I have a question, I'm a newbie nurse with only 2 years of experience. So, I work at a med/surg tele floor. I was assigned a pt who was very well known to be an IVDU and frequent flier. Pt was POD 7 from a spine surgery (totally forgot what the actual surgery was) and was getting pain med basically q1hr. She had orders for:
1. dilaudid PO 4mg q3hrs scheduled
2. dilaudid 2mg PO q4hrs PRN
3. diladid 2mg IV q2hrs for BTP PRN
4. oxycontin 10mg PO q12hrs scheduled
5. toradol 30mg IV q6hrs PRN
(**YES THERE ARE PAIN LEVEL PARAMETERS, but this pt is very manipulative and will do anything and I mean ANYTHING to get her beloved pain meds***)
So the nurse from previous shift was basically giving her pain meds every hour!! I did not feel that it was safe for her (and for my license) to be giving her all those pain med. It was a weekend and that particular surgeon who did her op was off. So I called their office and asked to for the on call dr. to be paged.
Dr. K came in to round on that pt, I told him my concern that Ms. so and so had been getting these kinds of pain meds basically every hour. The dr. was shocked when I told them all the kinds of pain meds and diff doses she was taking. He asked me who that pt was again and who was her primary ortho surgeon. I told him it's Dr. ***. Dr. K reacted very nonchalantly and said "Oh yeah she's known to our practice. She has high tolerance for pain meds since she's an IVDU. If she's still breathing just give it to her." I told him that her BP was low and his reply really caught me off guard, "I don't want to mess with whatever Dr. *** prescribe to her. Just wait for him to come back on Monday."
I was literally speechless!!! Pt's bp was already in the mid to low 90s, pt was not hooked up to tele.
Bottom line, I did not cater to her, I did not give her pain meds EVERY HOUR I made sure that atleast 2 hours has passed before I give her another pain meds. I explained her the legal side of nursing. Needless to say, she threw a **** show and threw the biggest tantrum a grown woman could every throw.
That pt filed a complaint against me to my director. My director talked to me and told me to just give her whatever MD ordered for her to have. I told her, NO it is my license on the line and not yours, if something were to happen to my pt it is not YOU AND YOUR LICENSE that would have to sit in front of the BON trying to explain why you did what you did. She said that it is very important that we earn pt's satisfaction.
I felt defeated and seemed like her priority was pt's satisfaction and not pt's and nurse's safety.
I told her and the charge nureses (whoever will be doing assigments) that I NEVER WANTED HER BACK as a pt.
DID I DO THE RIGHT THING? I MEAN I KNEW HER TOLERANCE FOR PAIN MEDS ARE HIGH GIVEN HER HX. BUT YOU REALLY NEVER KNOW WHAT WILL HAPPEN. 1 DAY SHE COULD BE FINE THE NEXT 2 FOR ALL I KNOW SHE'S OD from pain meds.
No, you did not do the right thing. If it's ordered, the patient asks for it, and there's no clinical reason to hold it but you hold it anyway, you are practicing well outside your scope. If you're concerned about long term opiate use, see about consulting social work or if there's a pain specialist on staff at your hospital.
The guilt & shame projected onto addicts as people and patients is one of the primary reasons why the addiction "cycle" will not end. Continue it or break it, the choice is yours. Holding their meds for an additional sixty minutes is not a known successful intervention to treat addictive behavior. It sounds more like a "time out". Our opiate orders all automatically default "hold for respirations less than 12". Benzos say, "hold for lethargy". My guess from the tantrum you described is she did not meet any of those parameters.
I have a question, I'm a newbie nurse with only 2 years of experience. So, I work at a med/surg tele floor. I was assigned a pt who was very well known to be an IVDU and frequent flier. Pt was POD 7 from a spine surgery (totally forgot what the actual surgery was) and was getting pain med basically q1hr. She had orders for:
1. dilaudid PO 4mg q3hrs scheduled
2. dilaudid 2mg PO q4hrs PRN
3. diladid 2mg IV q2hrs for BTP PRN
4. oxycontin 10mg PO q12hrs scheduled
5. toradol 30mg IV q6hrs PRN
(**YES THERE ARE PAIN LEVEL PARAMETERS, but this pt is very manipulative and will do anything and I mean ANYTHING to get her beloved pain meds***)
So the nurse from previous shift was basically giving her pain meds every hour!! I did not feel that it was safe for her (and for my license) to be giving her all those pain med. It was a weekend and that particular surgeon who did her op was off. So I called their office and asked to for the on call dr. to be paged.
