REFLECTIONS
By Peggy Vincent, RN, CNM
Editor’s note: We are often amazed by the richness of our archives here at AJN. This essay, originally published in the February 2002 issue, touches on topics as relevant today as ever: inadequate pain relief and the costs to patients of certain nursing scope-of-practice limitations.
“D
islocated shoulder just walked have responded, I wondered, if this in,” the nurse had hollered. screaming teenager had been their “I need 10 of morphine.” child? My 24-year-old son Colin had At last a nurse came and just lurched into the ED of a stayed. She called Skylar by private hospital on Californame, started oxygen, requested nia’s coast after a weightan X-ray, and treated me like a lifting mishap. “Allergic to colleague. But without a docanything?” the nurse had tor’s order, she was as helpless asked. When Colin had said as I was to ease Skylar’s pain. no, she’d immediately injected Three times she called the orthomorphine, saying, “With dislopedist to request pain medication, cations, we have a standing order. but each time she was told, “He’s not Morphine first; questions later.” available.” She confided that, beWhen I arrived 15 minutes later, cause of her dissatisfaction with Colin was calm and blessedly woozy. this HMO, she was quitting in But he held his arm at a strange antwo weeks to work at a private gle, and I couldn’t stop staring at the hospital. sickening hollow where his shoulder Eventually the orthopedist arTwo sons, similar injuries—two should have been. rived, an expressionless man with very different experiences of pain. the bedside manner of a bottle of I was grateful that my son was made comfortable while waiting for saline. He didn’t acknowledge me, treatment, especially with something as painful as a dislocated nor did he respond when spoken to. He ordered morphine shoulder. As a former delivery room nurse, there were times and left without speaking. The nurse injected the drug immewhen my first response upon a woman’s admission was to ob- diately. tain an order for pain relief. I remember thinking as I kissed my “Wow, my brain is clogged. That’s so weird,” Skylar said, son’s forehead, “This is how it should always be.” but 10 minutes later he moaned, “It’s not enough,” and again Four years later, my other son, Skylar, an athletic 15-year- his screams rang through the corridors. old, arrived at the ED of the largest HMO in the San Francisco When the doctor returned, I said, with forced composure, Bay Area. He had blocked a shot during a pick-up basketball “He wants to know if he can have more.” game and dislocated his shoulder. His screams silenced the “We’re taking care of him,” he said in a monotone. crowded waiting room, and he held his arm at that same, faYeah, right, I thought. miliar, stomach-turning angle. Skylar received a second dose and finally fell asleep. For the I know how hospitals function. I know the right language, first time in 90 minutes, I relaxed. Ten minutes later, the pokerhow to work the system, but none of my 35 years of experifaced doctor did an adequate reduction, straightened his lab ence helped my son. I said to a physician, “You’re a doctor, coat, and disappeared. We never saw him again. right? We need an order for pain medication. Please make my Like his older brother’s, Skylar’s shoulder injury healed well. son comfortable while he’s waiting.” Nothing happened. But their experiences in the ED couldn’t have been more difA nurse started an iv and left. I approached an ED guard, a ferent. One got morphine sooner; the other got it later—and registration clerk, a triage nurse, an ED orderly, five nurses, suffered horribly. Since then, I’ve tried to fathom the possiand two physicians. I appealed to them as an assertive nurse ble causes of the differences in their treatments. Regardless, and a desperate mother. Nothing worked. For 90 minutes I know my youngest child suffered far too long. people in white walked past us and did nothing except offer These two experiences reinforced my belief that nurses need meaningless updates: “We’ve called the ortho doctor,” or more autonomy in providing pain relief. While my midwifery “We’ll give him something as soon as we have an order.” For patients rarely asked for pain relief, my ability to provide im90 minutes my demands and pleas produced no one who said, mediate relief when requested was one of my satisfactions—I “Morphine. Now.” didn’t have to wait for a doctor. I had standing orders signed As a nurse and midwife, I was usually able to provide relief by a physician under whom I practiced, and those orders gave with my presence and speech, my touch, or merely by making me wide latitude. Why don’t ED nurses have the same indeeye contact. But when my patients needed pain medication, I pendence? ▼ was forceful in getting a doctor’s order—immediately. Peggy Vincent is the author of Baby Catcher: Chronicles of a Modern MidBut standing beside my writhing son, I marveled at the wife (Scribner, 2002). Reflections is coordinated by Madeleine Mysko, MA, RN: [email protected]. Illustration by Joseph Wigfield. callous attitude of most of the employees. How would they
Morphine. Now.
