Treating pain in ER

tewdles, RN · May 25, 2011

And you and patients like you are what are driving me out of ED nursing. I know that sounds harsh but its the truth. If your doctor is really aware that you have flareups then you and your doctor should have a plan in place to deal with these situations. and going to the ED is not an appropriate plan. That entire statement of "my dr sends me and tells me to tell the ED that normal painkillers won't work for me" screams drug seeking. Why doesn't your doctor call the ED in these cases and talk to the ED doctor, or set up a pain management plan for you. Just because i don't rub your trouble brow doesn't mean that I don't want you get better, perphaps by your ED nurse trying to talk with you about dealing with your pain with your PCP he/she is trying to help you deal with your pain in a more appropriate way.
okay blast away.

I would suggest it is not the patients who are driving you out of the ED...

wwfd · May 25, 2011

I would suggest it is not the patients who are driving you out of the ED...

And could I suggest that perphaps since according to your listed experience you have never worked in the ED...so you probably don't have a very good sense of what my job is like. I also view your comment as a personal attack and will report it as such.

Now please continue to enable each other on this site.

Butterfly0328 · May 25, 2011

And could I suggest that perphaps since according to your listed experience you have never worked in the ED...so you probably don't have a very good sense of what my job is like. I also view your comment as a personal attack and will report it as such.
Now please continue to enable each other on this site.

OK, NOW I WILL RESPOND!! I personally view your comments as personal attack stating it is patients like myself who will drive your out of the ED, not to mention making accusations to the fact that myself and keikei "want our brows rubbes". If you are being driven out of the ED by people like us then I suspect you don't belong there in the first place. The only thing we are asking for is proper and compassionate treatement. Is that too much??

Esme12, ASN, BSN, RN · May 25, 2011

My doctor does call the ED and does have a pain management plan in place. It's all in my chart and she always calls in advance, tells them why she is sending me in, what she would like done, etc. And they are waiting for me when I arrive. This particular hospital has a separate unit in the ER for longer term patients - people who are sick and need immediate medical care for whatever reason, but avoiding admitting them if possible. The patient is allowed to stay for 17 hours and either be discharged or admitted. It's quiet, each room is private (with a curtain for a door, the nurse is sitting right outside of the door at her station) and the nurse/patient ratio is low. None of the nurses in this department have been cruel or made me feel like it is my fault I am in pain and that since I already take painkillers on a very carefully regimented basis at home, throwing a percocet at me isn't going to help in any way. Kidney stones are very painful and there are those of us who don't have any control over when they are going to form, when they will lodge & cause pain or how long before they pass (IF they pass). And it's not my PCP that handles this issue, it's my nephrologist who depends on her co-workers in the ED to take care of her patients when she isn't able.

It's called a Clinical Decision Unit......CDU

Fribblet · May 25, 2011

The only thing we are asking for is proper and compassionate treatement. Is that too much??

Nope. And the proper treatment for your condition lies with your primary care physician, not the ER. If your PCP is pawning you off on the ER, then, frankly, you should be writing angry posts directed at him rather than the ER.

Might be time to get a PCP who will give you the proper treatment you need, rather than brushing you off and failing to treat your condition properly.

Butterfly0328 · May 25, 2011

You know, seriouosly, you are there to treat-PERIOD!! Not pass judgment etc. You may get a lot of people YOU FEEL should lot be coming to the ED, but if it were a perfect world and only those that needed to go to the ED went, you may not have a job!! So, I guess you could say those of of "idiots" that go to the ED to have our brows rubbed, like we are attention seekers or something, are the reason you even get a paycheck. So, please stop judging and do your jobs please. GEEEEZZ

wwfd · May 25, 2011

OK, NOW I WILL RESPOND!! I personally view your comments as personal attack stating it is patients like myself who will drive your out of the ED, not to mention making accusations to the fact that myself and keikei "want our brows rubbes". If you are being driven out of the ED by people like us then I suspect you don't belong there in the first place. The only thing we are asking for is proper and compassionate treatement. Is that too much??

