RN won't give pain meds - page 2

I am an LPN in a small facility. Many docs here order Morphine IV to be given to their pts. My problem is that as an LPN I cannot give IV push meds. When my pts ask for pain med for a pain level... Read More

  1. by   Silkiebyrd
    I agree about the University aspect with you, I know that not all places are like this but many are. I worked NICU for many years and when I first started we had a surgeon that everyone was scared to ask things of, he was famous for saying that premature infants of this or that age don't feel pain as their neurologic systems were not mature yet. Well, that is bullcrap...anyone who has worked with them has seen them grimace, cry, and get very agitated with VS changes with only minimally painful procedures...much less post op. I would call him whenever I had a baby of his and harrass him until he gave me orders for fentanyl or versed. I also gave him every piece of literature I could come up with regarding the fact that infants do feel pain. He would then throw them away and cuss at me but I just let it roll off my back...I had orders for my babes. He did it just so I would let him get sleep and not because he came to my way of thinking. The only way I didnt loose my job was because the NICU attending agreed with the nurses and not the surgeon...the surgeon had no pull in our unit but I did pray that none of my actual kids ever needed surgery. I could see him coming in their room and going oh yeah I know your Mom....this wont hurt a bit. Stick to your guns and keep on being a patient advocate; it could be your family member in that bed someday.
  2. by   Vito Andolini
    Quote from caliotter3
    I was thinking along these lines when I read your post. One of several good reasons to become an RN. Even if the RN in question were to get off her behind and assess the patient herself, that is extra time wasted when you could have already administered the med as you saw fit.
    Do you really expect the RN to give the med with absolutely no assessing by her of the patient?
  3. by   iwanna
    That is one thing that infuriates me, when a nurse feels that the patient does not need their pain med. We were taught that you always address pain, no matter what you believe. I always made pain issues, a priority. If someone would ask for pain med while I was doing a routine med pass. I would pause my med pass, give their pain med, and then continue where I left off. I was a pt. many times. I will never forget the time that I was in severe pain and was admitted to the hospital for pain control. I was ordered Dilaudid IV, however, I was in hospital for six hours before I got anything for pain med. But, I was smart enough to anticipate it, and medicated myself with percocet(prescribed by my dr. before she wanted to admit for pain control) before I was admitted. I know for a fact that my orders were faxed before I was even at the hospital.
    I think some nurses believe they have too much power when it comes to pain meds. If a pt. asks for pain med, the nurse should give it, regardless of their opinion.
  4. by   CharleeJo.RN
    Yes, yes, and yes. I have had a couple of surgeries and a few acute illnesses that required tubes and the like - I never knew that type of pain existed (post-op), and was in horrible misery for days because meds were under-prescribed. In a small town, docs are so afraid of being accused of "over-prescribing" that they opt to "play it safe" and under-prescribe. Ridiculous. I will always advocate for my patients, because as we know, pain is subjective - how can you tell someone THEY don't have pain when they say they do? Ludicrous.

    Oh, and I absolutely agree that the RN should do an assessment. whether or not she's busy, doesn't matter - she is there to help patients, period. i'm going for my RN and would not give a med to someone unless i had assessed them - i wouldn't go solely off another nurse's report. we are responsible for ourselves and our patients.
    Last edit by CharleeJo.RN on Jul 21, '09 : Reason: needed to add something
  5. by   shane69
    ill give you my 2 cents on what you wrote

    when my pts ask for pain med for a pain level of 5/5 i have to ask the rn to give the med for me.
    sometimes they will go and look in the room and if the pts is lying there with their eyes closed waiting for someone to come in and give them relief.

    as people commonly do when they're in pain, its all they can do. i mean i suffer from migraine and its all i can do to lie still with my eyes closed ....the pain is still there

    they will come back and say i am not giving them anything because they are sleep and don't give them anything if they can sleep. (they are not asleep because they call fifteen minutes laterasking for pain med.)

    im a nurse by the way, but id like to say what sort of idiot nurse would behave in this manner. they displayed no critical thinking at all. was it above their level of inter-ma-lectual functioning to consider, maybe they are awake with their eyes closed or to go over and see if they're awake. sometimes my colleagues make me mad

    if the doc ordered 1-3mg of morphine q2h prn. and my pt has just come from surgery and i ask if they can give the pt that i am taking care of 2mg for the breakthrough and then hopefully in three hours when they get their first scheduled po med it will cover them. they will tell me well just wait until they get their po, they just woke up they can't be in that much pain.

