Need some help with pain management

[miccay]

Hi Guys,

I am a nurse manager at a small nursing home. I am so fed up with the nurses there being oblivious to the resident's pain. I see it everyday. I have observed a little old lady who has metastasized lung cancer and advanced dementia, sit in her wheelchair, babbling, shaking and grabbing at anyone who walks by and the nurse not showing a care in the world about it. To me, this is a sure sign that she is in pain and when I point this out to the nurse, the response I get is "what do you want me to do?" Well, it is obvious right? Give her something for pain. And other examples are a lady s/p kyphoplasty, screaming out for something for pain and the nurse just saying "it's not time for your medication yet" Why not call the MD and get an order for increased pain med or something for break through pain?

My question is, how do you get your nurses to recognize pain? I know it is a monotonous job at a nursing home, punching out pills and getting the resident's to actually take them, but I believe it takes a special kind of nurse to work in long term care - one who really cares.

When I mentioned my concern to the DON, I was told I could hold a nurse's meeting on pain management.

Any suggestions on how to reteach these nurses about pain? I know they learned this in nursing school, but are either not recognizing the signs or just don't want to be bothered.

Thanks for letting me vent and I would appreciate any suggestions.

Michele LPN

[KellieNurse06]

I am not graduating until this December but it is drilled into our skulls all through school that pain is whatever the patient says it is and to deny/ignore that patients complaints of pain is neglect & abuse & we can have huge consequences for this also...as a matter of fact in the hospitals we did clinicals, they had pain scales and you had to check within one hour after giving the med and if no relief the doctor had to be notified and the med adjusted or whatever else needed to be done.

You know I hear of alot of different things that some nurses don't do such as what you have mentioned and I have one explanation for it....PURE LAZINESS

and that's all there is too it...they can't be bothered they just want to do the least amount of work they can do and get a paycheck....and it disgusts me to no end...and I am not even a nurse yet.

I have had a couple of home care nurses in my home for my daughter..and she has a ton of respiratory issues and requires nebs & chest pt & suctioning...and they were the type who would constantly say she's junky, she's conjested etc etc ..I could write a book.......and we had a neb order for every two - four hours prn..........do you think one of them would do a treatment???? nope! So I know what you are talking about...it's almost like they are afraid to give a med and also it is laziness without a doubt.

I would call them on it and not care one bit...because these people are not able to defend themselves............you can do it very suttly by getting a doctors order for the pain med every few hours round the clock instead of prn....that way they can't use the excuse of the patient wasn't in pain......if it is a scheduled med they have to give it..and you can say it is to keep the pain at bay so it doesn't get out of control, you know take the med before the pain gets bad & then it is hard to get under control type of thing..............see lazy people hate to have to do anything so you can play them at their own game by doing stuff suttly like this...............I have learned a lot of how to get stuff from other nurses when it comes to those who are not doing their jobs................because it's not about them.it's about those patients. I also always think of myself or a loved one in that patients place and what I would do...............good luck let us know how it goes.....It's just a shame that the really good nurses get a bad rap from people because of the ones like you mentioned here..............it's very frustrating!!

[tjb6929]

Wow this is very unfortuante, but is the reality of nursing home care. i would definitely hold a meeting, although it may not be the answer, these nurses need a refresher course in handling patients pain, and signs and symptoms of elderly in pain- since this is also different from younger individuals. the older adult may become more confused, combative, yelling out- etc. all because they are in a lot of pain, but unable to express their pain effectively and obviously being ignored by staff only adds fuel to the fire. i realize burn out in nursing homes is much of the reality too. nurses have many patients and very little staff and it is the same thing everyday, however i agree it takes a special nurse to do LTC, but if they have no compassion left for the patients then it is time they move on. what if it was their loved one, left to sit there in pain everyday- suffering?! i would address all of this (in a professional- yet direct manner) in a meeting, also i would try to think of some new documentation way that will monitor every patients pain and it should be required for all nurses to do- every shift...no excuses that clearly shows if the patient was in pain and what that nurse did to take care of it. however, if you are worried about nurses actually documenting correctly, then i would try to get the doctors to write around-the-clock orders as kellienurse06 stated. maybe someone from a pain clinic or a pain specialist could come in a talk to your nurses about the significance of pain and how pain is what the patient says it is- we are not here to judge and make assumptions, we are here to care for patients and make sure their needs are met. hope this was helpful!

[myk4408]

I read that you took the excelsior course and i was wondering if you have your course books available still. If your dont need them i was wondering if i can purchase them from you