Was I wrong?

[snickers17]

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.

[Kallie3006, ADN]

You will come to find some nurses try to get the previous shift to do a lot of various tasks, and the more you do the more they expect. You rounded on your patient, pain was not expressed or the need of pain medication, and you gave your report based on that. By giving report you have transferred the patient care to another competent nurse therefore severing your nurse patient relationship. This means you are no longer responsible for this patient and any due or requested medication is now the responsibility of the nurse that relieved you.

The statement she made as to ALWAYS having her patients medicated for you was made to make you feel guilty because you are not extending the same courtesy for her. This is hockey sticks and poor wording on her end by including an absolute in her passive aggressive jab. Do not let people guilt you into doing things such as this. Her medicating the patients prior to handing over patient care is not a favor to you but rather her doing her job and caring for the patients she has assumed care for.

Stand your ground.

[Persephone Paige, ADN]

I'm sorry, but I'm in recovery and this just sounds weird to me. I've never heard of such a thing. Immediately my mind goes to, "what? she wants you to medicate the patient first so that when she pulls an Oxy every 4 hours on her shift, the pharmacy won't flag her?" Maybe that's just where my head goes, but when nurses are dying to medicate someone, I see 'red flag.' Or, what does she want, as many of her patients knocked out as possible? We are fighting an Opiate epidemic, the patients should ask first before just medicating them because it's ordered.

[amzyRN]

No, you weren't wrong. The patient didn't ask for it, thus it would be wrong to give it. I might have asked her why she would give a PRN med if the patient didn't ask for it. If the patient asked her she should give it. PRN means as needed not scheduled right?

[MunoRN, RN]

Patients don't need to ask for prn pain medications, if the source and nature of the patient's pain makes it likely or even just possible that the patient's pain may require ongoing management then appropriate nursing practice would be to assess for pain around the time the next dose would be due, since that usually coincides with the duration of action of the pain med.

Appropriate nursing care shouldn't be provided only upon request.

[JKL33]

^ Agree. For some patients that will mean re-assessing and re-medicating as soon as the patient can have another PRN dose. For some patients it will mean calling the ordering service ahead of time to get additional orders. And/or whatever is best for the patient. The idea that a patient hasn't called out so must not need anything is not good nursing care.

Just the same, the oncoming nurse's concern would've been less drama and more patient-centered had she simply advised that patients be re-assessed periodically and particularly around the time that a previous dose's duration of action may be waning. The take-home point is knowing what a patient's needs are/reassessing appropriately/intervening based on assessment, etc., not "always" medicating patients with anything they can have prior to report.

[Kallie3006, ADN]

Patients don't need to ask for prn pain medications, if the source and nature of the patient's pain makes it likely or even just possible that the patient's pain may require ongoing management then appropriate nursing practice would be to assess for pain around the time the next dose would be due, since that usually coincides with the duration of action of the pain med.

Appropriate nursing care shouldn't be provided only upon request.

Just because the patient did not receive a prn medication the moment the dose could be given does not mean that the OP was not providing appropriate and prudent nursing care. PRN is for as needed, and if the patient did not need, request nor require the pain medication then the medication should not have been given just because the option became available.

The OP stated that the patient did not request the medication which leads me to believe the patient is oriented and is capable of understanding the prn medication will not be automatically brought in by the nurse. The need to assess and reassess pain should be done throughout the shift, thus the nurse is providing appropriate nursing care for the patients. Had the patient been unable to communicate being in pain the pain assessment would still need to be completed by the nurse, just using a different scale to determine the patients pain status.

There was not any information in the OP's post that led me to believe that the patient is or was requiring the medication to be given every 4 hours, just that the order was available to be given every 4 hours as needed.

I do agree that there are some patients that do need the pain medication as soon as they are able to have it again, and there are times when interventions need to be completed if the pain medication is not helping the patients pain to be maintained at a tolerable level.

IMO bringing pain medication to a patient when they have not displayed or expressed being in pain is not providing appropriate nursing care or judgment.

[humerusRN, BSN]

As long as you ASSESSED the patient's pain prior to shift change and addressed it, then you are fine. But if you are *WAITING* for a patient to call out for a pain medication, IMO - you are doing it wrong. I do not rely on my patients to contact me - I hourly round and always assess for pain.

I really does suck to get report and then have patients calling out for pain meds all at the same time. I try to always address these things prior to shift change to save me and the oncoming nurse a headache.

[queencityRN]

Don't feel bad. She just didn't want to have to go in there yet. That's not your problem! Make your rounds at 6 and evaluate patient needs. She should be rounding at 7. If the patient is needing the medication every 4 hours, then the provider needs to order it that way...not PRN. The only time I do take it every time they can have it is when they are in extreme pain and we're working to keep it from getting out of control or the patient is getting ready for a dressing change, to ambulate, etc.

Stand up for yourself and go with what you know is right! You'll never make everyone happy!

[ClaraRedheart, BSN, RN]

If it is a patient that generally takes their pain medication as soon as it's available, it's polite to assess the patient prior to your leaving to see if they need the medication.

[babedollRN]

Usually I would assess my patient's pain level before the next shift. If they need to be medicated I will do so, so the on coming nurse doesn't have to do that if they are due. Also, if you do bedside report, like the other person said, both of you can assess it at that time. Some patient will lay there in pain and not ask and those patients have to be assess. I know PRN means it they need it they should ask, but you have to assess and look out for the on coming nurse. I don't know the real story, but this is my take on it.