    'psychic nursing' how the hell would this nurse know that?? i mean she didnt even speak to the patient. what an outrage! over my years as a nurse ive come across 'psychic nurses'. you know the type , you know the nurses who can say 'you dont look anxious'.....well i say; 'how does an anxious person look???' can someone with a flat affect be anxious?? the answer is yes. but you wouldn't see the anxiety on their face because they have .......a flat affect! but many of these nurses simply rely on their clinical judgement oh i mean psychic nursing abilities to determine a patients mental state

    am i being overly sensitive to this because i am a new nurse? am i assessing my pts wrong when it comes to their pain? it makes me angry that i cannot be in control fully of medicating my pts when they are in pain.am i wrong for wanting the rn to give my pt pain med when i ask or are they wrong for just assuming that my pts are not in that much pain.

    i might be a little out of line here (please correct me if i am as im not so familiar with the us levels of training i.e lpn, rn etc)
    1/ your not being sensitive you are displaying critical thinking.
    2/ if you spoke to your pat' and they claim to be in pain and have a history of being factual with you regarding their pain coupled with your observation of them whilst they are unaware you are watching them (some patients when they know you're watching will play the sick role in the hope of securing more pain medication)
    3/ if they have a condition and are therefore likely to be experiencing pain then i would give the medication
    4/ it is up to the rn and out of your hands, you dont have a say. the rn is legally obliged to behave in a legally set out manner. whilst you the lpn are not allowed to give your considerations for the dispensing of this particular medication. you have not received the respective training (correct me if im wrong!!!) the state has organised various levels of training to protect the public, you can want the best for your patient but that as an lpn and in this situation counts for nothing and if you havent received this traing then your talking form your a$$ or about what you think you know rather than what you do know
    5/ if it makes you angry etc....you know what you need to do...........go to college and become an rn or doctor or pa. i work with ppl like you who think they know better than the nurse or the doctor etc.... and you know what you might!!! its all the same though, you dont have a say, period
    6/ they are wrong for assuming ....they displayed no critical thinking and were probably more interested in their conversation or coffee. i know because ive spent 12 years with other nurses ..i know the games they pull and i know that patient care sometimes is not high on their list particulalry on a quiet evening or night duty ....

    by the way in this facility i work nights and most of the time we have on 4-7 pts and the rn usually has 0-2 since they have more paperwork the lpn's take on the larger pt load.[/quote]

    which is common, i have found in my experience the more education you have the less intense your workload ( my opinion) you my friend are $hit kikker, the go'fer or lacky etc. you dont enjoy the privileges of being able to dictate, and let me tell you nurse know how to dictate. but let me add your experience is identical to the nurse-doc relationship i.e nurse who think they know better than the doctor .............its all the same!
  6. by   tewdles
    You are advocating for your patients and your assessment is valuable. The RN has NO BUSINESS contradicting your assessment based upon a NON ASSESSMENT from the doorway. I am sure that you will find some way to nice up my sentiment should you agree...but the RNs in your facility need an attitude adjustment. They are, afterall, professionally responsible for the nursing care that is delivered while they are present. It is bad enough if they are incompetent enough to choose ignorance when it comes to staff performance...it is a complete embarrassment to RNs that they might intentionally stand in the way of good nursing care! What exactly are their priorities?

