I just got off a busy night shift and I am feeling frustrated by one of the nurses I work with in regard to controlling a patient's pain.
Quick background on me - I am an LPN working as a CNA on a Rehab and Skilled unit at a hospital where they do not hire LPN's. I work homecare as an LPN. I will graduate from an ADN program in 3 weeks.
So...the issue I am wondering about is the reluctance to use the pain medications that the doctor has prescribed for a patient. We currently have a patient on our unit recovering from bilateral total knee replacement. She is female, 50's, a little heavy but not morbidly so, and she has a lot of pain. She is on our unit because she needs more time to recover and some PT to get these new knees working well enough to be safe at home. We put on her bil CPM machines at about 5am each morning. As a CNA, I make sure she is toileted before we do this, as we want her on the machines for 2 hours. I also think she should have pain meds about 30 minutes before CPM application, or right before if we are giving them IV.
For 2 nights in a row now, I have had the nurse assigned to this patient balk at the idea of giving her pain meds before putting on the CPM's. One of them gave her an oral pill at 4:30am, but when we got her up to the bathroom at 5:15am she was moaning in pain and talking about how much it hurt her to move. When she was back in bed at 0530, the nurse asked her about her pain, and said something like, "Do you want something for pain? I know you have been trying to get away from the IV meds," and then just went on with the interaction without giving the patient a chance to answer. As we were finishing up, the patient was still moaning and saying she hurt, and the nurse just said, "Call us if you need anything" and left the room. I followed her and told her that I thought the patient needed something because she was still moaning in pain. The nurse told me again how the patient had refused some pain meds earlier in the night when she was not in pain, and had been "playing on her computer" at another time, like this justified not giving pain meds. I guess I bugged the nurse enough because she did take her down some IV dilaudid.
Note: this patient has no documented history of addiction or any problems r/t opioid meds.
On the second night, before I ever saw the patient, I hear her nurse (a different nurse) complaining to the charge nurse about how the patient says she is having so much pain but that she (the nurse) does not want to give any IV pain meds. I know that patients have to adapt to using PO meds before they go home, but this lady is only up to 65 degrees on her CPMs - she is not going home that soon. I don't know how the pain med administration went for most of the night, but this time it was 5am when I went to toilet her before CPMs. Before I went, I asked the nurse if the pt had been given pain meds. She said she had her oral pill at 0330 (sorry, not sure what it was, but something like Norco), and then "something else" so she should be fine. But again, when we got her up to the bathroom she was moaning and continually saying how much her knees hurt. She had ice packs on when we walked in, and we put fresh ice packs on with the CPMs. It was 0520 when I approached her nurse and told her the patient was in pain and asking for pain medication. The nurse seemed very annoyed. But I think she did go down and give her something. I looked at her MAR and saw that the last thing she had been given was flexoril.
OK - so I know there are probably variables that I don't know about. Since I was working as an aide I did not read this patient's whole history. But I DID ask the nurse tonight WHY we shouldn't give her any pain meds and she said there are people who go home 2 days after knee surgery and they only use PO meds, and that by allowing her to use the IV meds we are letting her "go backwards" in her progress toward home. To me this is not a valid reason, as the patients who are healthy and strong enough to go home 2 days after surgery do not come to our unit. They come to our unit for pain control, recovery time and therapy to help them get stronger.
I guess I am looking for some insight, because I will be a new practicing RN soon and I feel that good pain management is important for these ortho patients if we want them to use their CPMs and do their therapies. I know we don't want respiratory depression, kidney problems, or people who are too dopey to get up in the morning. If the pain meds cause delirium I know we try to decrease doses or change meds. This lady has no therapy scheduled for today and breakfast doesn't come until 0745. She has had no confusion. Why are these nurses so hesitant to get her pain under control?
