I myself try po first and if non effective and their vitals hold up give an iv med one hour after. I do this to try and let the po have a chance to work because these meds last longer. If in severe pain I give the iv med for faster pain control then a po med after an hour. I know some nurses who have given both at same time and have been written up because of it although there is no policy against it, the manager just told them “you just don’t do it” . When an oncoming nurse doesn’t believe the same way you do about this issue this confuses the patient and anxiety contributes to pain issues. I honestly believe a policy about this would help because if the policy were put in place then if pain control was an issue then it would give a nurse a reason to call a dr for another med or to change the timing per dr order. Instead, if we call some docs late they say I have an order for iv med why did u not give that?