Dr. K came in to round on that pt, I told him my concern that Ms. so and so had been getting these kinds of pain meds basically every hour. The dr. was shocked when I told them all the kinds of pain meds and diff doses she was taking. He asked me who that pt was again and who was her primary ortho surgeon. I told him it's Dr. ***. Dr. K reacted very nonchalantly and said "Oh yeah she's known to our practice. She has high tolerance for pain meds since she's an IVDU. If she's still breathing just give it to her." I told him that her BP was low and his reply really caught me off guard, "I don't want to mess with whatever Dr. *** prescribe to her. Just wait for him to come back on Monday."
I was literally speechless!!! Pt's bp was already in the mid to low 90s, pt was not hooked up to tele.
Bottom line, I did not cater to her, I did not give her pain meds EVERY HOUR I made sure that atleast 2 hours has passed before I give her another pain meds. I explained her the legal side of nursing. Needless to say, she threw a **** show and threw the biggest tantrum a grown woman could every throw.
That pt filed a complaint against me to my director. My director talked to me and told me to just give her whatever MD ordered for her to have. I told her, NO it is my license on the line and not yours, if something were to happen to my pt it is not YOU AND YOUR LICENSE that would have to sit in front of the BON trying to explain why you did what you did. She said that it is very important that we earn pt's satisfaction.
I felt defeated and seemed like her priority was pt's satisfaction and not pt's and nurse's safety.
I told her and the charge nureses (whoever will be doing assigments) that I NEVER WANTED HER BACK as a pt.
DID I DO THE RIGHT THING? I MEAN I KNEW HER TOLERANCE FOR PAIN MEDS ARE HIGH GIVEN HER HX. BUT YOU REALLY NEVER KNOW WHAT WILL HAPPEN. 1 DAY SHE COULD BE FINE THE NEXT 2 FOR ALL I KNOW SHE'S OD from pain meds.
So you essentially ignored the doctors' orders and re-did the orders to suit your comfort level? Neither legal nor ethical; add to that you appointing yourself a her unasked for 12-step sponsor. My what an ego...she could sue you and not only would she win you would lose your license for practicing medicine without a license which is a felony.
In explaining away your bias you really have not done anything but demonstrate more bias. As the saying goes when you find yourself in a hole stop digging...
Sorry, I meant to say --I did not get any information why she rapid on that day -- it was end of shift and NOC are wanting to start the reporting. I before I left the unit I asked the charge nurse if they needed anymore help with the pt.. she said no they got everything under control -- as curious as I was, I did not stick around that night to gossip.
But yes when I became her nurse, yes I asked why she rapid. I might as well explain what happened..
Tech was doing her vitals because pt requested that the tech check her temp because she felt like she's getting a fever.
I do not remember all the specifics I believe her bp is low but not below 90s rr was low. What I did remember was her PR was in the 1teens and spiked a temp of 103 orally. The nurses checked it the pt will flag as septic and she did - her wt count was elevated but that was not new since she was also being treated for klebsiella. They activated a sepsis code. Then they did what they needed to do during sepsis code. Then she started complaining of shortness of breath and started "shaking" so a rapid was activated. They did another set of vitals, they wanted take her temp rectally and the she apparently started screaming she is in so much pain and trashing and cursing all the responders. When they did her temp i believe was 98.9 or 99. They continued treating her - got all the specimens that were needed to be collected.
Short story short the infectious dse thought it might be from the CL because the pt is known for picking at her CL line. The nurse that was giving me the report also said that the night nurse supervisor asked what the pt was on for pain meds. The supervisor was shocked that the pt is getting that much pain meds that often (granted she doesn't really know the pt's extensive hx).
May have acquired an infection while adding she 'picked at her central line.' You have been unable to make a single commentary without expressing your negative opinion of the patient...time to quit while you are behind.
Wrong , you don't have to follow orders if they aren't appropriate . OP stated patient was hypotensive, she could've called the MD and ask for clarification before administering. The way you come off is that you must follow MD orders no matter how ridiculous they are . Sorry , I've refused to follow orders and havent been taken to any board , I had a patient with an order for 60 of lantus with a wnl bg , called to clarify told me to give I refuse, charge gave and pt bg tanked to 40 . That's the difference between following orders needlessly and actually critically thinking .
And before being a bully and giving zero supportive advice maybe you should be the one quiting . Nurses such as yourself with this toxic attitude are the reason why floor nurses are running away from the bedside and are going into advance practice / other areas of nursing .
May have acquired an infection while adding she 'picked at her central line.' You have been unable to make a single commentary without expressing your negative opinion of the patient...time to quit while you are behind.