    Gosh...that was a wee rant
  7. by   chenoaspirit
    When our LPNs came to me and asked me to medicate their patients for them, I respected their knowledge of their patient. Of course I would do a quick assessment of their resp just for my own security. Kudos to you for advocating for your patients. No patient should suffer in pain needlessley, especially when there are pain meds ordered to relieve it. Next time the RN refuses, I would have to adjust her attitude, but thats just me. I would NOT put up with that at all. You are just as much a nurse as they are and they need to respect your judgement. The ONLY reason a RN should/could refuse is if she feels it would be unsafe, which is not the case here. That urks me. I know what its like to live in pain, and if you were to look at me you would never guess the amount of pain Im in. You cant always judge by facial expression, especially with patients who have chronic pain. They have had to learn to live with it and dont respond like acute pain patients. Sorry for my rant, but that just ticks me off. I would definitely address this with the manager. They are making your job hard and making your patients suffer needlessly.
  8. by   Icarus1964
    All I can say is keep on being your patient's voice!
    If an RN is able to "glance and decide" (dunno how), she should at least communicate her reasoning and perhaps tell you what else to watch for.
    Agree with all though, in my books, if a patient says they are in pain, it is very real to them!
    One cannot make an estimation on how much pain a person should be in based on their procedure or time lapse post op.
    Pain is an individual experience and all too often is played down by the person holding the key to relief.
    Still there are loads of really good RNs out there versus the ones who have lost their focus!
  9. by   txspadequeenRN
    you cannot assess a patient properly from the doorway.....go to your higher ups and get this addressed or you and your patients will continue to have issues......
  10. by   bunsterj
    I am the type of person that when in pain will lay very still and quiet, perhaps even with my eyes closed. I might even doze just to tune things out. I probably wouldn't ask for a med soon after the first request, might turn on my side away from the door and cry a little. With the nurse in question, it might look like to her that I am "resting quietly."

    Would it be possible for you to go along with the RN to see the patient and for you to initiate a conversation with the patient about his/her pain in the RN's presence?
  11. by   Heogog53
    As a Fibromyalgic, as someone who had a long term peritonitis that was missed for ?years despite my complaining of the pain, etc, I can say with great authority that there have been many times that I have been in a far amount of pain and not realized it until I assessed my behavior; as the pain got worse, the shorter, crabbier and meaner zI became.....whe it was poointed out to me or I suddenly realized it, then I had to decide how much pain I was in and take the proper amount of pain medication to control it enough to simply behave like a "normal person".
    I've seen patients who were histrionic about their pain, stoic to the point of lunacy because of the fear of addiction, and all points in between.
    I see a doctor who manages my pain. He has been audited 18 times by the state because there are several docs on the panel who disagree with his pain management style. He has never been found to have over prescribed, none of his patients are addicts, but the docs who give him the most trouble are surgeons. As an OR nurse, I find that extremely troubling; most surgeons are ok with treating post op pain liberally for the first few days to a week, but then there is a big push on to wean off of IV meds to oral meds, and then to reduce the strength of those ASAP.
    These surgeons are apparently some of the older docs; the new residents and docs I've worked with in university hospitals are much better educated at learning to use the pain service- first the acute service and then- if needed, somewhat reluctantly, the chronic pain service. I'm grateful that more docs are starting to realize that cultural differences give rise to misinterpretation of how severe the pain actually is; once again, culturally competent care raises it's head. If it's hard for the docs and some nurses to recognize pain being SUBJECTIVE AND WHAT THE PATIENT REPORTS for Americans, think about how hard it must be to recognize pain in the cultural melting pot that the US has become.....
    Pain is pain. It requires assessment and treatment. When I worked in critical care, if an LPN came up to me, reporting that her patient was in pain, could I give the IV med, I never questioned the initial request, but I always confirmed with the patient what the pain level was, so that the LPN and I could agree on what pain med to start with.

    So, yes, the RN is a lazy person, is certainly no longer a patient advocate(if ever was one before) and needs to be reminded that pain is what the patient states it is, and requires treatment.

    Kudos to you for being that patient advocate that you are.

    Sincerely, a nurse whose been on both sides of the bed, as patient, family member and nurse.
  12. by   suanna
    We can just hope that the RN in question develops a bad case of shingles and has a nurse who dosen't believe in narcotic pain relief. Honestly- thanks for your post. It is a shame how many nurses think just because someone closes thier eyes to pray for the strength to endure the pain untill the nurse gets back with the shot, that the patient must be sleeping quietly and shows "no signs of pain"! Do you know what the most common sign of pain I've seen in my practice?- the patient says "this hurts- can I get something for pain?". Any nursing assessment that contradicts that and withholds medication is the erroneous data.
  13. by   Heogog53

    I LOVED what you said about shingles!!! About a year and a half ago, I had the misfortune to develop the shingles. I thought it was a fibro flare, so I fortunately went to see my pain doc. He asked about the pain, then told me that he was the wrong one to be seeing for this...because, he said, you have shingles!!! However, he gave me a prescription for Dilaudid(4-12mg q 4-6 hrs) as well as famcyclovir(SP?) to prevent eruption. I went to see my GP, who then followed me for the remainder of the time...and kept me out of work for 5 weeks to make absolutely sure that I didn't develop any OTHER neuropathies....
    Yah- anyone with shingles and no pain meds- KARMA!!!!