72
AJN ▼ April 2015
▼
Vol. 115, No. 4
ajnonline.com
By Peggy Vincent, RN, CNM
Editor’s note: We are often amazed by the richness of our archives here at AJN. This essay, originally published in the February 2002 issue, touches on topics as relevant today as ever: inadequate pain relief and the costs to patients of certain nursing scope-of-practice limitations.
“D
islocated shoulder just walked have responded, I wondered, if this in,” the nurse had hollered. screaming teenager had been their “I need 10 of morphine.” child? My 24-year-old son Colin had At last a nurse came and just lurched into the ED of a stayed. She called Skylar by private hospital on Californame, started oxygen, requested nia’s coast after a weightan X-ray, and treated me like a lifting mishap. “Allergic to colleague. But without a docanything?” the nurse had tor’s order, she was as helpless asked. When Colin had said as I was to ease Skylar’s pain. no, she’d immediately injected Three times she called the orthomorphine, saying, “With dislopedist to request pain medication, cations, we have a standing order. but each time she was told, “He’s not Morphine first; questions later.” available.” She confided that, beWhen I arrived 15 minutes later, cause of her dissatisfaction with Colin was calm and blessedly woozy. this HMO, she was quitting in But he held his arm at a strange antwo weeks to work at a private gle, and I couldn’t stop staring at the hospital. sickening hollow where his shoulder Eventually the orthopedist arTwo sons, similar injuries—two should have been. rived, an expressionless man with very different experiences of pain. the bedside manner of a bottle of I was grateful that my son was made comfortable while waiting for saline. He didn’t acknowledge me, treatment, especially with something as painful as a dislocated nor did he respond when spoken to. He ordered morphine shoulder. As a former delivery room nurse, there were times and left without speaking. The nurse injected the drug immewhen my first response upon a woman’s admission was to ob- diately. tain an order for pain relief. I remember thinking as I kissed my “Wow, my brain is clogged. That’s so weird,” Skylar said, son’s forehead, “This is how it should always be.” but 10 minutes later he moaned, “It’s not enough,” and again Four years later, my other son, Skylar, an athletic 15-year- his screams rang through the corridors. old, arrived at the ED of the largest HMO in the San Francisco When the doctor returned, I said, with forced composure, Bay Area. He had blocked a shot during a pick-up basketball “He wants to know if he can have more.” game and dislocated his shoulder. His screams silenced the “We’re taking care of him,” he said in a monotone. crowded waiting room, and he held his arm at that same, faYeah, right, I thought. miliar, stomach-turning angle. Skylar received a second dose and finally fell asleep. For the I know how hospitals function. I know the right language, first time in 90 minutes, I relaxed. Ten minutes later, the pokerhow to work the system, but none of my 35 years of experifaced doctor did an adequate reduction, straightened his lab ence helped my son. I said to a physician, “You’re a doctor, coat, and disappeared. We never saw him again. right? We need an order for pain medication. Please make my Like his older brother’s, Skylar’s shoulder injury healed well. son comfortable while he’s waiting.” Nothing happened. But their experiences in the ED couldn’t have been more difA nurse started an iv and left. I approached an ED guard, a ferent. One got morphine sooner; the other got it later—and registration clerk, a triage nurse, an ED orderly, five nurses, suffered horribly. Since then, I’ve tried to fathom the possiand two physicians. I appealed to them as an assertive nurse ble causes of the differences in their treatments. Regardless, and a desperate mother. Nothing worked. For 90 minutes I know my youngest child suffered far too long. people in white walked past us and did nothing except offer These two experiences reinforced my belief that nurses need meaningless updates: “We’ve called the ortho doctor,” or more autonomy in providing pain relief. While my midwifery “We’ll give him something as soon as we have an order.” For patients rarely asked for pain relief, my ability to provide im90 minutes my demands and pleas produced no one who said, mediate relief when requested was one of my satisfactions—I “Morphine. Now.” didn’t have to wait for a doctor. I had standing orders signed As a nurse and midwife, I was usually able to provide relief by a physician under whom I practiced, and those orders gave with my presence and speech, my touch, or merely by making me wide latitude. Why don’t ED nurses have the same indeeye contact. But when my patients needed pain medication, I pendence? ▼ was forceful in getting a doctor’s order—immediately. Peggy Vincent is the author of Baby Catcher: Chronicles of a Modern MidBut standing beside my writhing son, I marveled at the wife (Scribner, 2002). Reflections is coordinated by Madeleine Mysko, MA, RN: [email protected]. Illustration by Joseph Wigfield. callous attitude of most of the employees. How would they
Morphine. Now.
72
AJN ▼ April 2015
▼
Vol. 115, No. 4
ajnonline.com
