RN won't give pain meds

Heogog53 · Apr 20, 2009

I am outraged that an RN would hold back on adminstering pain meds for any patient. If she/he has any questions in regards to the patients SELF assessment for pain level, instead of simply staring in a doorway, the RN ought to be doing his/her own assessment by actually talking to the patient.

I say this as someone who has been a nurse since 1982, who has had more than my fair share of illness and pain, have watched family members die, and feel that taking care of any patient should be like taking care of one of mine. I find that the biggest issue today in pain management is the disconnect that many health care "professionals" demonstrate partially because they are afraid of addiction issues(not usually a problem for short term acute pain care), or because the meds that the docs order don't cover the patients pain adaquately, and instead of asking the doc to increase the dose, or switch to something more potent, simply answer the patient with the old standby, "Doctor ordered this medication and you can have it in another _____ minutes." and that's supposed to help?

Another problem, of course, is if someone comes into the hospital, in acute pain with some acute condition that they've suffered with before, and tell the nurse that X medication is the best pain medication for that condition. Instantly the mental bars go up- "OOOOOooooooOOOOO, WE know ALL about drug seekers", even if the patient is simply trying to expidite things.

And worst of all, working in a university teaching center, is the fact that many of our health care professionals and students are young enough that they have never been ill enough to be in a hospital. They have NO idea how much pre-op and post-op pain hurts, or how nasty it is to have an NG tube shoved down your nose/throat...They are pretty much idiots were that's concerned. :madface: I once was working near a couple of medi students who were talking about a patient and the three of them were having a jocular talk about just "dropping a tube", as if it were no big deal. I turned and asked them, "Have any of you ever been ill enough to have a tube dropped?" No. No. And No. I said, "Well, perhaps you ought to try dropping a tube yourself and see how much fun that is." The three of them vanished....

Sorry, got carried away about the topic of pain medication and the lack of understanding on the part of oh so many health care "professionals" about how to treat it, professionally. :twocents:

Silkiebyrd · Apr 20, 2009

I agree about the University aspect with you, I know that not all places are like this but many are. I worked NICU for many years and when I first started we had a surgeon that everyone was scared to ask things of, he was famous for saying that premature infants of this or that age don't feel pain as their neurologic systems were not mature yet. Well, that is bullcrap...anyone who has worked with them has seen them grimace, cry, and get very agitated with VS changes with only minimally painful procedures...much less post op. I would call him whenever I had a baby of his and harrass him until he gave me orders for fentanyl or versed. I also gave him every piece of literature I could come up with regarding the fact that infants do feel pain. He would then throw them away and cuss at me but I just let it roll off my back...I had orders for my babes. He did it just so I would let him get sleep and not because he came to my way of thinking. The only way I didnt loose my job was because the NICU attending agreed with the nurses and not the surgeon...the surgeon had no pull in our unit but I did pray that none of my actual kids ever needed surgery. I could see him coming in their room and going oh yeah I know your Mom....this wont hurt a bit. Stick to your guns and keep on being a patient advocate; it could be your family member in that bed someday.

Vito Andolini · Apr 20, 2009

I was thinking along these lines when I read your post. One of several good reasons to become an RN. Even if the RN in question were to get off her behind and assess the patient herself, that is extra time wasted when you could have already administered the med as you saw fit.

Do you really expect the RN to give the med with absolutely no assessing by her of the patient?

iwanna · Jul 17, 2009

That is one thing that infuriates me, when a nurse feels that the patient does not need their pain med. We were taught that you always address pain, no matter what you believe. I always made pain issues, a priority. If someone would ask for pain med while I was doing a routine med pass. I would pause my med pass, give their pain med, and then continue where I left off. I was a pt. many times. I will never forget the time that I was in severe pain and was admitted to the hospital for pain control. I was ordered Dilaudid IV, however, I was in hospital for six hours before I got anything for pain med. But, I was smart enough to anticipate it, and medicated myself with percocet(prescribed by my dr. before she wanted to admit for pain control) before I was admitted. I know for a fact that my orders were faxed before I was even at the hospital.

I think some nurses believe they have too much power when it comes to pain meds. If a pt. asks for pain med, the nurse should give it, regardless of their opinion.

CharleeJo.RN · Jul 22, 2009

Yes, yes, and yes. I have had a couple of surgeries and a few acute illnesses that required tubes and the like - I never knew that type of pain existed (post-op), and was in horrible misery for days because meds were under-prescribed. In a small town, docs are so afraid of being accused of "over-prescribing" that they opt to "play it safe" and under-prescribe. Ridiculous. I will always advocate for my patients, because as we know, pain is subjective - how can you tell someone THEY don't have pain when they say they do? Ludicrous.

