You make the decisions on YOUR shift and I'll make the decisions on MINE

[CrazierThanYou]

Here lately, I've had a couple of situations where the oncoming nurse didn't agree with choices I made on my shift regarding patient care. Usually, it is regarding pain medication.

In nursing school, I was taught that it isn't my place to judge someone's pain. It is what they say it is. Therefore, if the medication is ordered and its safe to give it, I will. I do begin with less potent drugs and I try to stay with them but that isn't always possible.

I had a cancer patient who was having some pretty bad pain, if one judged by his behavior. He only had one percocet ordered to control this pain, besides IV morphine. He had been complaining to the nurses and doctors that his pain wasn't being controlled with the perc. He couldn't sleep, etc. So, finally, I decided to bump him up to 1 mg of morphine. Afterward, he was able to rest and that was that.

Well, the oncoming nurse, who is known for her snippiness, didn't like it. She asked me if I REALLY thought it was a GOOD idea to be giving this patient MORPHINE.

Yes, I do think it was a good idea. He was having a miserable time beforehand and had relief afterward. Perhaps she would have liked for me to call her at home in the middle of the night to get her take on the situation?

This is just one example but the rest are pretty similar.

I don't understand some nurses' attitudes regarding pain control. Some act as if it the drug will come from their personal stash or something.

[nurse.laura1989]

Ah yes, I agree - you should make your nursing decisions based on your judgement at the time... if no one is harmed, you made the right decision based on what was in front of you right at that moment.

As nurses we're too critical of each others practice at times... lets cut each other some slack once in a while!

Laura

[mc3, ASN, RN]

I'm assuming you don't suffer from chronic pain..you should educate yourself on how a pt typically acts in this situation

And her understanding of pain and pain management.....

mc3:cat:

[mc3, ASN, RN]

i just don't like when patients take advantage of the system. 90% of them rate their back pain a 10/10. Majority of the tim ei want to be like "well if you would listen to me and get off you're orifice and move a bt maybe you wouldn't be so cramped up and constipated" When someone tells me their pain is a 10/10 im thinking burn patients, or a woman in labor. Not someone who is comfortably enjoying a glass of choolate milk and a cheeseburger snuck in by family. i once had a patient who rated his pain an 8/10, was in for back pain. The guy would SCREAM out in pain when it would come on. He was so considerate, he asked me to shut the door so the others couldn't hear him scream. I gave that guy everything under the sun that i could. i fought for certain pain medications.

Its the patients who do not act like that and rate their pain a 10/10 and tell me "im doing nothing to control their pain" I know pain is what the patient says it is...but come on, lets get real here people. So whatever, I guess im "one of those nurses." I'll control your pain if it is there, but if you are laughing, eating cheeseburgers, visiting on the phone, texting, sitting on facebook then no i'm not going to control you for a 10/10 pain.

So, you take it upon yourself to "fix" the system, even though you have an MD order, just so people don't "take advantage of it"? At the expense of someone else's pain? Really???? mc3

[eric3]

OMG! Seriously?! I suppose you don't give money to the homeless because you prejudge that they might buy drugs instead of food, thus leaving them homeless AND miserable. If a doctor orders pain medication and the patient asks for it, if the patient's vitals and cognition permit, then GIVE IT! They are NOT going to become addicted to it in the short amount of time they are in the hospital. When I see a nurse judge a patient so harshly It seems as though they are jealous that the patient can have pain medication and they can't. What other medication causes such contempt from nurses? And for what reason? Because they are afraid the patient might undeservingly "get high"? Do us all a favor and stop playing God.

[eric3]

OMG! Seriously?! I suppose you don't give money to the homeless because you prejudge that they might buy drugs instead of food, thus leaving them homeless AND miserable. If a doctor orders pain medication and the patient asks for it, if the patient's vitals and cognition permit, then GIVE IT! They are NOT going to become addicted to it in the short amount of time they are in the hospital. When I see a nurse judge a patient so harshly It seems as though they are jealous that the patient can have pain medication and they can't. What other medication causes such contempt from nurses? And for what reason? Because they are afraid the patient might undeservingly "get high"? Do us all a favor and stop playing God.

