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snickers17 snickers17 (New Member) New Member

Was I wrong?

Med-Surg   (2,545 Views 20 Comments)
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I am a new nurse (5 months) on a trauma floor on dayshift. Today while giving report, the oncoming nurse noted that a patient was able to get PRN oxycodone starting at 1850, but the patient hadnt requested the medication yet and I was giving report at 1925. The other nurse asked "I have another patient to get report on, can you go give this patient their pain medication?" I normally always say yes to helping someone, but I was not comfortable giving a narcotic when the patient hadn't asked and told her so. She looked dumbfounded and said "I want you to know I will always leave my patients medicated for pain when I give you report." I felt absolutely terrible, but this same nurse has had me give pain meds right after report before and it caused me to stay until 2030. I just would like to know if it was wrong for me to say no.

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If she decided a pain med was necessary based on her assessment of the patient, then she can give the med. Simple as that. Won't comment on the apparent "prophylactic" use of PRN meds.

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Do you do bedside rounds? If so, a pain assessment at that time may have indicated a need for the PRN.

I don't give oxy just because it's available to the patient.

But also, why would going a pain med cause you to be there till 8:20?

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I don't think you were wrong. Oxycodone q 4hr PRN doesn't mean administer q 4hr, it means it's available to the patient every 4 hours if he needs it.

When I worked in the hospital, there were sometimes that we gave PRNs around the clock for certain surgeries but that was IV meds for like 24 hours post-op.

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Yeah, strikes me as sort of "make my life easier by heading off the possibility that my patient may be ask for a pain med soon."

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I am a new nurse (5 months) on a trauma floor on dayshift. Today while giving report, the oncoming nurse noted that a patient was able to get PRN oxycodone starting at 1850, but the patient hadnt requested the medication yet and I was giving report at 1925. The other nurse asked "I have another patient to get report on, can you go give this patient their pain medication?" I normally always say yes to helping someone, but I was not comfortable giving a narcotic when the patient hadn't asked and told her so. She looked dumbfounded and said "I want you to know I will always leave my patients medicated for pain when I give you report." I felt absolutely terrible, but this same nurse has had me give pain meds right after report before and it caused me to stay until 2030. I just would like to know if it was wrong for me to say no.

No. You were not wrong.

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If the patient hadn't asked for their pain medication and your assessment didn't indicate that they were in pain, you weren't wrong. The other nurse was.

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I am a new nurse (5 months) on a trauma floor on dayshift. Today while giving report, the oncoming nurse noted that a patient was able to get PRN oxycodone starting at 1850, but the patient hadnt requested the medication yet and I was giving report at 1925. The other nurse asked "I have another patient to get report on, can you go give this patient their pain medication?" I normally always say yes to helping someone, but I was not comfortable giving a narcotic when the patient hadn't asked and told her so. She looked dumbfounded and said "I want you to know I will always leave my patients medicated for pain when I give you report." I felt absolutely terrible, but this same nurse has had me give pain meds right after report before and it caused me to stay until 2030. I just would like to know if it was wrong for me to say no.

You were not wrong ...but I do typically check in with patients who are "due" for pain medication before handing the patient off to the next shift. I think it's a courteous thing to do, both towards the oncoming nurse and towards the patient.

The nurses I come in after tend to do the same. I suppose it's part of our unit culture, but it's not something people ever argue over.

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You werent wrong

I may prophylactically give pain meds if I know the patient is about to undergo something that may cause them pain, eg changing a dressing, getting them to mobilise etc however otherwise I give PRNs when the patient asks for it, or if a pain assessment indicates it is needed (eg modified abby pain score in non verbal patients)

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She looked dumbfounded and said "I want you to know I will always leave my patients medicated for pain when I give you report."

That's absolutely fine and good if they are in need of pain medication. So I would've said, "If doing so would represent the best nursing care for that patient, that's great. I will do the same, because it is prudent nursing care. If that particular timing does not happen to be prudent care of that patient, then I won't be doing it."

I'm not real fond of people pretending they have done me some huge personal favor by taking (what they insinuate is) proper care of patients.

I felt absolutely terrible...

You only have reason to feel bad if the patient's pain was uncontrolled because of your management and/or you unnecessarily delayed in medicating the patient when they were in pain.

Don't make a habit of feeling "terrible" based on someone else's declarations of their own perfection.

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No I don't think you were wrong. This wasn't an antibiotic or some other routine medication that must be given as ordered.

It's not like you missed a scheduled routine med - a PRN med is just that, and from the scenario you described the patient had not asked for it, or even indicated a need for it at that time. You are not obligated to administer a narcotic to a patient just because the incoming nurse wants you to.

She is not your supervisor, and you are not beholden to her orders. You act under your own nursing license as you see fit.

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