Lose your license for administering a PRN med without a pain scale?

[Cola89]

At my new job... a few of the nurse managers have been telling us who work the floor that if we administer a PRN for pain that doesn't have a pain scale given as a parameter, that our licenses are in jeopardy.

Say, if there's an order for morphine 1mg, ivp, q6h, prn, for pain... without a specific pain parameter say like "5-10" or what ever the doctor wants it to be ...

that we shouldn't be giving the medication until we get a specific pain scale range to use.

Although I have limited experience working at another hospital and a snf, I have never been told this before and was wondering if this is normal?

Also, say if a doctor orders a foley.... and doesn't write in their notes specifically WHY...we nurses are supposed to call the docs and get a specification as to why.

[Asystole RN]

The argument that you will "lose your license" is an old, tired, and silly scare tactic middle managers will use to compel their nurses to do something instead of just doing the professional thing like explaining the rationale for an action.

You won't lose your license. You can tell they never worked in the ED. Working in vascular access often times the LIP will write for a "vascular access consult" and the vascular access nurse is expected to use their education, training, and experience to determine what kind of line is to be inserted, where, and then do it.

Best practice is to have a range but it is by no means a hard rule...could be a facility policy but to use your professional discretion to give an ordered med is not malpractice.

Best practice is for the physician to write the rationale behind the Foley. This has NOTHING to do with you as the nurse, this is a tactic to annoy the physicians into not placing Foley's to decrease CAUTI rates.

[GM2RN]

Regarding the pain scale, sounds like a scare tactic to me. I don't believe for a second that it's possible to lose your license over something like that.

My hospital has really scaled back on the use of foleys due to the risk of infection so I can understand that they would want documentation on the reason for ordering a catheter. I can also understand why one might be reprimanded if they consistently did not document the indication for one; but again, I don't believe you could lose your license over it.

[jadelpn, LPN, EMT-B]

I am not sure about your license, but perhaps your job?

Because of the reimbusements on catheters, and hospital acquired infections regarding their use, there are policies that require a reason for catheter insertion in some facilities. It is a paper trail kind of a thing.

The pain scale thing is a bit odd. YES, for reimbursement purposes, you do have to ask for a number before and after you give pain medication. Also, the facility can get dinged on a survey if this is not all documented. What is odd to me is that if it is morphine, 1mg IVP Q 6 hours for pain, that is pretty direct. If it was "give morphine, IVP, q6hours as follows: 1mg for pain 2-4, 2mg for pain 5-7, and 4mg 8 or above, THEN you would have to base the dose on the pain scale.

With all that being said, 1mg of morphine every 6 hours for pain is a bit long in the timing. What I would ask for is more effective coverage if your patient is c/o pain 3 or 4 hours after receiving the dose. Which is highly likely.

I can see re-education on the benefits of correct pain control. And that you don't have a patient who says on the survey that they were not adequately medicated for pain. Which the hospital has no way of disproving if there's not documentation to back it up, as in a pain scale. But if you ask the question, you need to be able to do something about it. In other words, if the order is for pain 4-6, what do you do with an 8, or a 3 that for some is not tolerable?

With all that being said, some people do well on other pain control measures. So it there's say Tylenol or Ibuprofen or some other pain control option, THEN you would have to confirm with the MD where the morphine order comes into play--by getting a number range.

And just so you are aware, it is often not done that one can write 1-2mg q4-6 hours--it has to be all written out, no double ranges.

But I have never heard of this being a licensing issue. Unless your manager is going to report each nurse for unsafe practice when these things occur. Which could get messy and expensive...and dare I say this is kind of threatening behavior.

Be sure to get malpractice insurance. As in today.

[canigraduate]

Nursing judgment is still nursing judgment.

Tell your managers that they need to take it up with the providers if they don't like the orders. They're just being pusses and trying to get you to do their bullying for them.

[nursemaple2]

Talk about patient centered care....NOT. The patient's treatment will be delayed because, although the doctor wrote the order, the format does not optimize reimbursement. The solution is to torture the patient and scare the nurses. Shameful. These geniuses should be the ones afraid for their licenses. Sorry, my tantrum is over

[Cola89]

Nursing judgment is still nursing judgment.

Tell your managers that they need to take it up with the providers if they don't like the orders. They're just being pusses and trying to get you to do their bullying for them.

I really want to tell them that, because that's what this feels like. Pushing me to push someone else to do their job. I worked at another much smaller hospital earlier this year and we were never asked to do these things. NO, they didn't want foleys in over 1 or 2? days post-op, but they never had us call the docs at home regarding the matter either. Saved that to ask in the morning. Or actually, there were standing orders the few surgeons who worked with us had so that we didn't have to nag:)

[loriangel14, RN]

Our pain med orders never come with a scale. Seems like a silly scare tactic.

[Cola89]

Talk about patient centered care....NOT. The patient's treatment will be delayed because, although the doctor wrote the order, the format does not optimize reimbursement. The solution is to torture the patient and scare the nurses. Shameful. These geniuses should be the ones afraid for their licenses. Sorry, my tantrum is over

This is a non-profit umbrella company of a LARGE INSURANCE CORPORATION. Getting the feeling that they know all the ins and outs and aren't afraid to threaten their staff into getting max reimbursement.

[Cola89]

Our pain med orders never come with a scale. Seems like a silly scare tactic.

Do they REALLY stand to gain THAT much by threatening us nurses with our licenses then? To be honest, I am confused and overwhelmed by this place

[loriangel14, RN]

Yeah sounds like an awful place to work.

[Cola89]

Yeah sounds like an awful place to work.

Well around where I live, it's supposed to be the cool, progressive place to work. I thought it would be different or nicer? They have nice benefits like 20k tuition to go for a bsn or np. Really confused. It's a large corp.