1. Ufema, Joy RN, MS

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I'm a hospice home healthcare nurse. One of my patients tells me she's having severe pain due to her advanced lung cancer. I discussed this with my nurse manager, who called the patient's physician. He refused to order morphine, preferring Lortab (hydrocodone bitartrate and acetaminophen). How can we convince him that his patient is suffering and needs stronger medication? M.J., NEV.


Your patient deserves to be pain-free to finish her life with dignity and peace. I'm worried that relief of suffering no longer seems to be a mandate for some physicians.


Years ago, I visited a woman dying in great pain. Her physician had prescribed an inadequate dose of an inappropriate opioid. He hung up on me when I called for the third time in 15 minutes for an order for morphine. Finally I telephoned my patient's father, told him the problem, and gave him the physician's number. I boldly advised him that if the physician didn't agree to order morphine, he should discharge him. "Justcall me back and I'll give you the names of compassionate physicians who would be honored to take care of your daughter," I said.


No healthcare provider should have to be "convinced" to provide adequate analgesia. If your patient's physician isn't knowledgeable enough to manage end-of-life symptoms, consider enlisting her family to take similar action.