bad day at work again. Maybe I'm just asking for it, lol. This is a rant but I also have some questions for you. I wanna know what you would have done. You guys should know by know that I work at a nursing home, I was working 10-6 sunday night. I had a patient that has a very extensive GI/Abdominal Hx. Colon cancer, had part of his colon removed, paralytic illeus, Hx of obstruction. He also has back pain a lot, takes Darvocet N-100 for the back pain. Never has complained to me about any abdominal pain whatsoever. Well, at about 0200 in the morning he es screaming out in pain, has Right Upper quadrant pain. He is moaning, extremely restless, rates 10/10. I have never seen him so misserable. Now my med-nurse asked me if she should go ahead and give the Darvocet to him. Every place, hospital, and especially ER I have ever worked at says not to give Narcotics for abdominal pain, they mask the pain, and if it gets worse it will be harder to catch. Thats what I was thought in Nursing school too. At this point with the distress that man was going through, a transfer to the hospital was not out of the question in my mind. So here I am, its 0200 in the morning, I have a patient with a very complicated GI Hx, only a narcotic to give (doesn't even have an order for Tylenon). I decided to call the Doctor, did not feel comfortable giving a narcotic that was ordered for a different kind of pain in this situation. If he tells me to give it I'm fine with it, but I wanted him to be aware of the situation. He is very rude to me on the phone, told me to give the DCN, and send him to his office in the morning.
Well I come in to work at 10 yesterday, and I look through his chart to see what his doctor said, and on his progress note is this written "Nurse called last night about patient in pain, affraid to give pain meds. Told nurse to give pain meds if patient is hurting" and under his new orders, in big fat letters "GIVE PAIN MED IF PATIENT IN PAIN". Now that just majorly pissed me off, it is not that I was sitting here scared to give a DCN. I just thought that most places have a policy against giving Narcs for abd pain. And I just wanted him to be aware of the situation, since his patient has such a complicated Hx. Anyway, here is my questions:
1. What would you have done?
2. Was I wrong regarding the policy of narcs r/t abd pain?
3. Am i just to carefull or what?
I know I have only been an LPN for a little over 4 months, so I'm still learning every day. Should I have handled it differently. I think that doctor is just pissed off because I called him at 0200 in the morning. He is the same doctor that has called my administrator saying he might as well work in the building if we keep on calling him so much.
If you truly believed your pt was in a potentially dangerous situation WHO CARES if the Doc whines. Always err on the side of the pt's safety. And always, always write a rational and very complete CYA note in the chart!
I had a similar situation when I was an LPN. The difference was that the pt did not have an extensive GI hx and had long standing dementia.
As an LPN(at the time), I was not permitted to call the doc per facility policy. I asked my charge RN to assess the pt. She concluded it was no big deal, gave the pt Tylenol. Pt was awake, agitated and appeared to be in pain most of shift.
This was noc shift. In the am, I spoke to the DON telling her my concerns about the pt. I also told her and the charge RN that the pt had very foul breath that smelled like old blood to me.
She raised her eyebrows at this comment and said she'd speak to the charge RN. I charted, as appropriate.
I was off the next day but called a friend of mine who worked there and asked her if they'd called the doc, sent the pt to ER or what. She said they'd called the doc, Ativan IM had been ordered.
When I came back, I learned the pt had died. Autopsy showed massive GI bleed.
i would like to say i commend you for your actions in calling the doctor for the new abdominal pain. your scenario started out much like one i lived with my family member just over a month ago....my young (47) relative was in rehab following a CVA and his nurse chose to ignore his new pain complaints and just gave the narcotic......
well lets just say that he arrived to the ER with no b/p and wont be with us this christmas...
so whatever anyone says to you ....you trust your nursing judgement no matter how new of a nurse you are or if it is in a rehab/nursing home setting.
and like i said im behind you and what ive delt with recently has given me a different outlook
Specializes in ER - trauma/cardiac/burns. IV start spec.
:kiss You are not an idiot. But the MD might be lol. Why is he giving narc to ilius patient anyway. Perhaps with such extensive GI Hx doc feels there is no need to rework the patient. Having been ER nurse for 10 years I can tell you that around here that the NH ship us the patient and then let the MD know that way everybodies covered and the patient gets better care and better pain relief. You were right on. If MD does not like to be called at night he needs to get out of medicine.
I know it is hard but always listen to your gut instincts. You done good.
Real simple. New nurses are locked in to get a full year of med surg experience. After that, they can work where they please, even Agency.
I am sure a charge nurse saw the doctor's note. LTC facilities usually have a hand full of Doctors.
They tend to control the census. You are allowed your opinion, I, mine.
1) I went PRN at two ERs upon graduation, NO MED SURG experience ever...
2) I (as the weekend supervisor) and my DON at my LTC, control my census and admissions
3) I would have sent the patient first, called the family second, and then notified the doctor last...(I've done it this way, and have been backed up by my DON and CEO when the MD/NP complained "they weren't called first")
Never underestimate nursing judgement, as you are there, the doc is at home!
Write the order as "Send patient to ER, per family request"
You will ALWAYS look good, and be right to boot. If you don't send, and the family wants pt to go, and the pt has a bad outcome, guess who loses? The patient AND you.
If you get yelled at, give it right back...You work for the DON and the patient, NOT the doc/NP.
You were right and I would have done exactly the same thing. And you would be right to do the same thing if it happened again, no matter how much the doc cries about phone calls.
I keep tell you all Medical School is really a front for a Terrorist Training Camp.
I love it.....Topic of Lecture #109: 'Anti nurse terror techniques...How to subdue the resistant nurse'.
This is very common behavior for 50% of my acute care docs on call...and they hope we stop calling them when they retaliate. My response is 'Doctor, it is ALWAYS my option to notify you of a change in condition, as my Nurse Practice Act directs me to do. " '
You are a new nurse so talk to your mentors and get some support and suggestions....sorry this happened to you...happens to most of us too....even with legitimate concerns some docs think it's OK to abuse us. I get this a lot at night in my acute care facility. It almost becomes a game with me now....redirecting the conversation back to the patient and their symptoms, problems, etc...mentally picturing him in pink polka dot shorts while he lambasts me on the phone...I just calmly keep saying "Can we talk about the patient now?"
A patient with a cancer history on Darvocette for a 10/10 pain level is a whole 'nuther thread...
I just wanted to let you know that I went to my local ER about 2 years ago with the worst abdominal pain that I have ever experienced and I was sure that I was going to die. I couldn't cough, or move or even take a sip of water without being tortured by this pain. The ER doc did his routine to r/o a buncha stuff and sent me on my way, WITHOUT any pain meds or even a tylenol because he "didn't want to mask the pain in case it was something serious"
You did the right thing.
Its just sad that the doctor had to be such a jerk.
Specializes in Psych, Med/Surg, Home Health, Oncology.
Hi
YOU ARE NOT AN IDIOT!!
That MD may be one, though!!
You did the right thing! I have worked nites for almost 30 years & I have this philosophy--I would rather get yelled at or reprimended for calling a doctor than for NOT calling!!
If I feel it is the right thing, then I do it.
Like you said, the Darvocet was for back pain--not acute abd. pain;
That same MD would probably been all over you if you had not called!!
Chaya, ASN, RN
932 Posts
If you truly believed your pt was in a potentially dangerous situation WHO CARES if the Doc whines. Always err on the side of the pt's safety. And always, always write a rational and very complete CYA note in the chart!