Is my NM whack or is it just me?

Ruby Vee, BSN · May 8, 2009

i work on a busy orthopedic floor. we receive a lot of post-op patients. i work the night shift. the other night i medicated a patient of mine times 1 for some pain she having. after that, she was sleeping like a baby. her vs were stable and there were no other indicators that she was in pain, such as grminicing, etc. flash forward. the ortho doc comes in and the patient tells the doc that she had been in pain all night. so that following night i get called into my nm office and she asked me why is he upset, and i explained what i just explained to you. then she said something so utterly retarded i didn't know what to say. she actually told me from now on i am supposed to awaken the patients every few hours and inquire if they would like pain medicine or not. why on earth would i wake a patient up, especially when they look comfortable, if they want more pain medicine? is it just me or does this sound ridiculous to anyone?

in general, i've found that the majority of nurse managers have more or less lost touch with what it's like to be a nurse! that does sound somewhat whacky to me, but then i work in an icu and we'd be waking them up anyway for hourly vital signs, i & o and glucose checks.

nursej22, MSN, RN · May 8, 2009

We have told the same thing, that pts may appear to be asleep but still be in pain, and to truly assess their pain level, we must wake them up and ask. But I doubt that many of my co-workers actually do this, nor would I, as a patient, enjoy being woken every couple of hours. It'mis so hard to sleep in a hospital, and I truly believe that most healing takes place during sleep.

I suppose ideally, you could ask patients when medicating if they prefer to be woken for pain assessments, then document their answer.

When did patients stop being able to ask for pain meds, and relying on nursing to offer them? If a patient is hurting, surely they can call?

Ploppers · May 8, 2009

That is like saying "Hey wake up that newborn and see if its hungry." Who in thier right mind would do that??? Patients in general are sick. Sick people in general need rest... duh. :lol_hitti

(Yes, your NM is totally whack)

allnurses Guide · May 8, 2009

Just my two cents, but wouldn't you be waking fresh post op patients up every four hours for vital signs anyway? Seems to me that for people who seem to be sleeping soundly, that's plenty often to check for pain, especially since many pain meds are only ordered every four hours anyway.

ARRRGH!!! I have had this happen too so I know how frustrating it is! I *HATE* it when I have a patient that seemed to rest just fine, but then complains to the next shift that they had a horrible night.

My_brain_hurts · May 8, 2009

Yeah that's tough. You can wake up a pt and they're like "I was comfortable until you woke me up"

I work in the ICU and when I have a pt who can verbalize and who has been hurting I'll let them know if they have scheduled pain meds or PRN pain meds, and if it's PRN I'll ask if they would like me to wake them up at such and such time to see if they need meds. Some pts say "No, let me sleep, if I hurt I'll let you know", other says "Yes, please wake me up and ask me". We also have a place to document if pt is sleeping and if vitals are within normal limits for the pt in question.

But yeah, that's tough because when you have a pt who is FINALLY asleep, it makes no sense to keep waking them up. Ah, nursing judgement!

Midwest4me · May 8, 2009

that is like saying "hey wake up that newborn and see if its hungry." who in thier right mind would do that??? patients in general are sick. sick people in general need rest... duh. :lol_hitti
(yes, your nm is totally whack)

yep, ploppers is right!

allnurses Guide · May 8, 2009

I have just experienced being a patient (again) and prior to this I would have agreed with the majority of posts here, if you patient is sleeping then they are comfortable. But as a patient after fairly major orthopaedic surgery I can clearly remember lying in the bed with my eyes closed not moving feeling nauseous and in pain, because I was post op I didn't really have any idea of time passing so wasn't sure when pain relief was due and I was afraid to move because it made the pain and sickness so much worse so I just lay there waiting for the nurses to do my observations so I could let them know I was in pain.

This experience has changed my practice, with my post ops now if they appear to be asleep I will call their name and see if they wake easily, that way I know they are not just lying still with their eyes closed because it makes the pain more bearable.

beanhead_80 · May 8, 2009

I have to agree with NurseCard and Sharrie I too work the night shift and I try to arrange pain medications with usual cares like taking vital signs. I have found that even though I make rounds on my patients every hour that may wake up inbetween and not want to "bother the nurse." I am there to try and help them get better and sometimes that means waking them up.

Tweety, BSN, RN · May 8, 2009

Often when someone is woken up the beginning of the day shift after not being medicated during the night they complain of pain, often severe and it makes the night nurse look bad. However, I agree that if you approach a patient and they are sleeping (not "appear to be sleeping, but sleeping....some night nurses just stand outside the door and peek in, you should walk up to the patients bedside close up) don't bother them, but assess them at their 4AM vitals/assessment.

What's going to happen is that someone is going to complain that you woke up them all night and they didn't get any rest and the doc will complain to the manager and you will be called in and you're clueless management will switch out and say "if your patients are sleeping, let them sleep".

You can't win. Keep doing what you're doing.

UM Review RN, ASN, RN · May 8, 2009

I recall being asleep and having no pain to a screaming 10 within a split second. (Apparently the chest tubes caused some pretty horrendous muscle spasms.)

I so didn't want the night nurse to take the fall for that.

The point is, everyone's different. Use your judgement.

I_LOVE_TRAUMA, RN · May 8, 2009

Pain control is huge in my ED, and in the ICU/trauma unit. We have done many studies and have found that if the pain meds are not given when they are due, it is much harder to keep it at an acceptable level. We are required to offer the meds when they are due, or give them when they are due (unless signs of oversedation are present) or we will get into trouble. We push for dilaudid or fentanyl pcas, but even then we give po meds and many boluses through or around the pca. But we are in the room at least every half hour or so anyways. I have had many patients where I have thought that they were resting well and have decided to wait a few more minutes before giving the meds, only to have them wake up screaming in severe pain and then I have to hit them with everything available really quick to get on top of it again.