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Was I wrong?

Nurses   (12,984 Views 107 Comments)
by Munch Munch (Member) Member Nurse

Munch has 10 years experience and specializes in Med-Surg/Neuro/Oncology floor nursing..

7,798 Profile Views; 349 Posts

You are reading page 6 of Was I wrong?. If you want to start from the beginning Go to First Page.

RockinNurse2018 has 1 years experience and specializes in Geriatrics w/rehab, LTC, hospice patient.

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Based on everyone else's responses, I think the consensus is that you did the right thing. Your coworker was totally off the line. Honestly if I found out one of my coworkers were able to ease one of my patient's pain, I would be very appreciative, as I'm sure would the patient.

Thing is, once you got report, she was your patient, not your coworkers. I've never had anyone get mad because I didn't consult them before advocating for a patient. In fact, they'd probably be annoyed if I did. Also she was wrong that you should have just followed the medication orders. As nurses we are taught to do more than that. We do follow orders, but we also assess our interventions and make changes if those interventions are ineffective. And that's just what you did.

I would not worry about that nurse's opinion since she doesn't appear to care about her patients. Just rest well knowing you were able to help that patient.

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Tenebrae has 7 years experience as a BSN, RN and specializes in Primary Health, Gerontology, Palliative.

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What is it with some nurses(and docs) that think that just because someone abuses drugs and or alcohol that 1) they can't possibly be having real pain and 2)if they really are having pain they are addicts so no addicting meds for them like they should be punished for being addicted to something.

I dont know know if anyone would ever overtly admit to that, however it seems to be governing their practice.

Even if someone had a dependence it stands to reason that they are going to need more pain relief not less.

As far as sickle cell goes it really isn't relevant if they are addicts. They have a life long excruciating painful disease. Its almost like being worried about getting a patient in hospice addicted to narcs. With sickle cell the disease is never going away their is no cure. Some if not most will need narcotics for the rest of their lives. Being addicted isn't really relevent.

Ha! Been through that, people worry that Mr Such and such who has end stage CA something will get addicted to morphine. Its like seriously they are dying, its not going to make it any worse.

Thats another issue that comes up is the huge amounts of narcotics these SSC patients are indeed tolerant to. If they don't get the right dosages of these meds for these patients then you also have to deal with opiate withdrawal on top of the excruciating disease process sickle cell. Gosh can you imagine being in withdrawal during a crisis? I luckily can't even imagine but its something I wouldn't wish on anyone.

Like I said, you did good. You actually did awesome. you saw a patient with a need and went into advocate for your patient and achieved an excellent outcome. You should be proud:yes:

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Munch has 10 years experience and specializes in Med-Surg/Neuro/Oncology floor nursing..

349 Posts; 7,798 Profile Views

I dont know know if anyone would ever overtly admit to that, however it seems to be governing their practice.

Even if someone had a dependence it stands to reason that they are going to need more pain relief not less.

Ha! Been through that, people worry that Mr Such and such who has end stage CA something will get addicted to morphine. Its like seriously they are dying, its not going to make it any worse.

Like I said, you did good. You actually did awesome. you saw a patient with a need and went into advocate for your patient and achieved an excellent outcome. You should be proud:yes:

I was reading an old thread about a patient that was an addict and was prescribed something like a Vicodin for a really painful condition and the Vicodin wasn't working. One of the nurses on this thread replied that maybe they should think about the consequences of their drug abuse before they go using. As to say well you're an addict too bad. I was talking to my friend about the co-worker I was covering for and she said she is always the first to comment about a potential drug seeker and never gives anyone the benefit of the doubt. Its really scary to think she has been a nurse for all these years. I reported the incident to my manager. I sure hope something is done. Pain should be treated as real until proven otherwise..bottom line.

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Munch has 10 years experience and specializes in Med-Surg/Neuro/Oncology floor nursing..

349 Posts; 7,798 Profile Views

I dont know know if anyone would ever overtly admit to that, however it seems to be governing their practice.

Even if someone had a dependence it stands to reason that they are going to need more pain relief not less.

Ha! Been through that, people worry that Mr Such and such who has end stage CA something will get addicted to morphine. Its like seriously they are dying, its not going to make it any worse.

Like I said, you did good. You actually did awesome. you saw a patient with a need and went into advocate for your patient and achieved an excellent outcome. You should be proud:yes:

I was reading an old thread about a patient that was an addict and was prescribed something like a Vicodin for a really painful condition and the Vicodin wasn't working. One of the nurses on this thread replied that maybe they should think about the consequences of their drug abuse before they go using. As to say well you're an addict too bad. I was talking to my friend about the co-worker I was covering for and she said she is always the first to comment about a potential drug seeker and never gives anyone the benefit of the doubt. Its really scary to think she has been a nurse for all these years. I reported the incident to my manager. I sure hope something is done. Pain should be treated as real until proven otherwise..bottom line.

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My thoughts reading while reading this thread were pain meds q 2 hours is hard to do at times with multiple patients and I would have welcomed the PCA for my patient and myself. You gave that patient better pain control instead of constantly chasing it, and thus allowing you more time to care for your other patients. MDs where I work start out with "normal" doses of pain medication but if a patients admits to drug abuse ( having a high tolerance for opioids) they will adjust meds to meet their needs for pain control.

