I really want to know?

[hppygr8ful]

I was just reading a thread on how to be a good patient and the subject of pain control came up. Again I have heard a responder say that his/her nurses didn't care if they had pain if the med wasn't due they weren't given it period.

As a bit of background I will say that I am both a nurse and addict in recovery sober over 10 years. The subject of pain control has come up twice when I had surgeries and I was frank and honest and also adamant that I wanted my pain be controlled. I have Fibro-myalgia and so am always in pain I walk around and do my work and such with a constant 4 to 6 out of 10 and I don't take much more than Tylenol or Motrin or meloxicam. But when they cut me open from pubis to navel and removed 18 inches of my colon I wanted morphine and I got it. I had a PCA for 3 days then went to the pills which I took pretty much round the clock for another week and an half or so. Nurses did question this regimen but I had already talked to my doctor so he came in and said to the nurses " It's not our job to worry about someone's addiction or sobriety. Our job is to keep her comfortable so she can rest and heal. If she get's addicted I'll send her to rehab."

That was the last word on the matter as far as my treatment was concerned.

Perhaps because I deal with chronic pain on a daily basis I am a bit more compassionate about what chronic pain sufferers go through but when I am passing meds and it's close to the time and the patient is awake, alert and responsive they get they're medication. If it's way to soon and the report of pain seems unusual or way out of proportion to me - I will call a physician and ask for a pain consult for the patient. In the mean time I do everything to make the patient comfortable with repositioning, ice packs, diversionary tactics etc...

Even when the patient is a known abuser of medications their pain still has to be addressed and treated.

Bottom line is most addicts are in fact very sick people and when we deny them their medications we are not helping them to get better. I often use the time when I am talking to them to gently feel them out on how they feel about their medications and if they would like to know more about alternatives.

I really want to know why some nurses have no compassion when it comes to this matter?

Hppy

[nynursey_]

If a patient says their pain is 10/10 and they are sleeping when I return to the room with pain medication, or some other observable trait I will put that in a comment on a pain assessment especially if I decided to delay pain medication due to nursing judgement for sedation/vitals. I have also written progress notes when patients routinely have 10/10 pain that never gets better no matter what I'm doing or what other medications I get ordered, etc. Since clearly we all need a new plan. I admit that these situations do frustrate me, mainly because I want to help and I feel helpless....but that's about me, not the patient, and I know that and handle it appropriately.

Couldn't agree more. I chart "patient behavior .... " and "patient states 10/10." I chart what I see. I take the pain report subjectively. I medicate, but I refuse to medicate to a level where it's unsafe.

ETA: I'm also a big proponent of ordering the right medication for the specific type of pain. That in and of itself could avoid a LOT of physical and psychological dependency issues.

[Nonyvole, BSN, RN]

We have quite a few people who come in constantly for pain meds. It's hit the point where I'll do my initial assessment and as the doctor is walking in I'm heading to the Pyxis to pull their meds because we know what works, we know that they'll never see a specialist (even with their amazing insurance, and no that's not sarcasm), and they don't make it a daily event. Well, usually.

I've also seen patients come limping in complaining of 10/10 pain. Okay, sure, I'll bite. What made it different between the driveway - where I saw them bouncing around and looking happy and in zero acute pain - and the registration desk? I don't call them on it, but I'll certainly tell the doctor. Who then calls them on it. Welp, that leads to them stalking out - again, completely different than how they initially presented - complaining constantly about how we're "so mean" and they'll go to a different hospital where they're "nice there." (Um, the very same hospital that you were complaining about four days ago as having been mean to you? Oooookay...)

All the rest of my patients? I'll load 'em up with whatever the doctor orders, to a point. I've held medications due to patient's LOC/VS, or asked to give a lower dose. But I've a sneaking suspicion that just the reassurance that hey, the nurse does come and ask about pain, and says that she can't give more analgesics because of X, keeps patients calmer. Never mind that X usually equates to "and then you get a tube down your throat and end up in the ICU instead of just waiting for your CT to be officially read and then going home."

We won't talk about the times when the doctor looks at me and says "well, what do YOU want to give them?" Because my response usually falls along the lines of a benzo and/or a swift kick in the pants.

[Hpy_Vly_RNBSN]

This is a very hard one for me. And after working in inner city DC with the majority of my patients drug abusers, I will admit I was very frustrated. I felt like I was more of a drug dealer than a nurse. When patients refuse insulin for a BG of 300 because they didn't get an order for Dilaudid, where do we draw the line? I have had to drop care of acute patients to discharge a patient so they had time to make it to their Methadone clinic after I give them their PRN's first. I've had things thrown at me, I have been hit, kicked and threatened because I can't give them a medication early or one that is not prescribed. And after watching my sister die from a Heroin overdose, I became very bitter against these type drugs. There is a bigger issue here, one that I think we as individual nurses, are trying to combat by lacking compassion for these type people. I've been frustrated when I want to treat the person and not their addiction.

I've never withheld a med or deliberately avoided giving a med to a patient. I always do everything I can within reason. I've had to have "the talk" with patients many times that there is a fine line between managing your pain and putting you into respiratory depression. I will never compromise the safety of a patient or put my license in jeopardy. But I also dont think I should have to put my safety in jeopardy as well when it comes to angry patients not getting their meds.

[toomuchbaloney]

If my patient says they are experiencing pain 10/10 and when I return it appears they are sleeping I may just touch them gently, say their name, and ask if they would still like the medication.

Sleep and exhaustion occur even when one is in pain.