Sick of RNs not believing patients about pain

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Specializes in Operating Room, Long Term Care.

I'm in my last semester of nursing and I'm sick of staff nurses not believing patients about their pain. I had a one day post-op patient who was in pain and asked for his percocet. I gave him his meds and the nurse freaked out on me. She said "he's going home in two days and he needs to deal with his pain and you don't need to medicate him every time he complains he's in pain" She demanded my instructors name because she was going to talk to her about my actions. He was only getting it q4hrs. I have never been yelled at before in clinicals by a nurse, they usually tell me I'm doing great. My instructor told me to blow it off, but it just makes me mad about how she treated me and the patient.

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Specializes in Ortho, Neuro, Detox, Tele.

i understand....pain meds are my number 1 bugaboo as a staff nurse. I come in at 5pm and usually hear that patients haven't had pain meds since 11 or 12. by the time I get to them, it's about 6 or so. could be so much easier.....just take the patients word for it, and do what you can.

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Its poor practice to say "just deal with it." I sit on my hospitals pain committee and one of the principles of pain management is to stay on top of it with appropriate medication strategies.

For example the WHO ladder. See U.S. Department of Health and Human Services, Agency for Health Care Policy and Research Clinical Practice Guidelines, Number 9, March 1994 and http://www1.va.gov/Pain_Management/page.cfm?pg=22

The WHO ladder portrays a progression in the doses and types of analgesic drugs for effective pain management. The best choice of modality often changes as the patient’s condition and the characteristics of the pain change.

The first step in this approach is the use of acetaminophen, aspirin, or another Non-steroidal Anti-inflammatory Drug (NSAID) for mild to moderate pain. Adjuvant drugs to enhance analgesic efficacy, treat concurrent symptoms that exacerbate pain, and provide independent analgesic activity for specific types of pain may be used at any step.

painladder.jpg

To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand” This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective

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This link at http://www1.va.gov/Pain_Management/ has tons of information about best practice pain management.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
Rylee2008;4117496 My instructor told me to blow it off,

That's all you need to know, but it irks me to no end to see nurses refuse to give an ordered prn pain med. :mad: Who the hell are they to decide what level of pain is OK not to treat??

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Specializes in PICU/Pedi.

We studied pain management last semester and I was surprised how much our instructor emphasized the need to give pts. their pain meds when they say they need them. Our text says that there is a very small percentage of people in the health care setting that actually abuse drugs, and that pt.s need to be medicated on a regular basis, preferably on a schedule to keep the pain from recurring in the first place.

The only time so far that I have seen a pt. denied pain meds was when I had a post-op pt. who had been "snowed" during surgery. It was 24 hours since her surgery when I took care of her, and she was in alot of pain, but she also COULD NOT stay awake. It was everything I could do to keep her awake while she showered. I felt bad for her, because I knew she was hurting but the nurse was afraid that more pain meds would depress her further.

I hope that your situation is not the norm. It sounded like they were getting more reasonable about pain management, but maybe that's just the world of nursing school. I'm glad that your instructor backed you up. Sorry the nurse yelled at you, though. Ridiculous!

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Of course I don't know what type of surgery the patient had but.. At one day post op, staying on top of the pain is usually advisable! Regardless.. As nurses we treat the patients pain. The only thing I can say is, the nurse could have suggested..

Since the patient is going home in 2 days, once you have the patient comfortable, it would be a good time to teach some methods of natural ways to deal with pain ie deep breathing, imagery, heat, ice, etc.. (depending on the source or any restrictions of course)... This being said, if the patient is in pain your teaching will NOT be effective so medicating first would be best.

Also sometimes little things like repositioning or mobilizing help reduce pain depending on the pain of course.

Just some things to keep in mind, I would have medicated too :)

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Specializes in Operating Room, Long Term Care.

Thanks everyone for all the great advice. I know I'm the patient's advocate and I'm there for the best interest of the patient and not to make friends. I feel this nurse was just on a power trip.

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I am big about making sure my patients are comfortable. I lived with horrible migraines for over 20 years and no one believed how bad my pain was.

Believe me this happens with LPNs in long term care too. "I didn't give him a pain pill because he didn't ask for it"..uh hello, he's comotose and grinding his teeth, what would you like him to say?

I'm not sure why some people have issues with proper pain management. It is getting better. Making it the 5th vital sign is helping. Education in nursing school and md school is helping. I'm glad you will be another that will make sure their patient is comfortable.

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That is ridiculous. Pain is very real, there are people who take their own lives over pain. I went through a period where I had a mind blowing headache EVERY DAY OF MY LIFE for almost 2 years so I can totally understand. Asking the doctors for more than ibuprofen resulted in a sideways glance and a nearly visible blow off. I know that prescription drug abuse is off the charts these days but that fact shouldn't result in making everyone suffer!

BTW, I now take nortriptyline as a headache preventative and it works great!

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Specializes in being a Credible Source.

I completely agree regarding the inappropriate attitude that some nurses have toward pain medication... as though they are the moral arbiters as to whether a patient should receive the ordered medication.

On the other hand, there seems to be no shortage of patients whose pain is always 10/10 and can tell you to the second when their next dose is "due." Or the patient with excruciating pancreatitis (despite normal amylase/lipase) whose pain miraculously disappears the moment the MD pulls the dilaudid order.

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On the other hand, there seems to be no shortage of patients whose pain is always 10/10 and can tell you to the second when their next dose is "due." Or the patient with excruciating pancreatitis (despite normal amylase/lipase) whose pain miraculously disappears the moment the MD pulls the dilaudid order.

But if they have a doctor's order for dilaudid, who are you to judge?

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