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Posted about 5 years ago
Well, here's to nursing and the days you wish you just weren't doing it as much as you do.
I had a really crappy day. It was my second 12, and usually those are harder b/c i'm plum tuckered out. I work agency, and wouldn't you know got put on a different unit that I've never worked before. It was med/surg/oncology( yech). Sorry, but oncology was never my thing.I'm cheery and overly bubbly,and always figured I'd be too intense to be any good dealing with the death and dying process.
One of my pt's was in for pain management, and get this...had Dilaudid IVP q1 hr. If she had no relief in 30 min she could have a s econd dose. So , basically every 30 min if she needed it. I was overwhelmed just hearing this. From what the night nurse reported, she was pretty much giving it round the clock. My only saving grace, was the pain management team had orederd a new dose of 90 mg MS contin q 8hrs.I gave her her 1st dose at 9am. The med worked almost too good. I was able to forgo her 10am,11am and 12noon dilaudid.Every time I checked her she was asleep.
At about 1pm, one of the docs made rounds. I think the primary. He was concerned b/c she was so somulent. I explianed that I had hels her last 3 doses of dilaudid. The doc decided to decrese the MS dose to 80 mg after today. He told me to run it by pain management before implementing the order.
Later pain management came by (about 5pm) and basically had the same concern. The pain management PA said "The pt does not need to be taking all that diluadid now thet she is on MS Contin. He wrote to follow Diluadid orders as written.....confusing right? I asked the pharmacist and she said she interpreted that as q3-4 hours like normal PRN doses are usually written.
At 5:30 pm I proceeded to give my patient her 90 mg of MS contin. Bear in mind I had just given her 2 mg at 4 pm IVP. As soon as I walked in, the pt's husband started saying she needed her Dilaudid and the MS contin all at once. I explained to the pt's spouse that the dr's were concerned about over-dosing the patient and had said to slow down on the dilaudid q 1hr. The spouse said,'No, the pain management guy was just in here and he said she could still have her dilaudid evry hour." I informed the husband that I wanted to re-check the chart and clarify what orders were written. I wanted to make sure I was being safe. I told him I would return,and give the med if the chart had the order.
As I was leaving, I got paged to another pt's room whose IV pump was beeping. I checked that pt. He neded tape to reinforce his line.I was getting tape from the supply room, when I saw my patient's spouse at the nursing station talking to the charge nurse. He was telling her I was refusing to medicate his wife.
What really upset me was instead of the charge nurse giving me the benefit of the doubt, she basically chastised me in front of the patient and insisted I give the Dialudid q 1hr as the original order stated. I was humiliated. It had appeared that I was this cold uncaring nurse . The charge nurse fancied herself the hero who was saving the day.She made comments like"I'll handle this!", and only Dr. soand so knows anything about pain management!"(naturally this was the doc with the q 1hr dilaudid order)
Rather than argue with her and make a scene, I went and got the medication. When I got to the room, I apologized to the pt's husband and asked him why he did not give me a chance to check the orders. I informed him that I had an IV pump gooff, and was on my way to check her chart, when he had already gone to the charge nurse to make it appear that I was denying pain medication to a dying woman.
I explianed to him that the doctor may have said it was ok to give her Dilaudid, but he communicated something completely different to me.I educated him(as I had earlier in the day) to the danger of MS Contin and how people can overdose onit very easily and stop breathing.This was the doctors concerns which they had communicated to me twice. I told him that he nor the charge nurse were doctors and I can't just take their words and do what they say. For safety purposes, I wanted to check the chart.
The pt then said,"I think you've done a fine job relieving my pain, and I'm glad you worried and don't want to hurt me." She vindicated me, but I still want to report that charge nurse for being so blutery and rude at the front of the nurses station. My husband said I was a wimp and should have told her off. I think it was better for me to remain professional, smooth things over with the spouse, and report her actions to her immediate supervisor. I'm agency and don't want to step on any toes, but I think the charge nurse handled that situation poorly.