I feel like there is a lot of pressure on nursing staff due to survey results. At my facility, we are extremely liberal with our pain medications. Dilaudid, morphine, oxycontin, oxycodone, tramadol, norco & nucynta are all extremely common. Each patient has at least 4-5 of those listed pain medications on their profile. We give multiple different pain medications, many times simultaneously, and still it doesn't seem to be enough for some. These pharmacological methods are combined with non-pharmacological techniques such as ice, repositioning, distraction, rest, ambulation, massage etc. Our providers are usually very open to switching up medications based on patient preference or suggestion of the nurse. With all of these pain interventions, I feel like we are really trying our best.
When a patient complains that their pain wasn't managed properly or indicates poorly on the survey, the manager automatically blames the nurse that they did not do enough for the patient. I personally have been called in the office and reprimanded for only giving 4mg of morphine instead of 6mg without ever asking my reasoning for giving that dose. In attempt to raise our survey results, my facility has resorted to have every single person who goes in the patients room "assess" for pain. This includes CNAs, Pharmacists, kitchen staff and even housekeepers asking the patient about their pain level. I think it is crazy to have housekeepers "assessing" pain!! I personally feel like we need to have frank conversations with patients about realistic pain management goals. I know that I do always try to develop a plan and write the plan on the white board. Unfortunately this doesn't always translate to perfect survey results, which is how success is measured at my facility.