Tell me what you think of this scenario please

[Mystery5]

Today was an extremely busy day shift. One patient I had was a lady partsl hysterectomy. This gal was a breastfeeding mom, had gotten out of surgery around noon, had had 2 mg MS IV x 2 by about 1330. She was taking liquids well. She had had some nausea after the morphine, and also was very concerned about the quality of her breast milk. She was pumping and wasting what could have been affected by the surgery drugs. She was able to tolerate her 1400 Naproxin, so we discussed her options and she decided that if she needed something else she would like percocet. I mentioned all this in verbal report. Where I work we all get report on all the pts.

Well, 'Crystal' is an OB nurse who arrived to report a little late. The OB nurses generally hate floating over to Med-Surg in our small hospital. She's a sort of hyper gal. She was going to be the third nurse giving meds and generally helping.

I still hadn't done my I's and O's for the busy shift. (We hadn't had a CNA) I was in this gal's room emptying her foley when Crystal came in with some morphine for the pt. The pt said something about that affecting her baby. I noticed the morphine syringe and told Crystal that the pt had said that she didn't want morphine anymore,that we had talked about it and she had decided on percocet next time. Crystal looked put out, and tried to talk the pt into having the morphine in a pretty pushy fashion. The pt said that it had made her nauseous. I repeated that I had mentioned it in report, she must've missed it. I was really surprised that she wasn't just backing off, I didn't think it was any big deal that she didn't know this. But she seemed very put out, I could tell she didn't want to go to the trouble of wasting the morphine. All the while I'm on the other side of the bed holding this foley that I was emptying.

Finally, after repeating myself a couple more times she left the room. I also brought up the idea of pre-medicating with anzemet if the pt was worried about nausea. When I got back to the nurse's station, Crystal had just finished telling the nursing supervisor about my awful behaviour, confronted me that I had "chewed her out" in front of the pt and next time to call me out of the room.

Well, I hadn't chewed her out at all, and calling her out of the room would have made a much bigger scene in my opinion. I thought I was just informing her as to the pt's wishes which obviously she didn't know. I also thought her behaviour with the pt was inappropriate and disrespectful. I talked to the nursing supervisor privately and let her know what had happened. She also relayed all this to my manager, who is manager of both OB and med-surg.

Anyways, I was definately put on the spot by this gal, but it seemed like I had to defend the pt. Others tell me she is prone to this sort of stuff and always causes a stink when sent to med-surg.

So, what do you all think? It sure was unexpected and weird. I don't understand why she didn't just back off, since she hadn't been in report and heard this information. And, this poor woman was so vulnerable, with this gal trying to strongarm her into taking the morphine. It really bugs me.

[LPN1974, LPN]

It would bug me, too. The patient certainly has the right to refuse the medication.

WHY did she come in there with it in the first place??

You did say that the patient decided if she needed something else, she would use percocet, so I'm figuring the pain med was PRN.

Did the patient ask for something, and the nurse brought the MS, or did the nurse just decided on her own to take her something?

[Mystery5]

The other nurse said that the pt had said she was in pain so she had gotten the morphine. I told her that she must've missed that in report, but that the pt had requested percocet for the next time. I thought it was understandable that the nurse had brought the MS, but that the pt really wanted to go with PO meds.

The pt was in no position to defend herself, she was flat on her back, in pain, and making a weak attempt to argue her case. It really bugged me that the nurse didn't back off right away. A pt shouldn't have to expend emotional or mental effort for their simple requests. The nurse should just honor their wishes, period. All Crystal needed to do was say "Oh, I didn't realize that, let me get you some percocet and we'll see how that works". No one should have to repeat themselves, especially when you didn't even hear all of report, you aren't familiar with the pt, and you aren't the nurse for the pt. She was just doing med nurse/ helper nurse, not primary.

[LPN1974, LPN]

Well, I agree. The patient said she didn't want the MS, so that should have been the end of it. The med nurse was stepping over the line by trying to talk the patient into accepting it, after she'd told her it made her nauseated.

Rude and disrespectful to the patient.

I hope your NM sees your side of the incident.

[Mystery5]

Well, I called the nursing supervisor back, asking her if I should email my manager in order to circumvent 'Crystal' running to her and complaining about me. She said not to worry, she had already discussed the whole thing with my manager and with the other nurse. I think my manager is pretty familiar with this gal, this isn't the first time she has over-reacted. She basically made a scene at the nurses station. I just quietly apologized for having offended her. I'm not going to be drawn into a scene at the nurse's station.

I just don't see what else I could had done,this all transpiring in a short period of time, with me holding that pt's foley. I don't know what's so hard about wasting the morphine and getting the Percocet, who hasn't had to do that from time to time when a pt changes his/her mind. Anyways, if Crystal makes a habit of bullying pts and talking to them like that, I sure wouldn't want her for a nurse.