I've always questioned giving morphine to hospice pt. But I've never minded it so much. But lately I feel like I'm pushing comfort meds to pt. I work weekend doubles and when I come in I find that I am the only nurse who has given medication in a week. I was angry at first knowing that the nurse through the week hates hospice and wants to save everyone. I love that about her but at the same time its not always our job to save people. She's been pushing the evening nurse not to give these meds to the 2 pt whom need it most the night nurse will sometimes give it.
A few weekend ago I walked into my pt room he was crying. Asked me to kill him, tried to kill himself by pulling tubes or pulling off O2. I called the Don had him moved to isolation so family could visit when he was unresponsive after having he pulled his O2 off for to long before an aide found him. I asked fm about comfort meds. They said yes. This last weekend again pulled out tubes in pain. Asked hospice to up pain meds. They did. He recently died.
The nurse on morning shift asked me if I liked killing my pt. If it gives me joy? It hurt so much I've started to question myself. I just had another pt. Moved to comfort meds after talking to family hadnt eaten in weeks curled in bed constantly yelling out if an aide so much as touched him refusing anything but sublingual meds. She asked me if he was next.
I've talked to my DON and she says that my choices are good and that I'm helping them pass. She's mad at the other nurse but I don't want her to be, I'm just debating on if I'm helping or if I'm killing. If maybe I'm pushing to hard to let them die. I know my job isn't always to save but by giving them these meds I'm afraid I'm just killing them.
TLDR: giving pt. Morphine pushing comfort medication?
As for the pain inservice, while it would be expected and required of such an entity, it will not help those who are not doing their jobs by refusing to administer medications. Even the most naive and uneducated individual is aware of the basics of hospice when they enter that area. I knew that when I took my first hospice case. We actually discussed hospice in nursing school. Needed education on the underlying concepts does not fly as a reason for noncompliance in this instance. Defensive attack is almost always used to cover down to earth just plain LAZINESS. Hospice = sit in a chair and play on your phone, in or out of, sight of family, to many LAZY nurses.
I think you would be great as a hospice nurse. In hospice, they often give meds that are shocking to inpatient or LTC nurses. You have to remember, people build a tolerance to narcotics. That bit of morphine is a lot if you are narcotic naive, not so much if you have been on it for a month.
Not a whole lot is given PRN in situations where they are not under constant care. In inpatient hospice meds are every hour or so quite often while getting symptoms under control and during the dying process.
Mostly they want to prevent pain in hospice, so long-actings are only supplemented with breakthrough meds for home or LTC care administration. She should never be holding long-actings or scheduled pain meds without a darn good reason. That ruins what you have achieved in the way of pain and symptom control.
Sometimes I think nurses who withhold meds in this way either have a fear of death or a slight need for patients to suffer because they were taught to be brave in the face of suffering. But when you are talking death, there is no point in suffering. It is already known to be terminal. Acute pain sometimes serves a purpose either diagnostically, or to prevent the patient from overdoing it during recovery. Terminal pain and restlessness are symptoms of suffering that have no purpose. She needs educated. But you, I think you are a hospice nurse at heart.
And death comes when it comes. In hospice, it is thought that sometimes when a patient is finally comfortable they can relax and let go. If you are making that possible because others are not, then you are helping them to pass, not making them pass. I have seen nurses hold meds before the next shift was due to come because they were afraid the patient would relax and die before that shift change. That is wrong too.
I don’t throw around “BON” lightly... but I would seriously consider reporting this nurse. Her practice is so egregiously abusive, I think the public needs to be protected from her.
I once had a similar situation. I’d given morphine as ordered, the patient died through the night, and the oncoming nurse said something along the lines of me being the angel of death and killing them.
I talked to my mom who has been a nurse for almost 20 years because I was beside myself.
she said “would you want to live like that? Would you want help and comfort? Or would you like to go slowly, painfully, and wishing you had a way to help you?”
put everything in perspective and I’ve never thought twice about morphine orders since.
You love her about that? You love seeing or knowing that a patient suffered in pain and agony because the uneducated, irrational, naive nurse refused to give comfort meds per ordered? Just the thought is pissing me off. There is a reason why there’s a doctors order for this patient to be on hospice, not never mind the family/pt agreed to Hospice. What you coworker did was neglectful and unacceptable and she should be be reported, If not, fired. You can even say what she did was abuse, not just neglect and inattentiveness.
caliotter3
38,333 Posts
As for the pain inservice, while it would be expected and required of such an entity, it will not help those who are not doing their jobs by refusing to administer medications. Even the most naive and uneducated individual is aware of the basics of hospice when they enter that area. I knew that when I took my first hospice case. We actually discussed hospice in nursing school. Needed education on the underlying concepts does not fly as a reason for noncompliance in this instance. Defensive attack is almost always used to cover down to earth just plain LAZINESS. Hospice = sit in a chair and play on your phone, in or out of, sight of family, to many LAZY nurses.