[kk2000]

Hi.
First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
So, could you tell me what constitutes a 'seeker" in some nurses minds/
I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
please help me understand this!
Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
K-

[traumaRUs]

I am sorry that you are being taught to look for signs of a "pain seeker" when assessing pain. Pain is what the patient says it is. It is not the nurse's judgement about whether the patient has pain or not. Please know that this is not the prevailing theory in the nursing world. Continue in school and then see how others handle the issue.

[Nikki69]

I work in a large nursing home and I see this type of thing all the time. In my opinion, it really depends on the patient, and how well the nurses know (or think they know) the patient. In nursing, alot of what we do has to come from our own judgement. Some nurses try to push the patient to get better with a combination of drugs and therapy, not just the drugs. But I think you're right when you say "how can someone measure someone else's pain". It all comes from the heart. If these patients have a chance to get better and go home, why give them a pain med that is going to knock them out and sleep the rest of their lives? On the other hand, why not just give it to them and they'll be quiet and quit pestering you for the drugs? It's really a personal judgement call I think. Pain is what the patient says it is, even if we believe different

[asher315]

I have been a nurse for over 20 yrs and was "taught" about drug seekers but not that much about pain and its management. Early in my career, I made the classic mistakes and decided some pts were "seekers" & not in true pain. With experience and more personal experience, comes enlightenment. I think nurses are afraid they will enable addictions. I worked for 2 yrs in a pain clinic and absolutely loved it (if I ever find another one to work in, I'm there!) and I learned more about pain,medications and pain patients in those 2 yrs than in the 12 before.

Pain is what the patient says it is, regardless of who they are or how they look or act. We never used the term "drug seeker" but "drug abuser" because all of us, when we are in pain, are "seeking" relief by drugs or whatever may work. The "abusers" showed themselves by their actions not related to pain, calling the clinic saying they "lost" their meds, Once, we can believe but calling 3 times in 2 months because you dropped your pain pills down the toilet is a bit much. One girl phoned a pharmacy, pretending to be one of the staff and refilled her pain meds rx. (She got caught). One pt stole rx pads from a dentist office. A couple went dr shopping and 1 pt had a son who was a doctor and gave her whatever she wanted. These are the few that cast a bad light on the rest of the acute and chronic pain sufferers.

Having said all that, don't give up nursing, you can make a difference in the attitudes of your co-workers and others but most importantly, you can make a difference in a pain sufferer's life.

Take care,

sherry t

[grannynurse FNP student]

Originally Posted by kk2000

Hi.
First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
So, could you tell me what constitutes a 'seeker" in some nurses minds/
I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
please help me understand this!
Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
K-

The education of today's potential physicians and nurses is changing. Studies have shown that the average medical school provided just one hour of formal pain management education and nursing schools, three hours. Most of the remainder of education was provided by those all ready licensed individuals, who had been taught by previous generations. Most programs have expended their formal education programs.

Grannynurse

[sirI]

Originally Posted by kk2000

Hi.
First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
So, could you tell me what constitutes a 'seeker" in some nurses minds/
I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
please help me understand this!
Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
K-

Hello, K,

I am not sure what you mean when you say you are being taught to know who is seeking pain meds. Can you elaborate on the methods?

The individual in pain can more often than not, show nonverbally that they are indeed in pain. Facial expressions, sweating, anxiety, combativeness, restlessness, just to name a few. B/P high, pulse tachy, respirations rapid, deep or shallow. Just too many to name here. The patient may say, "I am in pain and rate it on a scale of 1-10 at an 8, but, the observer does not believe the individual. The patient in chronic pain sometimes will not say anything at all and the nurse just does not ask, "Are you in pain?" The patient will get nothing for pain because the individual did not tell the nurse and ask for meds. Or, the individual finally asks for something and the nurse thinks/says, "This patient was fine 5 minutes ago and now that want something for pain. They can't be in pain. They are drug seeking."

I just am somewhat concerned that teaching you (students) "how to recognize and/or tell who is drug seeking" is maybe clouding the students' judgement.

Please elaborate.

[kk2000]

Originally Posted by siri

Hello, K,

I am not sure what you mean when you say you are being taught to know who is seeking pain meds. Can you elaborate on the methods?

The individual in pain can more often than not, show nonverbally that they are indeed in pain. Facial expressions, sweating, anxiety, combativeness, restlessness, just to name a few. B/P high, pulse tachy, respirations rapid, deep or shallow. Just too many to name here. The patient may say, "I am in pain and rate it on a scale of 1-10 at an 8, but, the observer does not believe the individual. The patient in chronic pain sometimes will not say anything at all and the nurse just does not ask, "Are you in pain?" The patient will get nothing for pain because the individual did not tell the nurse and ask for meds. Or, the individual finally asks for something and the nurse thinks/says, "This patient was fine 5 minutes ago and now that want something for pain. They can't be in pain. They are drug seeking."

