A nurse on the cardiovascular step-down unit is caring for a patient who is postoperative day 2 after arterial bypass surgery. The patient has a PCA with hydromorphone infusion and has hydrocodone 10 mg po Q4 hours ordered for breakthrough pain. During morning assessment, the patient complains of pain rated 10 on a scale of 0 to 10. The nurse offers the patient the hydrocodone for breakthrough pain. The patient states, "I asked for pain medication from the other nurse and was told no because I have a PCA." On further questioning, the patient stated that the other nurse threatened to disconnect the PCA if the patient continued to complain. The nurse knows the next appropriate action is which of the following?

Discuss the accusations with the charge nurse and complete an incident report.


•Pain is a subjective experience, and all patients will experience pain individually from others. When a patient complains of pain, it is the nurse's duty to address the pain.

•If a patient has a PCA pump and orders for breakthrough pain medication, this is because pain medications provided through a PCA are shorter acting while breakthrough pain medications are longer-acting to help achieve better pain control.

•Any nurse who refuses to administer pain medication as ordered or who threatens patients with withholding pain medication can be charged with abuse and neglect.

•The appropriate course of action is to discuss the accusations with the charge nurse and file an incident report. Further action will be pursued with the accused nurse by appropriate hospital personnel as required, possibly even up to the state board of nursing.

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