Advice for dealing with addicts? - page 3
I'm in a detox clinic & this is my first nursing job & first experience in addictions. We have standing PRN orders for 25mg Vistaril Q6H PRN, Phenergen (must see vomit),75-150mg Trazodone for sleep... Read More
Sep 4, '13 by garnetgirl29, LPNQuote from TriciaJThis is EXACTLY what I'm trying to do. Thank you TriciaJ. When I originally posted this tread, I was brand new to this job. I have dealt with addicts before this position, but as a family member; not as a nurse. I am a brand new nurse and this is my first job. I was looking for good advice on how to be therapeutic with these clients. I am not " withholding meds". All of these clients are on either our suboxone protocol or librium protocol. Our doctor is very wishy washy and arrogant. He changes his mind all the time, so it's nearly impossible for all of us to be on the same page and some of our standing orders leave a lot up to the nurses discretion. We've tried clarifying standing orders, and we get nowhere. And it doesn't help that we get contradicting orders between the MD & NP.Seems to me the OP is trying to develop the judgement needed to support people in their efforts to get well and not support them when they manipulate to stay sick. It is a very fine tightrope and I think some facilities put way too much on us on the nurse. In a place rife with manipulative behaviours, it is really essential to have very clear MD orders and unambiguous unit policies. Most nurses don't withhold meds for the fun of withholding them; we are trying not to add to the problems people already have. Maybe addictions should be covered more thoroughly in nursing school so we have a better idea how to genuinely help people and not feel like we're sinking or swimming.
Being new, I was looking to the other nurses, but they all do things differently.
For example: Our MD wrote orders for 0.1mg clonidine for high BP & if not reduced on recheck, give 25mg HCTZ. Well, in shift report one day, a nurse reported following that protocol for a detox client, and our NP completely exploded & pretty much called us all stupid (for following the MD order). She said detox clients are at risk of dehydration and HCTZ should ONLY be given to psych clients.
Did she rewrite our orders? Nope. So, any nurse not aware of that outburst, will continue to follow the written order. Several of the nurses there have been there since the clinic opened 7 years ago, and they said they've always followed the order as written because that's what they were trained to do.
This is not a hospital. It's a very small, 16-bed facility. Most of the time, there is one nurse on duty to handle our current clients, walk-ups(last night I had 6 walk-ups - 3 admissions, all while staying on top of scheduled med passes and PRN meds), phone referrals, etc. It's very inconsistent and too much is left up to the nurse. As a new nurse, I'm just looking for more insight and ways to help my clients succeed and ways to grow and become a better nurse. So, to those of you who offered that....thank you!! To those of you who chose to bash me - well, no comment.
Sep 26, '13 by BamaRN2004This post is very very judgmental. You have no clue what those people go thru. Anxiety is mostly the reason they started using in the first place. And when detoxing the anxiety is unreal. so give them the meds who are you to say they can't have it unless they can't hold there eyes open. Keep on judging !!Last edit by Esme12 on Sep 30, '13 : Reason: TOS
Sep 28, '13 by NurseGirl525, ASN, RN ProI had to walk away from this yesterday and come back so I could write this appropriately. I have fibromyalgia that is very severe. Years ago I had a doctor put me on Fentanyl. I had no idea what is was at the time and thought it was ok. I had been on it a few months and I developed gastropariesis. My gastro doc wanted me off of that drug. I talked to my doc about it and he said no that it wasn't causing my stomach paralysis and he would not take me off. My gastro docs begged him to do it and I wanted off because my whole personality changed while I was on it. I eventually went off myself cold turkey. I took two days off of work thinking I would be ok by Monday. Let me tell you, it was the most awful thing I have ever done in my life. It took me a full week to come off of it. I had hallucinations, convulsed, puked, shook for days. It was terrible. To judge the people who are going through this and try to deny them something that would help them through this is cruel. Until you go through it you will never, ever begin to understand how hard it is. You have no idea how any of them got into the situation they are in but your job is to care for them not to judge and think that you know what is best. Their doctor will decide that. I am astounded at the comments I have seen from what should be caring, compassionate nurses. If you have a problem with these people then you need to find a different line of nursing.
Sep 28, '13 by garnetgirl29, LPNOk, if I came off sounding like I'm judging my clients, I am not. I can assure you that my supervisor has shown me numerous comments clients have put in our comment box to show their appreciation for me and many of my coworkers because we don't come off as judgy or condescending. I am far from perfect, but I find it very unprofessional to make my clients feel judged or that I am in any way annoyed by them. I'm very good at not coming off that way. I've hugged them, encouraged them, listened to them when they cried and I've offered numerous comforts meds when they haven't asked because I do not like to see anyone hurt. My concern was about giving too much at a time & causing them to be too sedated to participate in the facility's therapy groups. They get write-ups for missing groups. In the 8 months I've been here, no one has accused me of judging them(outside of this thread). I myself have not battled addiction, but the majority of my family has.
Many of my loved ones are alcoholics, some are meth addicts and some are opiate addicts. This is what I know. My goal is to help them and educate them about the risks of their lifestyle, but I always love them.