I just am somewhat concerned that teaching you (students) "how to recognize and/or tell who is drug seeking" is maybe clouding the students' judgement.

Please elaborate.

To elaborate a bit: Many discussions about patients that know the time the meds are due, know the name of the meds, or my favorite, "The patient was laughing and smiling when their family came in...they can't be in pain".
Just today in postconference a student was saying that his patient was exhibiting drug seeking behavior, evidenced by the fact that one minute he was laughung and the next minute moaning. I suggested that perhaps it wasn't our job to question this and stereotype this pt. as a drug seeker. i was told that even if he was in pain that he shouldn't have been so dramatic!
Now we are faluting our pateints for being dramatic?????One instructor told a story how of a patient she had in the ED that was in for a pain issue. Patient was also nauseous but instructor said that it was probably due to the pt. be ing an addict and that she was probably having withdrawal so it wasn't real nausea. Every single patient I have had for clinicals in the past 2 weeks has been described to me in report as a drug seeker. Every one! And the dx have been kidney stones, gallbladder problems, cellulitis, fibro and chrohns disease. How can everyone be a drug seeker? In thees instances shouldn't the instructor step in and tell the students NOT to make a snap judgement?
It is VERY obvious to the whole class during lecture that one instructor in particular does not generally believe pain patients. It is like an epidemic and then the whole class has to tell their stories about their drug seeking pateints.
I am so discouraged. We are breeding a group of very judgemental nurses.

[sirI]

Originally Posted by kk2000

To elaborate a bit: Many discussions about patients that know the time the meds are due, know the name of the meds, or my favorite, "The patient was laughing and smiling when their family came in...they can't be in pain".
Just today in postconference a student was saying that his patient was exhibiting drug seeking behavior, evidenced by the fact that one minute he was laughung and the next minute moaning. I suggested that perhaps it wasn't our job to question this and stereotype this pt. as a drug seeker. i was told that even if he was in pain that he shouldn't have been so dramatic!
Now we are faluting our pateints for being dramatic?????One instructor told a story how of a patient she had in the ED that was in for a pain issue. Patient was also nauseous but instructor said that it was probably due to the pt. be ing an addict and that she was probably having withdrawal so it wasn't real nausea. Every single patient I have had for clinicals in the past 2 weeks has been described to me in report as a drug seeker. Every one! And the dx have been kidney stones, gallbladder problems, cellulitis, fibro and chrohns disease. How can everyone be a drug seeker? In thees instances shouldn't the instructor step in and tell the students NOT to make a snap judgement?
It is VERY obvious to the whole class during lecture that one instructor in particular does not generally believe pain patients. It is like an epidemic and then the whole class has to tell their stories about their drug seeking pateints.
I am so discouraged. We are breeding a group of very judgemental nurses.

Hello, kk,

That is what I was afraid of.....the patients are getting labeled en masse. Not cool. This is poor instructing.

Please do not fall into that pit of placing a label on all your patients because they don't act like you think they should. And, I am not talking about you, per se. I am talking about how the students are being taught.

The patient is an individual. A human being that deserves to be cared for to the best of your (the nurse) ability. And, just because they are not writhing in pain and have a grimace as opposed to a smile, does not mean they are not in pain. Even in many cultures they will not allow overt displays of emotion such as pain.

I commend you upon looking at your patient with dignity and respect. Good nursing there!!

[kk2000]

Originally Posted by siri

Hello, kk,

That is what I was afraid of.....the patients are getting labeled en masse. Not cool. This is poor instructing.

Please do not fall into that pit of placing a label on all your patients because they don't act like you think they should. And, I am not talking about you, per se. I am talking about how the students are being taught.

The patient is an individual. A human being that deserves to be cared for to the best of your (the nurse) ability. And, just because they are not writhing in pain and have a grimace as opposed to a smile, does not mean they are not in pain. Even in many cultures they will not allow overt displays of emotion such as pain.

I commend you upon looking at your patient with dignity and respect. Good nursing there!!

I appreciate your, and everyone's, thoughful replies. I cannot believe what I am seeing and it frustrates me so!
I myself have some pain issues (6 herniated disks), and am fully aware of what it feels like to know you are not believed. Perhaps this sounds a bit strong, but I would rather medicate the "seeker" than take the chance of not or undermedicating the person who truly needs it.
Very, very disturbed, angry and disapponted at the attitudes I am seeing.
Thanks so much,
K-

[traumaRUs]

The issue of pain management is best not handled during an acute episode of pain. It doesn't matter at that point. However, it can and should be addressed at a primary care provider level.