Pain medication advice PLEASE!!

[PVL_RN86]

I've been hung up on this situation for a while and wanted your honest thoughts..

I recently worked a 12 hour night shift on an Orthopoedic hospital unit where patients would come to stay for a night or few for monitoring after hip/knee surgeries. I reassessed all of my patients for pain exactly 45 minutes before the day shift came in.

patient a: had right knee replacement. Pain controlled overnight with oxy 10mg times 2 over my shift upon my assessment of my patient and based on my patients complaints/signs/symptoms relating to pain. This patient ambulated to the restroom, then rated pain 4/10 after ambulating (during this 1 hour window before am shift coming). I gave patient a, oxy 5mg.

patient b: left knee replacement done. No pain all shift, rated pain 0/10 all shift and tolerated all activity throughout my shift. This patient has denied needing pain mess due to zero pain even after activity (again during this 1 hour time window before am shift came).

So... I give report and then the day nurse tells me in a bossy tone "you need to give patient a another pain pill because he is going to have therapy and is going to have pain." Same thing with patient b. This day nurse also tells me to give a pain pill to patient a because she "will have pain after therapy".

In in my defense, I told her my patients wear comfortable and were satisfied with their current pain management.. Especially patient b, whom denied needing pain medication as she had NO PAIN. Also, patient a report his pain was mild only and it was not necessary to give him an additional pain pill if he was already comfortable at a 4/10.

was I wrong for not medicating my patients?? What would you have done?? Thoughts???

please and thank u!! :)

[Libby1987]

It's conventional to give knee patients pain med prior to therapy whether or not they have pain with guarded movement. Otherwise it is likely that they won't be able to optimally perform their flexion and extension exercises which is essential with knee replacements.

[AJJKRN]

To each their own practice but...Pt "a" I would have continued to give the 10mg mainly because this had been the dose that was working for them previously and yes, because day shift is probably more active for the Pt with PT and what not.

Pt "b" I would have discussed trying a pain med prior to day shift for a few reasons, one would be getting ready to work with PT but the other reason is to try the med at least once that they will most likely be prescribed when DCing home to know that they will tolerate it and that the med will be effective for them.

I also encourage Pt's to take some pain medicine right before DC just for the car ride home which can be way more uncomfortable than they think.

I would not however have asked or told another nurse to address this but would have done so myself if I was feeling that strongly about it. Your practice and comfort level is not their practice and comfort level and vice versa!

[ktwlpn, LPN]

You controlled the patients pain appropriately.Day shift can admin the PRN prior to therapy.Stand up for yourself

[Libby1987]

What time do the PTs start seeing patients in the am?

[kidsmom002]

I do believe in offering medication prior to PT or other strenuous activity. However, the day shift nurse had no reason to treat you that way. For one thing, you can offer medication but if a patient states they have no pain and refuse medication you can not force it on them. Secondly, when will PT even see the patient? If you medicate prior to day shift arrival and PT doesn't see the patient within a couple of hours the pain medication may need to be administered again. There is no reason that the day shift RN can't speak to the patients and medicate them if she feels they are in need. If she is aware that PT will show up early in her shift she could politely inform you of that so you are aware that there is a valid reason that the patients should be medicated prior to the end of your shift. Working days she may be more aware of when therapy will occur and can inform the patient better than you could working nights. Don't be afraid to stand up for yourself. She sounds like a bully who doesn't want to have to medicate or educate the patients herself.

[loriangel14, RN]

I do advocate for pain meds prior to PT even if they are currently experiencing no pain but I see no reason why day shift couldn't have given the medication. I usually check with PT to see what time they plan on seeing the patient and medicate accordingly.

[brownbook]

Honestly I hate to say it, but in some ways the day nurse was right. Orthopedic pain is awful and pain meds are vitally important. The patients would be moving about more during the day so the nurse had a point. I was in a similar situation to yours and I also learned the hard way. With orthopedic procedures you have to stay waaaaaay ahead of the pain.

However that particular day nurse is an idiot, there are better ways to teach, correct, a co-worker than a bossy tone of voice.

All you can do is advise the patients, offer pain meds so they'll tolerate therapy during the day. If they refuse after you've advised them, that is the end of the story.

[Libby1987]

I have a feeling that tone was based on perception.

It sounds like OP is new, or she would have done more than simply asked her patients if they wanted a pain med or determined they didn't need pain mgmt based on how they were feeling at the time versus asking in the context of scheduled therapy with anticipation of potential for moderate to severe pain.

[AlwaysLearning247, BSN]

I think you did the right thing. I do not medicate my patients unless they ask me for it, why give someone pain meds and risk addiction if they're not even in pain? I do however explain that when PT comes and works with them that they may experience pain and ask if they would like their medication before working out. Some say yes and some do fine without needing any. Just keep assessing your patients and don't assume anything.

[~PedsRN~, BSN, RN]

I work with ortho (kids), and absolutely they are going to need pain medication prior to therapy.

However, no PT is coming in at 0700 to start making people walk laps.

Sounds to me that your day shift nurse is just trying to pass a task off. If your patient's pain was currently managed, then yes - you are fine. You assessed your patient's pain and they were comfortable and fine at the moment. The day RN can pop them a lortab or whatever with their breakfast.

I mean honestly, these nurses that feel like they have to have something to complain about every shift are so tiring. There are always a few like that on every unit, I guess. That the previous shift DREADS giving report to because they are going to pull this kind of crap.

[Meriwhen, ASN, BSN, MSN, RN]

I would have given pain medication prior to PT, even if the patient is not verbalizing pain issues. However, I'd give it an hour before PT at most. Give it any earlier, and you risk a dose wearing off before PT starts AND before you can give the next dose.