Terrible Clinical

[mkmatthew]

I recently had my second clinical rotation on the Med-Surg floor and I had the worst nurse EVER in charge of my pt. He was in for recovery after a lumbar surgery for decompression and when I got there at 6, he was still on a PCA pump. They were taking him off that day and he was still in quite a bit of pain. He rated his pain at a 5 when I got there and about two hours later it was at an 8. I asked my nurse if I could give him some morphine via injection or maybe some hydrocod. PO and she said no, that he was just faking it! His BP was going up a lot and my instructor told me that I was right to ask but there wasn't really much she could do unless something really bad was about to happen. I finally convinced my nurse (two MORE hours later) to let me give him 20 mg PO hydrocod. and I think it really helped. Then I went and got him 2 packets of crackers because I figured that it would upset his stomach. When I told my nurse she was like, "well, aren't you Ms. Caring." What the heck?! She called him a drug-seeker and said that he didn't even have a job. Well, I went through his charts with a fine tooth comb and didn't see anything about past drug abuse.

How should I have handled this situation?

[Cuddleswithpuddles]

Hi mkmatthew,

I think you handled the situation very well from what you have posted. The unfortunate reality of clinical rotations is that sometimes you have to see unsavory things and be close to powerless to do anything about it. You did well by asking the nurse, telling your instructor, not stepping out of your role as a student nurse but still advocating for the patient.

This was a learning experience. You can learn from everyone, including the nurse you were paired with. Sometimes the best lesson people offer is a lesson on what not to do.

[Lifeofanurse]

It's frustrating to have nurses who think every patient is drug seeking.

I had a patient with sickle cell crisis. Poor guy was having a really hard time. Had a pca but was still in pain. I did the same thing you did and was told the same thing.

Now here's the thing...some diseases will lead to drug addiction. I have no doubt that this guy was addicted however, it was a necessary evil of treating his disease process. Addicted or not our goal should be to minimize our patients pain, promote comfort and keep them alive.

I doubt giving this guy a norco is going to keep/promote his addiction...and it helps him get even a little sleep so be it.

It's wrong to withhold pain meds because of personal feelings.

[turnforthenurse, MSN, NP]

I think you handled the situation very well. You advocated for your patient the best you could. That was one of the things I hated about being a nursing student - you are so limited to what you can and cannot do. You will meet nurses who don't seem to give a d*** about their patients and are just in it for the money, basically. As JDBinCA said, those people will offer lessons on what NOT to do.

It is also said that just because a patient asks for pain medication often (or asks for a medication by name) they are instantly flagged as a drug seeker. Now, I have had patients with drug seeking behaviors in the past, noted in their PMH and everything - yet they are still prescribed pain medication. Pain is the 5th vital sign and you can only measure it by what the patient says. If the patient says they are in pain, they are in pain. It would be wrong with withhold pain medication.

[pockunit, ADN, RN]

Now here's the thing...some diseases will lead to drug addiction. I have no doubt that this guy was addicted however, it was a necessary evil of treating his disease process. Addicted or not our goal should be to minimize our patients pain, promote comfort and keep them alive.

I doubt giving this guy a norco is going to keep/promote his addiction...and it helps him get even a little sleep so be it.

It's wrong to withhold pain meds because of personal feelings.

There's a difference, however, between addiction and tolerance. Being in pain and receiving meds long-term will result in tolerance, but it will not necessarily result in addiction. Addiction is a psychological process, and people with chronic pain don't automatically become addicts.

Whether or not a pt is an addict, though, shouldn't play into treating pain. Worry about their psychological issues after you have their pain under control.

[sandyfeet]

You really did a great job with this patient. Usually when the thread is titled "terrible clinical" or something like that, you expect to read about a student floundering in the clinical setting. But you did everything you were supposed to do, and even was persistent about it! That's awesome. Sometimes you have to step back and look at the situation for what it is: your patient was in pain and you advocated for him until his needs were met. You had an issue with a judgemental nurse and you went to your clinical instructor for it. You had questions about your patient, so you searched his file yourself. Now in the future, you will be more caring, more assertive, and more proactive because you built on all of those skills today. Be happy about how you rocked!!

[ImThatGuy, BSN, RN]

Isn't any experience in med/surg terrible?