pertinent focus is the source of the tension. Why are some of the nurses concerned about the manner in which other nurses medicate? Poorly controlled symptoms? Too many undesirable side effects? Sedating for staff convenience instead of to relieve patient suffering? Narcophobia? Something else? If the outcome of treatment is acceptable to the patient, I would think that as long as treatment is within ordered perameters, variations are OK and desirable, as conditions change and we need to flex to accommodate. And if conflicts are producing tension, I would hope that each nurse could examine their part and answer the question of how important it is to do things "my way", and whether "my way" works. If you can't achieve consistent care that yields appropriate outcomes with nurse to nurse discussion, or if the tension remains, you need a meeting with someone with authority to resolve the matter.

Good luck with this! Conflict resolution can be a tough one, but if everyone puts the patient first and parks their personal agenda it goes a lot easier.

Edited for typos

[rosemadder]

Is this nurse providing comfort for the patients? Is she caring and onboard with the Hospice philosphy? It sounds like she has a lot of experience and might be more liberal because she knows a lot about these issues. In Hospice it takes someone who understands comfort and pain issues with the dying. Perhaps the new grads do not yet have the experience necessary to fully make a good judgment call. I know that many nurses handle comfort and pain issues differently but in Hospice the most comfortable patients who die the most painfree are the ones who have nurses not afraid to medicate.