The brows being rubbed was a direct reference something said that would provide a human connection. For the love of all that is right I will never understand where Non-nurse, nurse wanna be get off passing judgement on my job and what it entails. Now run along and continue to dream of the day when you can save the world by being Florence Nightengale reincarnated.

Esme12, ASN, BSN, RN · May 25, 2011

OK, NOW I WILL RESPOND!! I personally view your comments as personal attack stating it is patients like myself who will drive your out of the ED, not to mention making accusations to the fact that myself and keikei "want our brows rubbes". If you are being driven out of the ED by people like us then I suspect you don't belong there in the first place. The only thing we are asking for is proper and compassionate treatement. Is that too much??

Wow.....I can't believe this thread is still going.

I won't make excuses for poor care. Everybody deserves to be treated with dignity and respect reguardless of race, religion, ability to pay or diagnosis. So I won't excuse BAD NURSING. That being said......it is difficult to put into prespective the trash tossed at nurses in general but at ED nurses in particlar. It is difficult to describe the shear numbers of drug seeking, whinning, Academy Award Winner for "Chroinc" pain that frequent emergency departments....and cause loud and distracting, disturbing and disrupting holding the entire department hostage until their demands are met......I've always said on busy nights (and they always show up on busy nights) "Treat them like the terrorist that they are.....give them what they want so they'll release the hostages......THE STAFF"

It causes major frusration for ED nurses as we are caring for the sick and if we have someone very sick....and "this jerk keeps interrupting....I can't care for the one who is really sick.!" Our patience shouldn't run out nor should we sterotype that everyone who has a list of allergies and pain meds with large dosages are not all drug seekers but statistics show that in all likelyhood at 3 am they are.... We've heard it all....every diagnosis, syndrome, allergy, complaint and excuse as to why your script isn't working. I know that isn't fair but it's real.

Unfortunately when you become a nurse you too will have those mements that if that call light goes off onemore time you're going to scream and you joke to your so-workers about hiding their call button. The ED is no different. We have frequent flyers that go from ED to ED seeking "relief" We can tell who's comming in by their med list and their complaint......hell we can admit them as we have their information memorized! NOt that this excuses bad behavior but maybe the background to a lot of frustation. There is a lot of patients that come to the ED that never get upstairs....they are just like a bad penny...they just keep comming back.

The MD's don't help this feeling of being taxed by "seeking" behavior". Seeking behavior has been around a REALLY long time but over the years becauseof DEA restrictions and the prescribing/administration of narcotics are closely monitored for "HIGH USERS" MD's just don't feel it's worth the hassle any more and are more judicious in their ordering of narcotics. Some states have pain centers register so they know who's prescribing them or not....some states are requiring "contract" being signed by the patient stating that certian requirements be fullfilled before writing prescriptions. It's comlicated but when the MD's moan and groan do the nurses.

Unfortunately overtime....we sometimes become a little shortsighted when we shouldn't be......I feel bad when someone one someone like this and YES you deserve to be treated witout prejudice and with respect....So I am not excusing rude nor bad behavior....I just wanted to share a little insight to help you undertand and maybe help the next professional approach you differently by understnding their frustration....just a little.....Be Well:redpinkhe

Anna Flaxis, BSN, RN · May 25, 2011

The fact is, you just don't know what else is going in that ED at any given time. You are not a nurse, and therefore I can't expect you to understand the nursing process and prioritization. All you know at any given time is what is going on in your little corner, from your point of view. The fact is, you may very well be the least sick person that nurse is dealing with, and are therefore the lowest priority. It's not about lacking in compassion. In fact, it's the opposite. The compassionate ED nurse has her/his priorities straight and is spending the necessary time with the patient that needs their attention the most. Here is the typical assignment for me at any given time:

Rm. 22: Young woman with acute flareup of chronic pain r/t N/V. Has had Toradol, Compazine, and has NSS infusing.

Rm. 24: 84yo female BIBA for R hip pain s/p GLF. RLE is shortened and externally rotated. X ray shows displaced fracture of femoral neck. Has had EKG, X rays, Dilaudid, still needs blood bank tubes pulled, foley cath placed and urine spec sent.

