I was just starting to feel comfortable in my new job when another nurse, (who used to be my preceptor, until I asked for a new one) went into my patient's Pyxis med of removed meds. She called me into the med room and her and this other nurse cornered me. She told me I couldn't give my patient IV pain medication after she had been on PO. The patient had pain level of 9/10, excruicating pain which wasn't being managed by PO meds. I was going to give the patient PO Dilaudid until I thought about switching her back to IV, so I had not had not returned the PO Dilaudid yet. The nurse flipped her lid & started yelling at me, you need to return pain meds right away, you can't just keep them in your COW, (computer on wheels), you need to be more careful, you're nursing license is on the line. My stomach is upset, my weekend off has been consumed by this "confrontation".
I talked to other experienced nurses on the unit and they said it's ok to switch a patient back to the IV form of a pain medication, if POs not cutting it.
The confrontation has raised other questions for me, since I've been dwelling on it. For instance, say that the patient has two pain medications that they can have, i.e. Flexeril & MSIR, MSIR is not working on their back pain & another dose is not due for another hour, can I give the Flexeril or should I call the doctor & get a one time order? What are people's thoughts on this situation?
The nurse that yelled @ me gave a fresh post-op ventral hernia repair Motrin for pain because she wasn't due for another PO pain medication, what do you think of this?
Also, if I have a patient who is not due for another dose of PO dilaudid for another hour can I give them IV Dilaudid 1 mg which they can have every 2 hours? Is it possible to give a patient a dose of IV pain med to get their pain under control & switch them back to PO later. I realize they are two separate orders w/ different directions I feel that I should call the doctor to be on the safe side and say, "So and sos pain medication regimen is not cutting it..." Advice?
First things first, your ex-preceptor really had no business to check up on your work! What was she do ing, printing out all your 'meds given' on ALL your patients, looking for some descrepancy?? Who the H does she think she is?, and to ambush you w/another nurse to confront you? I hope you spoke w/ your preceptor or another senior staff member. That is inappropriate, I would be pretty ******.
Exactly. Given the history, it sounds as though this jerk was playing a game of 'gotcha' and is trying to get back at her for requesting another preceptor. I sincerely hope she takes this to the manager. Like it was said above, even if this person was right the way she went about it was dead wrong.
My old preceptor went to my boss, I received a phone call at home later that week. I told my boss what had happened & nothing became of it. I'm glad my clinical leader called me because it gave me an opportunity to let her know how my old preceptor has been treating me. Thanks again for taking the time to listen & respond to my concerns.
EmmaG, RN
2,999 Posts