    A long time ago I had 2 sinoscopies in one year. My doc believed in doing those cases under MAC, not general anesthesia. The first post-op medication I was given was Percocet....which did NOTHING. The next thing they gave me was IV morphine which did the trick, but I was so nauseated they had to give me Phenergan(Told you- LONG time ago). Between the MSO4 and the Phenergan, I was stupified and remembered the anesethiologist coming in and asking- Hey, why is Helga still here?
    I had been the first case of the day- and was still there at 5:30 pm.
    The next time, The anesthesiologist and I had a long talk about post-op pain meds....He felt that PO wasn't worth it, and instead of Morphine, he gave me IV Dilaudid. I discovered that Dilaudid was THE BEST pain med for me. Post-op, since I had to wait on a ride, I spent the whole day just resting quietly, was easily rousable to voice, responded correctly, etc, but if left to my own devices, I just slept comfortably....

    Big difference between the two pain treatments- and from that time on, I made certain to tell my surgeons and anesthesiologists that Dilaudid was the best pain med for me, for severe pain. I got THE LOOK, but once I explained myself, it was OK.

    However, when I ended up in the ER in tremendous pain from a paralytic ileus, and told the nurse that IV Dilaudid worked best, the INSTANT reaction was a shift from sympathetic nurse face to tightened up pruny faced "Oh ****, here we go again, a drug seeker" face. I understand that the ER gets all kinds of folks who are drug seekers, but if one has a board like, rigid abdomen that can't be touched, who then proceeds to vomit explosively, I'd hope that the "drug seeker" label would be put aside ASAP. I told the nurse that I'd had the med for surgeries at that hospital, he could look it up in my old records, that so and so were my docs, etc....
    He did his job, placing the IV, then moving me to a different room after I vomited prodigiously, but instead of helping me clean myself up, he just tossed a clean gown and towels at me and left. My daughter had to clean me up, then go ask for warm blankets and the like. The attitude was icy and mechanical. Finally, after getting the OK to treat me with some powerful pain med IV( it seemed like hours, but I really have no idea), and then watching my body relax, my vital signs change, etc- only then did he treat me with the slightest positive attitude.

    What do you do with nurses like that? I was obviously in distress, unable to rest or stay still, then the vomiting, etc.....and he treated me with contempt for asking for the one med I knew would work....

    I've had a total of three paralytic iliuses(?). The next time, the nurse was far more relaxed about the whole thing, but once again, it wasn't until I went through the explosive vomiting that something was done. I was even moved to the row right in front of the nurses station on a cardiac and O2 monitor so they could give me Fentanyl for immediate relief- and what a blessing that was!!!!

    The last time I had an ileus, I stayed home, took some PO stuff, stayed as NPO as I could and as still as I could until things started to move along again, because of THAT first nurse in particular. If the ileus hadn't started to resolve within a reasonable amount of time, I would have reluctantly gone to the hospital for treatment, dreading the way I'd be looked at and treated.

    So, for an RN to ignore a report of pain, or to fail to assess the patient's pain level properly because of their own prejudices, is simply abhorrent to me, both professionally and as a family member or patient. It's a throw back to the days when the docs would be stingy with pain meds, because of a belief that giving more than this amount of pain medication indicated that the patient was a drug seeker, or morally incapable of controlling him/herself, or the belief that it should only take X amount of medication to do the job.

    In this day and age, when medi students and residents are taught that there is a huge difference between treating acute pain and chronic pain, and that having Pain Services is just as important as any other consult service for patient care, you'd think that all nurses would eagerly embrace a more progressive attitude as well. To not instantly respond to a report of a patient's pain, in my opinion, is like ignoring a report that the patient's vitals are changing rapidly, or that there is frank blood in his/her urine. It is an URGENT matter that needs to be taken seriously and treated rapidly.

    Sorry about the rant.....I've seen every attitude in the world towards patients whose pain isn't cared for properly or recognized as an equally important part of vital signs as BP, HR, O2, and Respirs.

    Thanks for putting up with the long read....