Rm. 30: 3yo male with history of asthma brought in by PV for SOB, has increased WOB with wheezes and retractions noted. Receiving neb tx, needs Decadron given STAT.

Rm. 32: Currently being prepared to receive full trauma, 30yo male unrestrained passenger ejected through windshield at high rate of speed. Currently unresponsive with advanced airway in place, bleeding through large head lac. controlled with direct pressure, hypotensive and tachycardic, ETA 5 minutes.

Now, my patient in room 22 is reporting, through the registration clerk who just happened to be walking past the room, that her pain medicine isn't working. Should I go to her doctor and get an order for more/different pain medication, or should I be preparing to receive the trauma?

Am I lacking in compassion because, in my nursing judgment (for which I get paid to exercise), I have determined that going into room 22 to stroke the patient's hair and show her some empathy is not my priority?

You see, OP, this is what we deal with. I've just gotten out of a trauma, in which a young man is now a paraplegic for the rest of his life, if he even survives, and I just want to scream at the tragedy of it. I've checked on my kiddo first, then my LOL with the hip fracture, and now you, because you are the least sick. I walk into your room to check on you, and you're sitting there completely stable and not in any life threatening situation, and you want me to stroke your hair to prove to you that I have compassion?

I'm really sorry that you're hurting, but you're not actively trying to die on me, and that's what matters most at the moment. Oh, your nausea has resolved? Great! Now you can go home and take your prescribed medications!

Music in My Heart · May 25, 2011

You know, seriouosly, you are there to treat-PERIOD!! Not pass judgment etc.

But let's be frank: You were treated by the physician, just not in the manner that you think was appropriate. The nurses, I'm sure, did exactly as the physician ordered. The physician decided upon his/her treatment plan based on your presenting signs and symptoms and his/her experience and clinical judgment.

Only you know whether it was adequate but understand that not all physicians endorse the "narcotics 'til free of pain" philosophy. Truly, I think your main gripe should be with your primary care provider or pain management specialist more than with the ER doc.

That said, just this last rotation I was forced to discharge a patient whose pain, in my opinion, was not adequately nor properly treated. Did that physician blow it? In my opinion, yes. Sometimes, for various reasons, they (the ER docs) choose not to aggressively treat the chronic pain folks. Those patients' personal physicians should ensure that their patients have adequate PRN meds and the patients themselves should ensure that they don't lose that privilege.

Pain is a tough, tough subject.

Esme12, ASN, BSN, RN · May 25, 2011

You know, seriouosly, you are there to treat-PERIOD!! Not pass judgment etc. You may get a lot of people YOU FEEL should lot be coming to the ED, but if it were a perfect world and only those that needed to go to the ED went, you may not have a job!! So, I guess you could say those of of "idiots" that go to the ED to have our brows rubbed, like we are attention seekers or something, are the reason you even get a paycheck. So, please stop judging and do your jobs please. GEEEEZZ

BREATHE.........ED across the nationare way over burdened......they get busier and busier everyday as ED across the country close.....30% of all ED have closed in the last OH .....10 years.....burdening the rest......I have to tell you.......... I feel venting on the sysem in general rather than a personal attack on you although it feels that way.........This is a tough profession filled with bright, intellegent, educated, opinionated and strong will humans....there will be conflict.

But we ALL need to consider that ALL patients with chroinc conditions are not"DRUG SEEKERS" and should NOT be treated any differently than ANY other .....and even if they did...do we care hat the have to say???? NO because we willgive what WE feel is appropiate...RIGHT....

We can agree to disagree and we can disagree and be kind at the same time......Butterfly obviously had a bad exprience and just wants to be heard.....so we CAN LISTEN........

Anna Flaxis, BSN, RN · May 25, 2011

We can agree to disagree and we can disagree and be kind at the same time......Butterfly obviously had a bad exprience and just wants to be heard.....so we CAN LISTEN........

True. But, last time I checked, this forum was called "allnurses", not "allpatients". I listen to my patients when I am at work. When I come here, it is to discuss topics relevant to my work as a nurse with other nurses, not to be chided by people who are NOT nurses, telling us how we OUGHT to practice. :nurse: