RN won't give pain meds

[Laught3r]

I am an LPN in a small facility. Many docs here order Morphine IV to be given to their pts. My problem is that as an LPN I cannot give IV push meds. 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. 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.) 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.

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.

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.

[suanna]

We can just hope that the RN in question develops a bad case of shingles and has a nurse who dosen't believe in narcotic pain relief. Honestly- thanks for your post. It is a shame how many nurses think just because someone closes thier eyes to pray for the strength to endure the pain untill the nurse gets back with the shot, that the patient must be sleeping quietly and shows "no signs of pain"! Do you know what the most common sign of pain I've seen in my practice?- the patient says "this hurts- can I get something for pain?". Any nursing assessment that contradicts that and withholds medication is the erroneous data.

[Heogog53]

@Suanna,

I LOVED what you said about shingles!!! About a year and a half ago, I had the misfortune to develop the shingles. I thought it was a fibro flare, so I fortunately went to see my pain doc. He asked about the pain, then told me that he was the wrong one to be seeing for this...because, he said, you have shingles!!! However, he gave me a prescription for Dilaudid(4-12mg q 4-6 hrs) as well as famcyclovir(SP?) to prevent eruption. I went to see my GP, who then followed me for the remainder of the time...and kept me out of work for 5 weeks to make absolutely sure that I didn't develop any OTHER neuropathies....

Yah- anyone with shingles and no pain meds- KARMA!!!!:yeah::yeah::yeah:

A long time ago I had 2 sinoscopies in one year. My doc believed in doing those cases under MAC, not general anesthesia. The first post-op medication I was given was Percocet....which did NOTHING. The next thing they gave me was IV morphine which did the trick, but I was so nauseated they had to give me Phenergan(Told you- LONG time ago). Between the MSO4 and the Phenergan, I was stupified and remembered the anesethiologist coming in and asking- Hey, why is Helga still here?

I had been the first case of the day- and was still there at 5:30 pm.

The next time, The anesthesiologist and I had a long talk about post-op pain meds....He felt that PO wasn't worth it, and instead of Morphine, he gave me IV Dilaudid. I discovered that Dilaudid was THE BEST pain med for me. Post-op, since I had to wait on a ride, I spent the whole day just resting quietly, was easily rousable to voice, responded correctly, etc, but if left to my own devices, I just slept comfortably....:redbeathe

Big difference between the two pain treatments- and from that time on, I made certain to tell my surgeons and anesthesiologists that Dilaudid was the best pain med for me, for severe pain. I got THE LOOK, but once I explained myself, it was OK.

However, when I ended up in the ER in tremendous pain from a paralytic ileus, and told the nurse that IV Dilaudid worked best, the INSTANT reaction was a shift from sympathetic nurse face to tightened up pruny faced "Oh ****, here we go again, a drug seeker" face. I understand that the ER gets all kinds of folks who are drug seekers, but if one has a board like, rigid abdomen that can't be touched, who then proceeds to vomit explosively, I'd hope that the "drug seeker" label would be put aside ASAP. I told the nurse that I'd had the med for surgeries at that hospital, he could look it up in my old records, that so and so were my docs, etc....

He did his job, placing the IV, then moving me to a different room after I vomited prodigiously, but instead of helping me clean myself up, he just tossed a clean gown and towels at me and left. My daughter had to clean me up, then go ask for warm blankets and the like. The attitude was icy and mechanical. Finally, after getting the OK to treat me with some powerful pain med IV( it seemed like hours, but I really have no idea), and then watching my body relax, my vital signs change, etc- only then did he treat me with the slightest positive attitude.

What do you do with nurses like that? I was obviously in distress, unable to rest or stay still, then the vomiting, etc.....and he treated me with contempt for asking for the one med I knew would work....

I've had a total of three paralytic iliuses(?). The next time, the nurse was far more relaxed about the whole thing, but once again, it wasn't until I went through the explosive vomiting that something was done. I was even moved to the row right in front of the nurses station on a cardiac and O2 monitor so they could give me Fentanyl for immediate relief- and what a blessing that was!!!!

The last time I had an ileus, I stayed home, took some PO stuff, stayed as NPO as I could and as still as I could until things started to move along again, because of THAT first nurse in particular. If the ileus hadn't started to resolve within a reasonable amount of time, I would have reluctantly gone to the hospital for treatment, dreading the way I'd be looked at and treated.

So, for an RN to ignore a report of pain, or to fail to assess the patient's pain level properly because of their own prejudices, is simply abhorrent to me, both professionally and as a family member or patient. It's a throw back to the days when the docs would be stingy with pain meds, because of a belief that giving more than this amount of pain medication indicated that the patient was a drug seeker, or morally incapable of controlling him/herself, or the belief that it should only take X amount of medication to do the job.

