Hey guys I have a scenario I want to run by. So I work on a cardiovascular surgical floor. One of the things we do is heart valves. Every so often we get the endocarditis from drug use. Sometimes we get repeat offenders which is sad.
So anyways, thats the background. So I get my patient, 20 something year old female drug addict who had recent heart surgery. I got report in the morning and of course pain was a major issue. The night nurse was like I gave her vicodin and that seemed to help. So I come on and shes crying and visibly in pain. The vicodin is due, so I give that. Hour later she is still crying so I look on the mar and she has a small dose of morphine. So I give that. '
Next day nurse confronts me and says why would you give an IV drug user morphine? She goes on to say she was only giving the patient Tylenol. I tell her that the night shift nurse told me she was taking vicodin. She says he should not have even given her that.
Did I do wrong? The patient was clearly in pain and the medication was ordered by the surgeon. If the patient is in pain shouldn't we treat it?
You're fine. treat the patient. 'Drug history not drug addict'...semantics. Beside the point however. Again, treat the patient. No, she should not have been written up. Counseled or 'told how it is' but not a write up. Too much flared up emotions in nursing.
Um yeah...when I hear about someone crying in pain because they've been denied pain relief after open heart surgery... I get a bit emotional.
I have been a nurse for 21 years & I was taught that you are never to question a patients complaint of pain. I'm so tired of hearing the healthcare professionals label patients as "drug seekers/addicts.
Specializes in Med-Surg/Neuro/Oncology floor nursing..
I don't even understand how this is even an issue. Bite the bullet went out the window a long time ago. So since a patient has a history of drug abuse that means they aren't entitled to pain relief ever? OP you were not in the wrong at all..you're colleague on the other hand really needs to reevaluate the way she does her job. Tylenol? Really someone who just had a valve replaced and she thinks Tylenol would suffice? That's just barbaric in my opinion, especially if the patient is crying out in pain. The teaching hospital I work at does a lot of valve replacements and since the hospital is inner city we happen to get a lot of drug abusers as patients. The admitted drug abusing patients that legimately need narcotics the docs dont hesitate one bit to give them what they need, even what they want. One doctor frequently says "they can score heroin by yelling out the window to one of the many dealers on the corner, unless they express a desire to go to the detox unit, we aren't going to fix their addiction in 4 days."
Now if a patient with substance abuse issues expresses in no uncertain terms that they want minimal narcotic intervention, if that then of course the patients wishes are respected. But addicted or not surgeries hurt, they are still human beings that can feel pain(at times their threshold is lower) and they deserve to have their pain treated. Period.
Specializes in Oncology, Med/Surg, Hospice, Case Mgmt..
This is an old post, but reading it makes my blood boil and also makes me proud to be a nurse. The pride comes from the unanimous compassionate and educated responses. This situation happens all the time in hospitals every day and the attitude is not only reserved for addicts who abuse illegal drugs, but also handed out regularly to those with a history of chronic pain who are prescribed and have taken opiates for years.
What gives a nurse working on a surgical floor or in an ER the right to decide that the practitioner who has been prescribing pain medication to this patient for years or decades is wrong, has purposely turned the patient into an "addict" and it is THEIR job to fix it or "not enable" it? A nurse who thinks like the Tylenol nurse should leave the profession and he/she should be reported to the nursing management at the hospital and the patient's doctor. I have seen patients, who I know personally, denied pain medication after surgery in this type of scenario and it turned out the surgeon was not aware the nurse had done this.
It must be reported. Nurses like this need to be educated promptly or removed from their position. As was mentioned earlier, a post-op patient in uncontrolled pain is not healing properly and their post-op path has just been extended. It is the responsibility of the doctor to order the pain medication and the job of the nurse to administer it, period. If a patient who is addicted to whatever- street drugs or prescribed opiates, is in the hospital and their pain is unbearable, they will contact someone from outside to help them. No question about it. Is that what we want? Patients taking drugs that we don't know about when they are in our care? Patients who have had their pain disregarded by holier than thou sadistic nurses will also be permanently scarred by this experience and may avoid important healthcare they need at any cost. Very scary...
An addict in recovery who does not wish to take pain medication after surgery will tell the doctor or the nurse if this is what they want. They are aware of the potential problem. We do not need to make that decision for them or debate about whether the decision to medicate them will undo all of their hard rehab work. That is not our business. That is the patient's decision and it is their business.
Nurses who administer pain medications to patients are never "enablers". We are doing our job.
Specializes in ER - trauma/cardiac/burns. IV start spec.
The doctor wrote orders for pain meds so there is no excuse to withhold them from the patient. Doctors will take the patients history into consideration when writing orders. Hell, I had an ortho doctor write admitting orders that included "3 beers with meals". When I asked he told me that he was not going to treat his alcoholism and did not want to send the patient into the DT's. If the doctor wrote for pain meds then that is the end of the story..