Oh, and I absolutely agree that the RN should do an assessment. whether or not she's busy, doesn't matter - she is there to help patients, period. i'm going for my RN and would not give a med to someone unless i had assessed them - i wouldn't go solely off another nurse's report. we are responsible for ourselves and our patients.

shane69 · Oct 16, 2009

ill give you my 2 cents on what you wrote

when my pts ask for pain med for a pain level of 5/5 i have to ask the rn to give the med for me.

sometimes they will go and look in the room and if the pts is lying there with their eyes closed waiting for someone to come in and give them relief.

as people commonly do when they're in pain, its all they can do. i mean i suffer from migraine and its all i can do to lie still with my eyes closed ....the pain is still there

they will come back and say i am not giving them anything because they are sleep and don't give them anything if they can sleep. (they are not asleep because they call fifteen minutes laterasking for pain med.)

im a nurse by the way, but id like to say what sort of idiot nurse would behave in this manner. they displayed no critical thinking at all. was it above their level of inter-ma-lectual functioning to consider, maybe they are awake with their eyes closed or to go over and see if they're awake. sometimes my colleagues make me mad

if the doc ordered 1-3mg of morphine q2h prn. and my pt has just come from surgery and i ask if they can give the pt that i am taking care of 2mg for the breakthrough and then hopefully in three hours when they get their first scheduled po med it will cover them. they will tell me well just wait until they get their po, they just woke up they can't be in that much pain.

'psychic nursing' how the hell would this nurse know that?? i mean she didnt even speak to the patient. what an outrage! over my years as a nurse ive come across 'psychic nurses'. you know the type , you know the nurses who can say 'you dont look anxious'.....well i say; 'how does an anxious person look???' can someone with a flat affect be anxious?? the answer is yes. but you wouldn't see the anxiety on their face because they have .......a flat affect! but many of these nurses simply rely on their clinical judgement oh i mean psychic nursing abilities to determine a patients mental state

am i being overly sensitive to this because i am a new nurse? am i assessing my pts wrong when it comes to their pain? it makes me angry that i cannot be in control fully of medicating my pts when they are in pain.am i wrong for wanting the rn to give my pt pain med when i ask or are they wrong for just assuming that my pts are not in that much pain.

i might be a little out of line here (please correct me if i am as im not so familiar with the us levels of training i.e lpn, rn etc)

1/ your not being sensitive you are displaying critical thinking.

2/ if you spoke to your pat' and they claim to be in pain and have a history of being factual with you regarding their pain coupled with your observation of them whilst they are unaware you are watching them (some patients when they know you're watching will play the sick role in the hope of securing more pain medication)

3/ if they have a condition and are therefore likely to be experiencing pain then i would give the medication

4/ it is up to the rn and out of your hands, you dont have a say. the rn is legally obliged to behave in a legally set out manner. whilst you the lpn are not allowed to give your considerations for the dispensing of this particular medication. you have not received the respective training (correct me if im wrong!!!) the state has organised various levels of training to protect the public, you can want the best for your patient but that as an lpn and in this situation counts for nothing and if you havent received this traing then your talking form your a$$ or about what you think you know rather than what you do know

5/ if it makes you angry etc....you know what you need to do...........go to college and become an rn or doctor or pa. i work with ppl like you who think they know better than the nurse or the doctor etc.... and you know what you might!!! its all the same though, you dont have a say, period

6/ they are wrong for assuming ....they displayed no critical thinking and were probably more interested in their conversation or coffee. i know because ive spent 12 years with other nurses ..i know the games they pull and i know that patient care sometimes is not high on their list particulalry on a quiet evening or night duty ....

by the way in this facility i work nights and most of the time we have on 4-7 pts and the rn usually has 0-2 since they have more paperwork the lpn's take on the larger pt load.

which is common, i have found in my experience the more education you have the less intense your workload ( my opinion) you my friend are $hit kikker, the go'fer or lacky etc. you dont enjoy the privileges of being able to dictate, and let me tell you nurse know how to dictate. but let me add your experience is identical to the nurse-doc relationship i.e nurse who think they know better than the doctor .............its all the same!

tewdles, RN · Oct 20, 2009

You are advocating for your patients and your assessment is valuable. The RN has NO BUSINESS contradicting your assessment based upon a NON ASSESSMENT from the doorway. I am sure that you will find some way to nice up my sentiment should you agree...but the RNs in your facility need an attitude adjustment. They are, afterall, professionally responsible for the nursing care that is delivered while they are present. It is bad enough if they are incompetent enough to choose ignorance when it comes to staff performance...it is a complete embarrassment to RNs that they might intentionally stand in the way of good nursing care! What exactly are their priorities?