Too true, I had 'adventures' with substances other than alcohol in the '80s but not opiates and not anything an ER would serve-up. I've heard many a nurse openly express their disdain toward addicts while appearing to think the patient will not pick-up on it; they are mistaken on this.
Actually I wouldn't let anyone know my history if hospitalized, I was a 26 year-old never arrested, non-nurse when I got sober, I didn't use opiates or benzos and I prefer not to have the 1st thing to greet me if I ended up in an ER staff passing judgment.
My that is quite a character assassination for one who claims to be all supportive, I daresay it is a bit toxic. As of note it is spelled 'quitting' and toxic nurses are the reason I don't do floor nursing any longer.
Your job is to follow prescribed medication orders and GET THE PATIENT COMFORTABLE.
Instead, you chose to judge the patient and worry about yourself.
I truly hope you are written up for this travesty of nursing judgement.
Awwww Man...I wish I could like this post about a million times.
Ive seen and dealt with so many Nurses like the OP. I always do my best to "lay a little education on them" rather than pick a fight (not in the literal sense of course)
Ive been judged by the best in this type of situation minus the drama and "fit-pitching". "WE" collectively know what people like the OP think of us or of our pain. Do you REALLY think we dont hear or see the whispers? Do you think we dont feel it in your facial expressions or attitude?
You cant know our pain, our history, our event causing Chronic Pain et al. But then you wouldnt believe it anyway because you've already decided that we dont need all that medication and you're going to be different and stop the "nonsense". Being reasonable is one thing, being judgmental is an entirely different beast. I would reckon that MY doctors know me better over the years than a nurse ever could.
Lol I'm on my mobile with autocorrect but thanks for the correction , I guess we are typing APA style papers on allnurses professor. I am supportive , you are the one telling people to quit and not looking at the whole picture . Your post proves it all , a bully .
My that is quite a character assassination for one who claims to be all supportive, I daresay it is a bit toxic. As of note it is spelled 'quitting' and toxic nurses are the reason I don't do floor nursing any longer.
I disagree with you on this. She had spinal surgery and was definitely in pain, despite being a drug user. Addicts have a much higher tolerance for pain meds. It is your job to treat her pain safely. If she was screaming at you, she was definitely not at risk for OD. You assess, and if her respirations are ok, then you give the med. A systolic BP in the 90s is not an indication that a patient should not get pain meds. A depressed respiratory rate would be.
So yeah, you were wrong. A great deal of nurses treat their drug abusing patients with the same level of outrage and withholding though, so you will be in good company here.
Another good post. Sheeeeeesh I need to come here more often.
Ive been a patient recovering from back surgery. A failed one I might add. I am not a "dug user" of any thing illicit. But have had 30 some surgeries to keep me upright and walking with some kind of quality of life. I am one of "those" patients who need more pain meds, or more often anyway to deal with my pain. One of the things people like "us" worry about is going into withdrawals because a NEW nurse doesnt know "our" history and will fight giving us what is "ordered".
Ive had a nurse refuse a pain med (back then it was 125mg of demerol and 50mg of phenergan) because it was 15 minutes early and shes headed to report. I remember waiting for 90 minutes and being in tears because I hurt so bad. Ive since learned.....never tell a Nurse you're a Pain Mgmn Patient. Never tell em that your pain is 10 /10, they claim that's a dead give away for drug seekers. Never tell them what works or better yet what doesnt. Dont tell them your pain is thru the roof....they wont believe it and will say you're histrionic and there enters a whole new ballgame that wont have good results. Also, dont spend time telling them about what you'd call an allergy because the nurse will pound that home!!! Learn fast and hard that there is a difference between Allergy and Sensitivity.
It is very hard on everyone involved. Before I get flamed here let me add....I know some great nurses, in fact most are very suited for the job they do and they take a beating for it. I love to give kudos to ANY Nurse or even DR that will give me an even shake with my pain. Ive had nurses, LPN and RN alike....even the DON that would sit at my bedside and just talk to me. THAT lowered my pain level the best and didnt leave me feeling like pond scum.
So....with all that said (Im in a hella lot of pain lately) I give to each and every one of you that pays attention and listens to their patience major applause and kudos. YOU are the best of what seems to be a dying breed. PLEASE PLEASE dont give up on us.....we're human just like you....the only difference is we hurt so bad all the time and usually thru no fault of our own. My pain is a PIA for you and your attitude or judgment is a PIA for us.
rescueninja1987
51 Posts
No, you did not do the right thing. If it's ordered, the patient asks for it, and there's no clinical reason to hold it but you hold it anyway, you are practicing well outside your scope. If you're concerned about long term opiate use, see about consulting social work or if there's a pain specialist on staff at your hospital.