I recently was not pleased with an encounter with a covering resident who was there for the night shift. I was just finishing my last 12-hour shift of 3 days in a row, and I had been fortunate enough to have the same patients for all 3 days. That is always very helpful for a nurse as you REALLY get to know the patients and can understand them better which leads to better treatment. You really understand when they are describing their pain, and you get a good grip on how to treat it.
At the end of my shift one of my patients informed me he was in a ton of pain. Now, he was receiving 4 mg of Dilaudid by mouth every 4 hours, and I had noticed that he was never drowsy, and would smile and get out of bed and walk around when pain was under control. However, he was also quite the stoic and wouldn't always tell you right away how much pain he was in. He most certainly had a high tolerance for both pain and the medication. I immediately paged the doctor on call to come check him out when his wife called me into the room because he was in too much pain. I walked in the room to see him breathing rapidly, tears in his eyes, and refusing to move from the chair he was in. (It had taken 3 days to get him to be comfortable showing me how he was feeling.) Something didn't seem right to me, and even if everything was okay I needed an order for some IV Dilaudid fast.
The doctor came up within 15 minutes (thank-you) but then argued with me over how much pain he was in. I had managed to get a verbal order for 1 mg of IV Dilaudid, but I wanted to give him 1 more mg as he was still very uncomfortable 15 minutes later. The doctor fought me tooth and nail. He said the patient was comfortable (even though 1 minute prior I had seen for myself he wasn't) and he wasn't going to write it, that he was fine. Instead he wanted to just give a new order of up to 6 mg by mouth.
I understand his concern of not wanting to over-medicate the patient, but I don't understand the need to make a patient in that shape wait another 30 minutes for pain relief when we have the means to stop it in 2. I also was furious over the doctor feeling like he knew the situation better than I did when he has known the patient for all of 3 minutes and I've been taking care of him for the past 3 days.
I wish he would have listened. I'm sorry the patient was in pain 25 minutes longer than he needed to be.
Tuesday, December 18, 2007
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Sympathy and total empathy. I'm an oncology nurse in So Cal. Have had similar experiences. Maybe a pain induction class in medical school... (just joking - not really)
I'm not a nurse, but was a spinal cord injury patient for 8 months. I am still thankful for the nurses that worked with me! They made sure I got what I needed and had countless arguments with the Dr's to get what I needed.
In fact one of the Dr's was trying to get papers signed saying I was incompetent and couldn't make decision for myself because I didn't want to use a power wheelchair and live in a nursing home! I was in my 20's! She also almost had my guide dog (I've also been blind since birth) taken away from me because I wanted to live on my own like I had been.
Thankfully the nurses on my unit all got together along with the psychiatrists that she sent to see me and said they wouldn't let that happen!
When I got discharged I move into a new apartment with my guide dog and have been completely independent ever since! All because the nurses really cared about what happened to me!
They even stole the Xmas tree from the hallway on Xmas Eve and brought it into my room and put my gifts under it lol!
I will never forget all they did for me!
How long do you expect lmg dilaudid iv to last? What was the source of the pain? As I read your post, I thought perhaps you were going to say that the patient was hiding his oral dilaudid since he was never drowsy. Maybe you could cut the doc a little slack. How long had he been on his shift?
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