Pain medicine and bone mets

Sam J. · Feb 10, 2014

Here's my comment from above. BostonFNP, for clarification:

"If you believe that nurses (other than APNs) can make suggestions about drugs, you haven't read the NPA from your BON."

And here's a comment someone else posted to my topic about uncontrolled pain (https://allnurses.com/pain-management-nursing/uncontrolled-pain-how-904447.html in which I did not even mention the word 'drug' a single time:

"Yeah, but I was advised not to believe everything I read on an anonymous forum. For all I know, you're simply a drug-seeking patient looking to trick someone into giving you prescription medications to get high." This comment brings up another reason why nurses should leave medical decisions (drugs) to the physician- to avoid any semblance of impropriety on the part of any nurse.

chopwood carrywater · Feb 10, 2014

I think it's okay now for everyone to go to neutral corners re who should or shouldn't do something.

At this point I think the thread would be better served by giving information r/t ways of dealing with pain specifically bone pain.

Think of it as being similar to when we ask a pt what works best - or least - for your pain. Place the other 'responses in another thread.

Retired APRN, MSN, RN, APRN · Feb 10, 2014

Speaking as a nurse and as a patient with bone mets - YES, some doctors do under prescribe for pain control. YES, the pain of bone mets is ghastly. YES, nurses can and should make suggestions to the prescriber (physician or NP) when the current treatment is not obtaining desired results.

And again with both hats on, I'd like to mention methadone again. It is an excellent medication and well worth exploring with the prescriber if there is a component of nerve pain.

(I'm very blessed in that my docs are very involved in my pain control and quality of life.)

ktwlpn, LPN · Feb 10, 2014

It's a collaborative effort for me, too (an LPN in LTC) I come armed with all of the info I need, the current regimen, the number of times within 24 hours the PRN meds are being given and the resident's response to it and their description of the pain. Then the physician and I DISCUSS together what we feel is appropriate. I have seen methadone used with some success in the earlier stages but most of our patients are close to end of life when we get them and have come close to requiring conscious sedation at the end. Prior to that time I have seen non-pharmaceutical interventions be of some effect if the patient is open to them. It's an awful pain and if you have brain mets it's a horror show.

ktwlpn, LPN · Feb 10, 2014

If the physician doesn't see the patient, who signs the hospice directive/certification paperwork- the nurse?
And what difference does it make if a hospice patient is at home, or in an institution- the fact remains that physicians (not nurses) make medical (which include prescribing) decisions, yes- largely based on what nurses 'report' to them.
If this forum is such a bore, why are you posting in here- that's a very valid question.

In LTC the staff physician sees the resident on a monthly and/or acute change basis. Hospice nurses make recommendations based on their protocols and our physicians may or may not concur. I don't know what areas of nursing you have worked in but in my almost 25 years of experience most physicians will ask me my opinion regarding a host of issues, not just pain control. If you have not had that kind of relationship with the physicians you have worked with maybe there is a reason for that....The physicians I work with seem to respect me and my opinion and I work hard to foster that relationship with continuing education and I make sure I know everything I can about that patient when I report to them. And I'm not out to score points and win,I want what's best for the patient.

Sam J. · Feb 11, 2014

Despite all the lively debate about what nurses should or should not suggest, or recommend- the question has not been answered about whether the physician has been notified about the continued distress the patient in question was, or is going through. That in mind, I started a new post about how to approach physicians that have been notified about pain (or any other situation), and how to try to solve that impasse. So far, there are quite a few positive, and unique replies. And as far as OP, here- there's been no further comments from OP, so evidently this case is closed?

Kabin · Feb 11, 2014

If the physician doesn't see the patient, who signs the hospice directive/certification paperwork- the nurse?
And what difference does it make if a hospice patient is at home, or in an institution- the fact remains that physicians (not nurses) make medical (which include prescribing) decisions, yes- largely based on what nurses 'report' to them.
If this forum is such a bore, why are you posting in here- that's a very valid question.

Community docs regularly ask for hospice nurse recommendations for hospice patient med treatments and that includes pain management. This is what we do every day unlike most community docs.

Sam, if you're really interested in learning more you should do a drive along some time.

Race Mom, ASN, RN · Feb 11, 2014

My license allows me to recommend anything I want! SBAR! The R stands for something! My medical director expects me to be educated on my patients and anything I may recommend. Sam J., you are making a big deal about a nurse trying to educate herself (or himself)? I would never want a hospice nurse caring for me that blindly did what ever the doc said, or ignored that the doc didn't order the right tx. We are ultimately responsible to these families. I have a pt with lung CA with probable bone mets that is having a hard time with pain. (BTW, her doc IS aware so I am safe to post now) I came here to educate myself and see what others have seen work with there pts so that I have backup plans. If you work in a hospital and allow physicians to "scare" you away from recommending treatments then THAT is part of the problem with nursing being "inferior". You can continue to bow down before your all mighty doctors and I will continue to work side-by-side with my medical director whom EXPECTS me to be educated and ready to recommend what I believe may work. Hospital work is not the type of "team" that hospice is.

Bubbles · Feb 12, 2014

Woogy.

Absolutely! It's been a long time since I worked in hospitals, but the good, secure in themselves physicians always listened to the nurses. We were their eyes and ears so they respected our observations and suggestions. At least that is my experience working in both ICU/CCU and Med-Surg. We were never little handmaidens who were expected to bow down to a physician. Oh sure there were a few physicians who seemed to think that, but that was their problem.

Sam J. · Feb 12, 2014

Although this post is really closed, by virtue of OP's disappearance, I'll add a few final thoughts, since my 'reading comprehension' has been discredited:

-Nowhere did OP mention a physician was contacted. Even a guide from this forum has asked that same, plain question.

-Nowhere did OP mention 'hospital', but several prior posts mention what goes on in 'hospitals'.

-Nowhere did I mention that I had 'ever' had a problem with my obtaining the cooperation of any physician, with any patient condition, that resulted in 'any' condition (pain or otherwise) being ignored.

Aside from this version of my real reading comprehension- I'll also add that again, OP has appeared to have 'disappeared'. If that lends credence to a poster seeking advice for a patient that is/was suffering, then that's anyone's perogative.

Amistad, RN · Feb 12, 2014

Does heat work at all for bone mets? Some of my patients find heated blankets comforting in addition to medication, but I haven't had someone with bone mets. I've seen some patients recently with fentanyl patches and that seems to work well.

The thing about pain management in oncology is that sometimes it seems impossible to reach/manage a patient's pain. It can be very distressing for everyone involved... Doctors and nurses alike. There's not always an easy fix.

OP I hope your team found something that works for this patient!

Race Mom, ASN, RN · Feb 12, 2014

The OP hasn't had much luck getting information on this post so what is the OP supposed to comment about? Why are you so stuck on how much communication the OP has had with physicians? The OP did come back to answer your question about physician being aware but you are still harping on the Op for not saying that initially. You may not care if our nurses seek out education but those here at AN do and will continue to help where we can!