[Mommy&RN, BSN, RN]

The biggest complaint that I have is when a pt is on chronic pain management. Then we admit them to the hospital or they have surgery, then give the pt less or the same as their maintenance dosage

My other one is they suddenly cancel antidepressant or anxiolytics. Withdrawal cold turkey from those meds is BRUTAL!

[surferbettycrocker]

i think alot of nurses think they will accidentally od the patient and maybe the apprehension is a guise for anxiety over potentially overdosing the pain med seeker (although how opiate naive would many 'fakers' be really). but overdosing a patient is a real possibility that we should not ignore. especially a patient who is chronically ill with a host of renal/liver/lung/cardiac issues. i have seen it happen. the med is given 'as ordered' to keep a semi verbal patient 'quiet' and "pain free;...only to have narcan given after 'as ordered STAT; am i advocating for letting people writhe in pain; no but the expectation is as comfortable as we can make a person while towing the line of too much of a good thing.but cancer patients/burn patients i do feel are certainly different in terms of pain control right

[goalienrse]

Crazierthanyou, I have a hard time understanding other nurses (bad) attitudes about a lot of things.

[uRNmyway, ASN, RN]

OMG! Seriously?! I suppose you don't give money to the homeless because you prejudge that they might buy drugs instead of food, thus leaving them homeless AND miserable. If a doctor orders pain medication and the patient asks for it, if the patient's vitals and cognition permit, then GIVE IT! They are NOT going to become addicted to it in the short amount of time they are in the hospital. When I see a nurse judge a patient so harshly It seems as though they are jealous that the patient can have pain medication and they can't. What other medication causes such contempt from nurses? And for what reason? Because they are afraid the patient might undeservingly "get high"? Do us all a favor and stop playing God.

Lol, while I don't withhold pain meds, even when I think the patient is drug-seeking, I refuse to give cash to homeless people. Tell me you want money for food, I will bring you somewhere and buy you a meal, heck, I'll even buy you extra for later. But if I want my hard earned money spent frivolously or on dumb things, it will be by me!

[MomRN0913]

I m generous with the pain meds, but I don't give money to the homeless either. I do however give them some food or drink if I have any on me.

[Btts]

I don't understand why you cannot give a pt morphine if the po pain med did not work. You shouldcontrol the pt's pain. It is all nursing judgements and experience. The truth of the matter is that pain is what the pt say it is but at the same time you should be looking at the pt's age, dx, and hx. I have seen where a pt pain was not managed and the nurse just kept giving all the pain meds available to the pt and the last dose that made the pt comfortable was the dose called for narcan. Like I said the pt's dx, hx, and age should come in to place, and pt education is important. Some patients will be patient when you tell them you gonna have to wait to get pain med cause " your bp is 80/39 and HR is 59, and you want them to be still breathing.

The thing is start low, go slow. If the md ordered 20 -40 oxy prn and this is the first dose it will still be a good nursing judgement to give the pt 20 oxy first instead then addid anothe 20 instead of giving 40mg just because the pt pain is a 10/10 .

[SoldierNurse22, BSN, RN]

I don't understand why you cannot give a pt morphine if the po pain med did not work. You shouldcontrol the pt's pain. It is all nursing judgements and experience. The truth of the matter is that pain is what the pt say it is but at the same time you should be looking at the pt's age, dx, and hx. I have seen where a pt pain was not managed and the nurse just kept giving all the pain meds available to the pt and the last dose that made the pt comfortable was the dose called for narcan. Like I said the pt's dx, hx, and age should come in to place, and pt education is important. Some patients will be patient when you tell them you gonna have to wait to get pain med cause " your bp is 80/39 and HR is 59, and you want them to be still breathing.

The thing is start low, go slow. If the md ordered 20 -40 oxy prn and this is the first dose it will still be a good nursing judgement to give the pt 20 oxy first instead then addid anothe 20 instead of giving 40mg just because the pt pain is a 10/10 .

Generally speaking, this is usually not a bad idea. But if the patient is telling you that their pain isn't controlled with PO AND they're an oncology patient, that's a totally different animal.

I've been known to give the lesser strength med (perc) in combination with the stronger med (morphine) in order to get a synergistic effect for better relief. You'd be amazed how drugs in combination with different mechanisms of action work to relieve uncontrolled pain.