As many of you know, I am an LPN in a nursing home..and I currently work on a physical therapy rehab unit, I was really enjoying the change of pace and was recieving nothing but kudos until the past few weeks..however, as is sometimes the case in nursing homes, it has been our unit's "turn" to have a few falls occur, with one lady in particular. We brainstormed and tried all types of interventions with her, but she had prior to her placement suffered a stroke, was placed with us for strengthening etc..but as some of you may know, in patients recovering from strokes, it is sometimes difficult, if not impossible, to rationalize with them nor make them understand the purpose of said interventions.
Well, as happens at most times, the blame starts getting shifted around until it falls upon my shift..my fellow nurse and I took their "constructive criticism" and suggestions to heart and have done our best to preven any further falls for this woman..but our nurse manager's big "suggestion" was to run a study regarding how many pain medications we dispense in the evening and to "suggest" that perhaps I don't give enough pain medication, specifically narcotics..and that perhaps I should attempt to give more of them in an effort to help prevent falls. I calmly explained to her that our "frequent faller' was on routine pain meds, and that *most* of our other patients are with us strictly for rehab, and as such are "with it" and perfectly able to tell me if they need pain medication or not, and further that I offer pain meds throughout the shift..if they tell me they don't need anything I don't give it..if they state that they would like it I ask what their level of pain is and dispense the proper pain medication. She then stated "well, some of these people wouldn't tell you if they were in pain to save their life, so maybe you should just give them something anyway"..I then explained to her that I went to one of the best nursing schools in this state (which has a 100% passing rate on the LPN boards for the past 7 years), and that I was trained VERY well, that I know the physical AND non physical indicators of pain, even with patient denial..AND reminded her that the patients pain level is whatever they state it is..so that *I* was confident in my ability to judge such AND in my competency as a nurse..further, my feeling is (and I plan to state such to both my nurse manager and the ADON) that if they *aren't* as confident in my ability and competency to do my job to tell me now and I will gladly submit my resignation and go elsewhere as I will *not* be made to feel as if I *have* to give pain meds that I don't feel justified in giving..as giving those extra pain meds can actually INCREASE a person's chance to fall related to drowsiness and other side effects....especially in the case of narcotics..that's why they are *controlled* and to be kept under lock and key...
Anyway..thanks for letting me vent..I'm probably overreacting..but still..I just felt strongly that she was trying to push me into giving more meds that just aren't justified..like I said..I KNOW how to do my job and I strongly believe in my competence..if they want them given more frequently, get the order from the doctor to give them routinely..then it's not on my license and they can try to justify it to him..
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