The 'On' Button


I’m on call tonight.

Most of our patients are in their own homes. A handful of our patients are in Assisted Living, Group Homes or Nursing Homes. We have a patient census of 75 at the moment, and when the nurse is on call for the night – – it means that she is on call for all 75 of those patients from 4:30 in the afternoon until 8:30 in the morning. Generally, we’re on-call for emergencies, crisis and death. Makes for exciting evenings, let me tell ya. It’s not so bad, though – – we’re only on call about 5 times per month and we get a nice healthy on-call bonus that makes it worthwhile.

Tonight, I get a phone call about one of our nursing home patients. She is on a Morphine Pump — meaning that the Morphine is to be delivered through an IV line via a PCA Pump. That’s one of those fun and fancy gadgets that allow the patient to administer their own doses of Morphine, as needed.

PCA = Patient Controlled Analgesia.

So, this is a new thing for this patient. This nursing home is staffed with 15 nurses – – 12 of which are Registered Nurses – the other three are LPN’s (Licensed Practical Nurses). I was there earlier this evening until about 7pm doing my assessment and setting up the orders for the Morphine Pump and walking the staff through what to do.

The LPN on the unit assured me that she has years of experience with PCA Pumps because she had worked 10 years in Ortho/Surgical floors in the acute care setting. I told her that the pump would be delivered later this evening and to give me a call if she needed help trouble shooting the darned thing.

The pump comes from the medical supply company already pre-programmed according to the doctor’s orders. It’s already set for the amount of continuous morphine the patient is to receive and it’s programmed to allow for the amount of ‘in-between’ morphine that the patient is allowed to give him/herself via what we call the ‘happy button’.

So…I get a page around 9pm this evening. The pump arrived (yay!). The LPN explained that the pump did, indeed, come pre-programmed like I said it would. (double yay!) She said that she primed the tubing (for the IV infusion – – meaning she removed all the air out of the tubing so that it didn’t go into the patient’s vein) and everything was all hooked up and ready to go – – all that needed to be done was to push the ON button.


Then she explained that their nursing home had a policy that only Registered Nurses are allowed to ‘activate’, or run, an IV or PCA pump. LPN’s weren’t allowed to run them. They could set them up – – they just couldn’t run them. She wanted to know if I would come out and push the ON button.

Well, normally I’m a very accommodating person. I have hopped out of bed at 3am to attend to a crisis for a patient…..gotten dressed and made it to a patient’s house at 2am to help deal with the details of a patient’s death and stay for hours to comfort the remaining family. This nurse wanted me to drive 30 minutes out to the facility – – push the ON button – – then drive 30 minutes back home.

I ask, “Don’t you have an RN Supervisor in the house?”

She says, “Yea – but she’s useless.”


I ask, “Is she able to push a button?”

She says, “Yea – but she probably won’t want to get off her butt.”

double hmmm.

I say, “Well, I would advise that your RN Supervisor do what she can to follow your facilities protocol regarding this IV Pump, as I’m sure her Director of Nursing really doesn’t want to know that she was too lazy to get up, walk down the hall and press the ON button. I mean, I could drive an hour to come do it for you – – however, in the morning, when my boss sees my on-call log – – she’s going to want to know why the RN House Supervisor couldn’t do it and will probably necessitate a call to your Director of Nursing. You know how companies are about paying for man-hours and mileage that may not have been completely necessary?”

I state further, “I am more than willing to come out there and help you through this – – if your RN Supervisor cannot find the time to push the ON button on this woman’s Morphine Pump – – please let her know that I will come out and do it…but it will take time for me to get there, and that is time that the patient is going to have to wait for her much needed Morphine – – which is yet another issue that potentially could be taken up with your Director in the morning. I’m just trying to look out for ya.”


The LPN replies – “I’ll just push the damn ON button and answer for it later.”


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