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???
Oh the joy of shift change on the ortho floor. It is important to let your patient know that if they are hurting they can take pain medication and how often they can have it. It is also ok if they decide they don't hurt and don't need narcotics (some surgeons put in local pain blocks and patients don't feel pain at all 24hrs+ after surgery!). However it Is always a good idea to encourage pain medication before therapy even if they don't hurt right now. It is also good for you to tell them you are going off shift soon, if you don't take it now they'll have to wait for the next shift whenever they're ready.
Our floor we had to wake up all joint replacements at 5am and have them out of bed and in their chairs before 7am. Their therapy was at about 830am. The class they went to presurgery would encourage the importance of pain pills atleast 30mins prior to therapy which wasn't always feasible and shift change was 7am so pfft. Peoples pain pill schedule just didn't line up correctly all the time and it isn't easy as the oncoming shift to give pain pills all at the same time within an hour of clocking in.
I encouraged patients at night to take their pain medicine if they were awake and wanting it no matter if it mismatched their therapy schedule. Near shift change though I'd make a final run through between all my patients and if they could have pain meds id ask of they wanted it or if they wanted it closer to therapy. I let them know if they were waiting til closer to therapy that it WOULD NOT be me who gave it to them that the day shift would and I'd pass it on in report to bring it with morning meds (they have a morning med pass anyway and it gives the patient a time frame of when they'll get it).
If my patients were not hurting all night and didn't want pain meds in the morning I'd tell them the same thing. You should still take something before therapy and day shift would have to give it.
No matter what you do the next shift is always going to be slightly miffed at you. You could medicate everybody before report and the next nurse will be upset that everybody is due for meds at the same time or they'll be miffed that you gave that pain pill at a weird time and it isn't lining up with therapy or they're just miffed you didn't medicate.
For the sake of making your hand off quick do make sure though that you ask your patients one last time "I'm leaving in 30 minutes do you need a pain pill now!?"
Specializes in orthopedic/trauma, Informatics, diabetes.
I work on an ortho floor and our pts usually are on scheduled tylenol, many times scheduled oxycontin (or other long term opiod-depends o hx), celebrex and/or gabapentin/lyrica. It is kind o expected that at shift change, both morning and evening, that pts are checked to see if any prn meds are needed. We have plenty time in the morning to give prn meds pefore PT so OP was not unreasonable. If you give a prn med at 0530, they are going to need more before PT gets there after breakfast. Our OT/PTs are really good about checking with us. the possible d/c's are always seen first, so they are first ones medicated. We also use a lot of regional pain medication, so many of our pts have zero pain. It is possible :)
Having had both knees replaced, I can speak from a patient perspective. When I was just hanging around my hospital room (in bed, in the chair, walking to the bathroom) my pain was 0-2/10. I refused pain meds then. However, knowing that PT would most likely be painful, I absolutely took something prior to PT. The thing that surprised me was that even PT didn't increase my pain level. I think I'm just blessed with a high level of pain tolerance.
As others have said, you can offer pain meds but if the patient says they don't need them you can't force them to take the meds. Just emphasize the fact that they may have more pain with PT & that it's easier & more effective to medicate before the pain is bad than it is to try to relieve horrible pain once it's there.
It might be on that floor it's customary that night shift give the pain meds for therapy because they have PT that early, it could be the floor's culture you didn't know about.
I work day shift with these kinds of patients and I like to the be one to administer pain medication prior to my patient's PT since it's usually between 0800 and 1000 and giving it to a patient that's not in pain when their therapy may not be soon isn't appropriate.
I agree that the day nurse should give meds for morning therapy. I would encourage the patient who had no pain to take something before therapy. I have had shoulder surgery and medication before therapy was a must so I could participate. I also had a nerve block and took pain medication as often as allowed so I wasn't miserable when the block wore off.
Thank you to all nurses who offer (give) pain meds to pts before therapy. I'm an OT, and sometimes we schedule sessions very early in the morning for completion of ADL (activities of daily living) tasks. Sometimes pt's don't report pain when they are at rest, but the minute they start moving they have pain. Some pt's don't have the foresight (for example, pt's with cognitive deficits) to ask for meds in anticipation for being mobile. In some settings, therapy sessions can last from 50-75 mins, that's a really really long time to spend with someone in pain. It also limits what activities we can engage the pt in during the session, and it's difficult to motivate a pt to move (that day and the following days) if their pain is not being managed. As therapists, we have some tools for pain management but sometimes they're not as effect as the meds. Oh well, just my two cents, I know there are proper protocols for everything.
You are 100% correct in what you did on YOUR shift. It is up to the day shift nurse to medicate appropriately for her/his shift. You assessed to be certain patients were comfortable before giving report. As a nurse, you are not there to shove pills down the throats of patients. Furthermore, PT isn't going to be on the floor before breakfast at 7am, so what good is that PRN going to do being passed at 6:45am?
Do what you feel is right on your shift. Sounds like the day nurse was lazy and didn't want to deal with assessing these patients for PRN's.
dausy
3 Posts
Oh the joy of shift change on the ortho floor. It is important to let your patient know that if they are hurting they can take pain medication and how often they can have it. It is also ok if they decide they don't hurt and don't need narcotics (some surgeons put in local pain blocks and patients don't feel pain at all 24hrs+ after surgery!). However it Is always a good idea to encourage pain medication before therapy even if they don't hurt right now. It is also good for you to tell them you are going off shift soon, if you don't take it now they'll have to wait for the next shift whenever they're ready.
Our floor we had to wake up all joint replacements at 5am and have them out of bed and in their chairs before 7am. Their therapy was at about 830am. The class they went to presurgery would encourage the importance of pain pills atleast 30mins prior to therapy which wasn't always feasible and shift change was 7am so pfft. Peoples pain pill schedule just didn't line up correctly all the time and it isn't easy as the oncoming shift to give pain pills all at the same time within an hour of clocking in.
I encouraged patients at night to take their pain medicine if they were awake and wanting it no matter if it mismatched their therapy schedule. Near shift change though I'd make a final run through between all my patients and if they could have pain meds id ask of they wanted it or if they wanted it closer to therapy. I let them know if they were waiting til closer to therapy that it WOULD NOT be me who gave it to them that the day shift would and I'd pass it on in report to bring it with morning meds (they have a morning med pass anyway and it gives the patient a time frame of when they'll get it).
If my patients were not hurting all night and didn't want pain meds in the morning I'd tell them the same thing. You should still take something before therapy and day shift would have to give it.
No matter what you do the next shift is always going to be slightly miffed at you. You could medicate everybody before report and the next nurse will be upset that everybody is due for meds at the same time or they'll be miffed that you gave that pain pill at a weird time and it isn't lining up with therapy or they're just miffed you didn't medicate.
For the sake of making your hand off quick do make sure though that you ask your patients one last time "I'm leaving in 30 minutes do you need a pain pill now!?"