I would have personally thanked you for caring for my patient and getting the PCA pump. We pledge to take care of everyone equally even if we don't like it.

You did the right thing!

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

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Thanks for being a patient advocate, your actions were appropriate to acheive adequate pain control. I've cared for hundreds of patients with Sickle Cell Disease.... they are admitted often for pain management and hydration, many with vaso-occlusive disease causing cell and bone death, which many nurses don't understand. Following article informative of this disease.

Sickle patients best managed by Hematologist. Having a pain management + care plan for handling acute crisis as part of patients medical record is best practice these days.

American Academy Family Physicians.

Approach to the vaso-occlusive crisis in adults with sickle cell disease

...the vaso-occlusive crisis, or sickle cell crisis, is initiated and sustained by interactions among sickle cells, endothelial cells and plasma constituents.1 vaso-occlusion is responsible for a wide variety of clinical complications of sickle cell disease, including pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.

a vaso-occlusive crisis is initiated and sustained by the interaction among sickle cells, endothelial cells and plasma constituents. clinical complications include pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.

acute pain in patients with sickle cell disease is caused by ischemic tissue injury resulting from the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. chronic pain occurs because of the destruction of bones, joints and visceral organs as a result of recurrent crises. the effect of unpredictable recurrences of acute crises on chronic pain creates a unique pain syndrome.2,3

acute bone pain from microvascular occlusion is a common reason for emergency department visits and hospitalizations in patients with sickle cell disease.4 obstruction of blood flow results in regional hypoxemia and acidosis, creating a recurrent pattern of further sickling, tissue injury and pain. the severe pain is believed to be caused by increased intramedullary pressure, especially within the juxta-articular areas of long bones, secondary to an acute inflammatory response to vascular necrosis of the bone marrow by sickled eythrocytes.5 the pain may also occur because of involvement of the periosteum or periarticular soft tissue of the joints.

the approach to pain control must include measures to treat acute pain crises, prevent future vaso-occlusive crises and manage the long-term sequelae of chronic pain that can result from multiple recurrent bony infarction....

Edited by NRSKarenRN
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Lexi McDonough has 3 years experience and specializes in CCRN, CMSRN, ACLS, Tele, Code TeamLeader.

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You did nothing wrong. Regardless of whether or not you are covering part ofsomeone's shift, once you take report and the patient is handed off to you, you are supposed to provide whatever care you think is best (provided of course you are engaging in evidence based practice and not doing anything against policy).

If this were me, I would report the incident. Even if you did do something wrong, her response was very inappropriate and surely against your organizations code of conduct. Also, just because you suspect a patient is a drug seeker and even if you know they are an addict, you still assess and treat their pain the same way. Considering he fact that addiction is now a diagnoseable disease, she is doubly wrong.

IMO from what you said, your coworker is not a good nurse and may actually be harming patients by improperly addressing real pain. Even if you are one of those people who think addiciton is not a disease and addicts should not get narcotics, you should realize that you arent going to cure their addiction during this admission and giving them the meds isnt going to make things worse, it might actually make things better because what if (and this happens relatively often) they sign out AMA because they arent getting enough drugs and instead go and do something illegal or dangerous? Regardless of you views on addiction, you have to admit that getting pharmaceutical quality medication while being monitored in a hospital setting is safe better/safe for the patient and everyone else than having them do something dangerous/illegal (i.e. mug someone for drug money) and use street drugs that are not only sterile, but could contain any number of harmful even deadly additives. Even from a financial perspective it costs a lot less to give and admitted patient pain meds than treat them for hep C or other drug use related disease later on.

Sorry to rant, In short, your coworker was wrong and you did everything right. Even if we ignore the whole addiction is a disease thing she still behaved inappropriately in front of a co-worker and you treated you patient according to how the ANA, state BON, and most medical professionals would consider correct.

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Lexi McDonough has 3 years experience and specializes in CCRN, CMSRN, ACLS, Tele, Code TeamLeader.

93 Posts; 1,395 Profile Views

Exactly. The patient was her responsibility and when you are responsible for a patient, you are required by ethics, the law, and hospital policy to treat them as best as you can and the fact that you are covering for someone doesn't change a thing.

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3ringnursing has 25 years experience as a BSN and specializes in ICU; Telephone Triage Nurse.

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She was actually YOUR patient at the time when you made the call for a med change request.

One of the delightful types of personalities one may run into on a day to day basis in the work place - whether you are an accountant or a street sweeper, doesn't matter what profession you are in.

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Leader25 has 35 years experience.

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I would have called her and put our two heads together.

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

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Always treat the patient, not the diagnosis. Sorry this happened to you. So many people see drug addiction as a choice, instead of as a disease. If the patient had cancer, would you even question yourself? She was in pain. You did the right thing by advocating for your patient. The resident had full access to the records for this patient - the decision was ultimately made by the prescribing authority. Your colleague could possibly use some education.

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