Gosh...that was a wee rant

chenoaspirit, ASN, RN · Dec 21, 2009

When our LPNs came to me and asked me to medicate their patients for them, I respected their knowledge of their patient. Of course I would do a quick assessment of their resp just for my own security. Kudos to you for advocating for your patients. No patient should suffer in pain needlessley, especially when there are pain meds ordered to relieve it. Next time the RN refuses, I would have to adjust her attitude, but thats just me. I would NOT put up with that at all. You are just as much a nurse as they are and they need to respect your judgement. The ONLY reason a RN should/could refuse is if she feels it would be unsafe, which is not the case here. That urks me. I know what its like to live in pain, and if you were to look at me you would never guess the amount of pain Im in. You cant always judge by facial expression, especially with patients who have chronic pain. They have had to learn to live with it and dont respond like acute pain patients. Sorry for my rant, but that just ticks me off. I would definitely address this with the manager. They are making your job hard and making your patients suffer needlessly.

Icarus1964 · Jan 11, 2010

Hi,

All I can say is keep on being your patient's voice!

If an RN is able to "glance and decide" (dunno how), she should at least communicate her reasoning and perhaps tell you what else to watch for.

Agree with all though, in my books, if a patient says they are in pain, it is very real to them!

One cannot make an estimation on how much pain a person should be in based on their procedure or time lapse post op.

Pain is an individual experience and all too often is played down by the person holding the key to relief.

Still there are loads of really good RNs out there versus the ones who have lost their focus!

txspadequeenRN, BSN, RN · Jan 11, 2010

you cannot assess a patient properly from the doorway.....go to your higher ups and get this addressed or you and your patients will continue to have issues......

bunsterj · Apr 18, 2010

I am the type of person that when in pain will lay very still and quiet, perhaps even with my eyes closed. I might even doze just to tune things out. I probably wouldn't ask for a med soon after the first request, might turn on my side away from the door and cry a little. With the nurse in question, it might look like to her that I am "resting quietly."

Would it be possible for you to go along with the RN to see the patient and for you to initiate a conversation with the patient about his/her pain in the RN's presence?

Heogog53 · Apr 18, 2010

As a Fibromyalgic, as someone who had a long term peritonitis that was missed for ?years despite my complaining of the pain, etc, I can say with great authority that there have been many times that I have been in a far amount of pain and not realized it until I assessed my behavior; as the pain got worse, the shorter, crabbier and meaner zI became.....whe it was poointed out to me or I suddenly realized it, then I had to decide how much pain I was in and take the proper amount of pain medication to control it enough to simply behave like a "normal person".

I've seen patients who were histrionic about their pain, stoic to the point of lunacy because of the fear of addiction, and all points in between.

I see a doctor who manages my pain. He has been audited 18 times by the state because there are several docs on the panel who disagree with his pain management style. He has never been found to have over prescribed, none of his patients are addicts, but the docs who give him the most trouble are surgeons. As an OR nurse, I find that extremely troubling; most surgeons are ok with treating post op pain liberally for the first few days to a week, but then there is a big push on to wean off of IV meds to oral meds, and then to reduce the strength of those ASAP.

These surgeons are apparently some of the older docs; the new residents and docs I've worked with in university hospitals are much better educated at learning to use the pain service- first the acute service and then- if needed, somewhat reluctantly, the chronic pain service. I'm grateful that more docs are starting to realize that cultural differences give rise to misinterpretation of how severe the pain actually is; once again, culturally competent care raises it's head. If it's hard for the docs and some nurses to recognize pain being SUBJECTIVE AND WHAT THE PATIENT REPORTS for Americans, think about how hard it must be to recognize pain in the cultural melting pot that the US has become.....

Pain is pain. It requires assessment and treatment. When I worked in critical care, if an LPN came up to me, reporting that her patient was in pain, could I give the IV med, I never questioned the initial request, but I always confirmed with the patient what the pain level was, so that the LPN and I could agree on what pain med to start with.

So, yes, the RN is a lazy person, is certainly no longer a patient advocate(if ever was one before) and needs to be reminded that pain is what the patient states it is, and requires treatment. :mad:

Kudos to you for being that patient advocate that you are. :yeah:

Sincerely, a nurse whose been on both sides of the bed, as patient, family member and nurse.