I am not withholding meds from my clients. They often ask for things I cannot give or want them sooner than I can give. I came here looking for encouragement and advice on how to better do my job & how to handle the disrespect. I have gotten much better at that & developed better judgements over the past months. Some clients have told me that they get a "high" from phenergen & many of them enjoy getting shots. This is why I feel the need to validate giving phenergen, especially IM.
I was brand new to this position when I started this thread. I had a lot to learn and was trying to develop a good nursing judgement. I still have a lot to learn & often tell my clients that I appreciate their insights because it helps me to understand what they're going through.
Heathermaizey, coming off fentanyl cold turkey like that was very dangerous. Without a proper detox, I'm surprised it only took a week to recover. I'm glad you're ok & hope you are where you want to be right now. I fully understand that many, many people become addicted due to circumstances out of their control. My cousin is addicted to fentanyl and I love him very much. We spend a lot of time together & when he has tried to detox himself in the past, on his own, I've tried to discourage that because I'm concerned for his well-being and safety - as I am with my clients.
I got defensive because what I perceived as looking for advice and information to help myself become a better nurse, others saw as me being judgmental. I didn't expect that. No one I work with has called me judgmental & in my performance review, I was told I was very good at what I do & they were receiving a lot of positive feedback about me.
Sep 29, '13 by TheMoonisMyLantern, ADN, RNQuote from HeathermaizeyTheir doctor will decide that. I am astounded at the comments I have seen from what should be caring, compassionate nurses. If you have a problem with these people then you need to find a different line of nursing.
Nurses deal with substance abuse disorders in every single area and while I agree that compassion and caring attitudes are essential in delivering nursing care to those with addiction I think it's unrealistic to expect that caring and compassion to never be tested or erroded.
Like it or not, addiction is a disease that turns beautiful people into monsters and they are some of the most emotionally draining and challenging patients to work with. While the person with addiction is indeed suffering they also inflict an enormous amount of emotional damage to those around them and sometimes even for the best of nurses it can be challenging to allow that behavior to not bother you.
Don't get me wrong I am not judging and I have an enormous amount of respect for anyone recovering or battling the disease of addiction but there is also a school of thought that the victim mentality mode of thinking merely feeds into the maelstrom of addiction. So yes I may never begin to understand how hard it is, but that's not unique addiction the same could be said about any disease or trial.
To the OP, I don't think you're trying to do wrong by your patients and I think that you probably came here with noble intentions. I hope you continue to grow as a nurse and continue to be an advocate for your patients.
Sep 30, '13 by VivaLasViejas, ASN, RN GuideI've been reading the various responses here and am appalled at some of the harsh words directed at the OP, who I feel needs to learn more about addictions overall, but whose heart is in the right place.
Now I'm going to offer a bit of perspective from someone with a long history of ETOH abuse plus mental illness.
First, anyone working with alcoholics/addicts should understand that most of us have co-morbid psychiatric disorders, which we may unknowingly be trying to tamp down with substances. For example, I abused alcohol off and on from the age of 17 until my early 30s, never realizing that I was masking symptoms of manic depression. I never landed in a rehab, but when I stopped drinking for the last time, I remember wondering what I was supposed to do about my anxiety, restlessness, and agitation. Food came in handy, and that's what I self-medicated with for decades until finally being put on mood-stabilizing medications in early 2012.
This thread makes me wonder how my recovery (been sober almost 22 years now) might have gone had I not had access to my "drug" of choice. Or if someone had tried to teach me some sort of "lesson" by withholding Oreos and Cheez-Its when I desperately needed SOMETHING to calm me down during the stresses of early sobriety. Yes, I gained 30 lbs. that first year, but I was so much healthier overall because I was no longer poisoning myself with ETOH. And the compulsive eating also went away once I went on medication to control my mood fluctuations.
I'm telling all of this because I want nurses who work in addictions to know that early recovery is NOT the time to take away everything that helps hold an addict/alcoholic together. There's a reason doctors write the PRN orders the way they do, and if the patient knows s/he can get the meds when s/he needs them, s/he is less likely to be anxious about it. Nursing staff also need to be consistent across the board---a patient shouldn't be able to get meds Q 2h from one nurse, and few or none from another.
The other point I want to make is this: a patient is much, much more than a diagnosis or a set of symptoms. Underneath that manipulative, whiny, unpleasant exterior is a hurting human being who did NOT come into the world with the desire to be an addict/alcoholic. No, you can't "fix" these folks, and some will never recover no matter how many times they visit your facility. But some will, and you should want to make their transition to clean/sober living as welcoming as possible for the best chance at full recovery. The tough stuff will come later, and it'll keep right on coming for a long, long time.....trust me.
Sep 30, '13 by Esme12, ASN, BSN, RN Senior ModeratorQuote from BamaRN2004I know you are struggling with addiction yourself and I congratulate you on your sobriety....I don't think the OP was being judgmental. They are asking the advice of other addictions RN's for the med regime of their patients....what would BEST help them.This post is very very judgmental. You have no clue what those people go thru. Anxiety is mostly the reason they started using in the first place. And when detoxing the anxiety is unreal. so give them the meds who are you to say they can't have it unless they can't hold there eyes open. Keep on judging !!