I need to get this off my chest so to speak... It's been bugging me all weekend.. here's what happened.
Here's the background, pt has cancer and has radiation 4 days a week and has marks from the radiation. Patient is also on routine pain meds. valium, darvocet and fentanyl patch. She was in pain alot of pain, (crying, shaking, not her normal self) well she has an order for methadone PRN q3hrs. So I gave it to her and I charted on it.
I come in the next night and get my face ripped off by day shift. I get told that this ladies family never wanted her to have it and that they had sent her to the hospital for resp distress and that it was because I gave her methadone. Never mind that they gave her darvocet @ 8am that morning and she didn't go out until that afternoon. So the head nurse tells me that they went through my charting and everything. And I started crying because I felt horrible, But I have no idea if I did anything wrong. The lady was in pain. She had the order and I gave it to her. Everyone that I work with has told me that I didn't do anything wrong and that it's just day shift trying to cover their butts...
What do you guys think??? Am I horrible nurse??? Should I have not given methadone???
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
The patient was in pain and it doesn't sound as if she were having any respiratory problems at the time you assessed her. You gave the medication she had ordered.
I agree with the other posters, it doesn't sound as if you did anything at all wrong. What were you supposed to do, ignore her pain???
Since the day nurse knew the family did not want the med, it was her job to notify the doctor and have the med discontinued. You did nothing wrong. The order was present, the patient was in pain and you gave it what was ordered. Cut and dry.
First off, I commend you on trying to make your patient as comfortable as possible. You did nothing wrong.
How were you supposed to know that the family "didn't want the patient to have this medication"? This is the same in my facility, such poor communication!
Next, I am so saddened by families that don't want their loved ones on certain meds because they don't want them "out of it" or "doped up". It's such a shame that someone with end stage cancer has to suffer needlessly.
I am not sure if I read you post correctly. Is this patient in a long term care facility? On hospice? CMO?
If I were that patient, I would have been happy you were my nurse. Several times I've seen a patient in pain who won't take pain meds if the family is at the bedside, but will beg for it as soon as they leave. We are our patient's advocate, and not the family's. It's a cryin' shame that someone who is NOT experiencing the pain would dare to tell someone who IS experiencing the pain what they should take.
What makes it worse is that 2 family members are nurses. I just don't know what to do anymore.... The families dictate everything on this unit... I have 6 families now that only want their "mom" or "dad" on this med but don't give them that med because it makes them loopy...
I'm sorry but I have 5 pt's that have cancer on my unit and everyone looks at me like I'm nuts when I ask them if they want a pain pill... If it was me I wouldn't want to feel anything!!!!!! I want something to take the pain away!! Why should anyone suffer in that kind of pain????
That's what I don't understand about this place, if you give a pain pill (narcotic or even tylenol) you get "the look" and I follow my MARS and check the orders. I only give what's prescribed....
If your patient is in pain you are right to relieve it.
If anyone disagrees with the order or the treatment plan they are perfectly able to call the doc and express their concerns, get orders changed, whatever. Until then the two laws above still stand.
Next, I am so saddened by families that don't want their loved ones on certain meds because they don't want them "out of it" or "doped up". It's such a shame that someone with end stage cancer has to suffer needlessly.
I can understand where those thoughts come from.
I took care of my mom when she was first diagnosed with stage IV breast cancer up until six months later when she was placed on home hospice.
In all honesty, the hardest thing I had to do for her do was to administer the morphine. I knew every time I gave it to her (she was on it around the clock) it was going to take away more of what little time we had left together.
The half-month she was on hospice, I was extremely torn between her pain and my selfishness to have her awake and oriented for just a little longer.
That said, I couldn't even begin to imagine withholding pain medication from someone in pain. However, I have to say I did have the same resentful feelings toward the side effects of heavy-duty pain medications that some family members described here seem to have.
Cmariehart, I think you did the right thing. I would have been very grateful to have you as my nurse. :)
Here's an update so far for you guys. When I came back from my dinner break last night one of my CNA's came up to me and said pt X's daughter is here and wants to see her chart. So I went out and talked to the daughter. (I did have a really good bond with this pt's family before this happened)
1. The daughter wanted to know what MD gave the order of the
methadone. I looked it up and told her. Her brand new MD
ordered it.
2. Then she wanted to know what nurse took the order, so I looked
that up and told her. The nurse that took the order is our training
cordinator. Not from our unit.
3. Then she asked who gave it to her mom and I told her it was me
and I even told her what time.
4. Then she wanted to know what all her other meds were and what
time they were given. I gave it to her, and this is what I found
out. Day shift gave her: Darvocet, Valium and Zoloft between
8am & 9am that morning.
5. I'm talking to her daughter and I find out that she's a nurse for one
of our local hospitals (I never knew that) and that the day that her
mom was sent to the hospital that they had called the daughter @
home and left a message on the machine "your mom is slightly
unresponsive call us back when you get home"
6. She was @ work when the lady in triage called her and said they
just brought your mom in on a stretcher. That day shift had never
even cleaned her before she went out, her pants were around her
ankles, she had a cloth diaper on and a depends under that.
7. She came into check on her mom Friday during day shift and it
took them over an hour to get down to her mother's room to
change her colostomy bag that had burst, and that she ended up
doing it herself. She went down and complained to the DON.
8. Then Saturday night her husband called her and said the nursing
home called, your mom fell out of her wheel chair.
The daughter's telling me all this and I'm crying and she told me that it's not your fault. They should have caught this long before now, and that she would be coming in within the next couple days to talk to our head nurse and DON. So I'll let you guys know what happens tomorrow when I go back to work......
Thanks for all the encouragment you guys!!!! I really needed it!!!
santhony44, MSN, RN, NP
1,703 Posts
The patient was in pain and it doesn't sound as if she were having any respiratory problems at the time you assessed her. You gave the medication she had ordered.
I agree with the other posters, it doesn't sound as if you did anything at all wrong. What were you supposed to do, ignore her pain???