In this day and age, when medi students and residents are taught that there is a huge difference between treating acute pain and chronic pain, and that having Pain Services is just as important as any other consult service for patient care, you'd think that all nurses would eagerly embrace a more progressive attitude as well. To not instantly respond to a report of a patient's pain, in my opinion, is like ignoring a report that the patient's vitals are changing rapidly, or that there is frank blood in his/her urine. It is an URGENT matter that needs to be taken seriously and treated rapidly.

Sorry about the rant.....I've seen every attitude in the world towards patients whose pain isn't cared for properly or recognized as an equally important part of vital signs as BP, HR, O2, and Respirs.

Thanks for putting up with the long read....

[CRIMSON]

Always advocate for your patient. Insist the RN assess the patient fully. A patient has a right to pain management. Unfortunately, society and a fracked up legal system has allowed too many frivolous law suits which has painted a terrible stigmata on pain treatment. Unless giving a pain med would endanger the patient (respiratory depression in an already struggling patient) pain should be treated and even then a medication can be found to treat at least some level of pain. I cannot stand nurses who have the audacity to determine a patient is not in pain just by glancing at them. It shows laziness and a serious lack of empathy. This should always be addressed. Patients and families need to address it to a supervisor as well. If a nurse cannot understand and treat pain then they need to find another profession.

That being said the other side of this is LVN's should not work floors where they cannot give the needed meds. Unfortunately, this limits them to Dr's offices which is now days pretty much all medical assistants. For this reason I believe they should do away with LVN's in all acute settings and require RN's for all hospital/acute type care. These situations put the RN at risk b/c she would need to totally assess the patient and at least the most recent history ect,, and then give the med and followup with in minutes/hours depending on how meds are administered to be able to document appropriately. This puts her behind in her own patient care and places an additional patient on her load for the shift. Hence, one of the main reasons I believe all acute care should be RN only so they may tend to all needs of their patients. In today's society an RN holds an independent license and is responsible for every decision she makes with every patient and is expected to be perfect and never make mistakes and is almost always overloaded with patients that hinders the safety of the patients. Until the whole system is restructured lowering patient/nurse ratios and appropriate support staff be available at all times we will continue to see such terrible flaws in healthcare. But that is a whole other long story.

[HazelLPN, LPN]

Always advocate for your patient. Insist the RN assess the patient fully. A patient has a right to pain management. Unfortunately, society and a fracked up legal system has allowed too many frivolous law suits which has painted a terrible stigmata on pain treatment. Unless giving a pain med would endanger the patient (respiratory depression in an already struggling patient) pain should be treated and even then a medication can be found to treat at least some level of pain. I cannot stand nurses who have the audacity to determine a patient is not in pain just by glancing at them. It shows laziness and a serious lack of empathy. This should always be addressed. Patients and families need to address it to a supervisor as well. If a nurse cannot understand and treat pain then they need to find another profession.

That being said the other side of this is LVN's should not work floors where they cannot give the needed meds. Unfortunately, this limits them to Dr's offices which is now days pretty much all medical assistants. For this reason I believe they should do away with LVN's in all acute settings and require RN's for all hospital/acute type care. These situations put the RN at risk b/c she would need to totally assess the patient and at least the most recent history ect,, and then give the med and followup with in minutes/hours depending on how meds are administered to be able to document appropriately. This puts her behind in her own patient care and places an additional patient on her load for the shift. Hence, one of the main reasons I believe all acute care should be RN only so they may tend to all needs of their patients. In today's society an RN holds an independent license and is responsible for every decision she makes with every patient and is expected to be perfect and never make mistakes and is almost always overloaded with patients that hinders the safety of the patients. Until the whole system is restructured lowering patient/nurse ratios and appropriate support staff be available at all times we will continue to see such terrible flaws in healthcare. But that is a whole other long story.

Remember that LPN practice varies from state to state. In some states, LPN practice is very similar to that of an RN and they are still useful in acute care settings. In other states, the scope is much more restrictive.

[JSBoston]

As an LPN, are you able to place the IV medication in a 50ml bag and run it over 10-15 mins? Where I have worked before, that was something a lot of LPN's did. It takes more time, but it's at least a way for your patients to have pain relief.

[MikeR26]

You're right to want to give your patient's pain medication if they are in pain and there is a doctor's order for it. You are your patients' advocate so I recommend continuing to ask the RNs to give them the prescribed medication. Pain is what the patient says it is, not what the RN thinks it is.