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
You did the right thing. Thank you for doing your job and caring for the patient in need. Never allow someone to make you feel less than or that you did the wrong thing. you did the right thing. You are an excellent nurse and I would be proud to be your patient or any of my family members.
Specializes in ER - trauma/cardiac/burns. IV start spec.
MrBlueSky you were correct and you did just as you should have done. The "day nurse" however, seems to have been substituting her personal decisions for the physicians written orders. She was wrong not you. It is a strange world when a nurse will decide to treat someone different just because "they are drug users". While I have never been a drug "addict" I was afforded the benefit of being a chronic migrainer when I was young. I had my first one at 17 and they continued for many years and I was in chronic pain due to bad disks in my neck (discovered many of the migraines were not migraines at all but pinched nerves in my c-spine), all of this before I went to nursing school. I had my neck surgery during school and being older my migraines eventually stopped. In fact I would get shots for my migraines at the same ER I eventually went to work for. As a result most of the Doc's on nights would get me to review charts for the "migraines" that presented. I could pick out the real from the act but most of all I could see the little signs and most Docs trusted my judgment. However there was one Doc that would not for any reason give narcotics for people with back pain. He held fast to his beliefs right up until he went down and had to have back surgery. Then he realized how prejudiced he was toward "druggies" and narcotics in general. Just because someone was an addict does not mean they deserve to suffer post surgery. I admitted an alcoholic one night for an ortho doc and in the mans orders he wrote "2 beers with meals". I was shocked and he told me he was going to operate to save the arm but he was not going to treat his alcoholism so the beers were to prevent the DTs from starting. Drug addict, or any other kind of addict, should be treated for the pain now, today not treated less because of what they are. Treat the body, the whole person, treat them like a human being and if the doctor has ordered morphine and the patient is still in serious pain you give the morphine period end of sentence. Pain in the US is under treated as it is but allowing pain to go unchecked with an order written is cruelty. We saw a lot of sickle cell patients, one of note was know to use street drugs too but when he came in in crisis, intractable pain, dehydration the fact that he used street drugs did not stop us trying to treat his pain. Before I went off duty I had given that man 34 mg of morphine, 34! He was still talking, crying, unable to be still. I gave days report and the oncoming nurse made a snarky comment about the amount of morphine that I had given - the Doc coming on heard her remarks and they disappeared into the nurse managers office. I did not see her again for several days. Seems she had to go to a class for a week for "refresher course on pain medication when dealing with a drug user who is also a sickle cell patient".
You were right, the day nurse was wrong and you stand your ground when advocating for your patient. You might be saving or changing their life for the future.
This is my floor. We do have a few patients who use their pain medications sparingly, but most are Endocarditis, Sepsis due to abscess, etc...
If they have medications ordered by their physician, it's not mine or any other nurse's place to ration it out to them as we see fit. That's another issue for another time. We are a hospital, with sick people who deserve compassion and no judgment. If I catch a patient who cheeked their dilaudid and is attempting to crush it and snort/shoot it up, they are going to hear from me. Otherwise, it's not my box.
If the patient decides they want to get treatment someday for substance abuse, then they can address it.
I am just trying to get into nursing school at the moment, so I am not here to pretend to know things I haven't learned yet.
But I wanted to thank the original poster and those who disagreed with the nurse giving tylenol. my dad is a recovering opiate addict who has had several surgeries for peripheral vascular disease and most recently, a CABG. I've encountered a medical professional in the immediate ICU period following each surgery who wanted to deny opiates or give him ineffective doses.
I clearly don't want my dad to return to abusing opiates---it was partially the actions of a surgeon rxing Oxycontin to him for over a year at the max daily dose following a surgery that led to his addiction ( the other component is my dad is a person with addiction illness-he was an alcoholic for forty years before getting sober).
However, I may not be a nurse yet and certainly wasn't then but especially following his CABG, I found it deeply unethical for one of his nurses to suggest the day after his surgery that he voluntarily refuse stronger meds. He still had three chest tubes in, had his chest cracked, and was in the worst pain I've witnessed him in throughout 8 surgeries. My common sense told me that while giving former addicts narcotics is obviously inadvisable to do for casual injury, the body's response to the trauma of serious surgery doesn't change whether someone has been an addict or not.
To say that I complained would be putting it kindly, but we didn't encounter that problem for the rest of his stay. Poor pain control, as his surgeon told me, leads to drastically poorer patient outcomes, whether the patient in question was or is struggling with addiction.
I wanted to thank all of you for standing up for you patients who have or are grappling with addiction. As a family member who has been in the situation of seeing their dad judged or attempted to be denied medicine he needed acutely, I am grateful for advocates like you and hope to become one of you soon.
Here.I.Stand, BSN, RN
5,047 Posts
Um yeah...when I hear about someone crying in pain because they've been denied pain relief after open heart surgery... I get a bit emotional.