Nurse accuses patient of drug addiction!

[Penelope_Pitstop]

A fellow RN on my floor did something last week that continues to amaze and shock me.

There was a patient admitted with pancreatitis, receiving the usual for that diagnosis: NPO, IVF, Dilaudid and Phenergen. Apparently she was asking for her meds as soon as they were due, if not sooner. Nothing new under the sun for pancreatitis.

Was she drug seeking? I don't know, but I don't think it matters. I know I've never had pancreatitis so I don't suppose to know the agony involved. I imagine it's a painful experience. With those cases, I give the meds if they're ordered, due and there are no contraindications. No problem, right?

Well...

My coworker had the bright idea of printing out information on drug addiction, highlighting parts of it and placing it on the patient's bedside table as she slept.

I most likely don't have to share that the patient was very upset. Oh yeah, did I mention that the patient is a hospice nurse? The patient stated after the incident that if she wanted to abuse drugs, she didn't have to come to the hospital. She had easier access to much better stuff.

I cannot understand how or why anyone could think that this is acceptable!

But ya know what? Nurse Nancy doesn't think she did anything wrong.

I'm going to add that this is the same nurse who told me in report that a patient suffering from a stress-induced flair-up of oral herpes virus "need[ed] an HIV test." Hmm, okay. The patient was septic with S. pneumoniae and intubated for a while. Yeah, I think my body would be stressed too...especially since I have HSV! Does that mean I need an HIV test?

Just so y'all know, management is aware and has spoken to her. Patient relations is also involved.

I just had to see if other nurses were as horrified as I am concerning her behavior.

[cherrybreeze, ADN, RN]

I know it's a little off the OP, but...

It's all fine and dandy to use VS and facial grimacing and all that good stuff to try to objectively measure your patient's pain. But, in chronic pain patients, this isn't necessarily going to work. I think we are all aware of that fact by now, right?

Some people just don't and will not understand it. I had surgery last summer for a chronic condition. Not curative, mind you, but palliative. The "specialist" I saw, in another city, was appalled by the meds I'm on long term..."none of the patients I have with this problem are on meds like this." Really? NONE? Is it because you simply refuse to prescribe them? She put me HUGELY on the defensive in my initial consult. I've dealt with this for YEARS, and to get where I am at for meds didn't happen overnight! I got in to pain management for a reason, but my regular doc was the one prescribing before PM, so I'd have liked to see a convo about it between him and this doc. Post op, she prescribed me less than what I take normally for breakthrough pain before I was discharged, and nothing to supplement after I went home, since "I was already on so much." Nevermind the fact that this was a big surgery, and I was in a lot of pain. What got me through my normal pain obviously wasn't going to be enough to cut it, but it didn't matter...she held firm to her belief. And the whole experience SUCKED, and didn't have to.

I don't talk often about what I have, or what I have to take to control my pain daily, due to the judgements I receive. I will only go to an ER if I am half-dead; I don't want to know what's being said when they walk out my door.

[vsigns]

Cherry Breeze,

I agree with you! I was crying out in horrible unbearable pain and accused of drug seeking and attention seeking behavior. It's as if I have PTSD from that experience. I was also judged at a local hospital ER when I arrived in a scissored, fixed position from an idiosyncratic reaction from 1 dose of Tegretol. I also had chest pain and SVT, PVC etc. They could not get a BP or an IV. Tegretol did not work, just had to wait for effects to stop. I was miserable. I went back on Diazepam 10 mg at bedtime and my spasms are under control. The Dr. came to my cubicle in the ER and asked if I was feling anxious-sorry but what a dumb question. I replied "of course and how would she feel under the same conditions". The Dr. walked out of the room. She then came back and offered Diazepam, I refused and asked to be discharged so I could just go home and take my Diazepam. I have never felt so judged in my life. Why does everyone think every patient is a drug addict??? I understand as a nurse being on the look out and that we-as nurses are in the high risk group-but I am disabled and no longer working. I will leave the judging up to god. By the way I take no pain meds inspite of chronic pain, as I will be judged. I'd rather suffer. My ARNP recently stated that she was so proud of me for not taking any pain meds. My thought-if you only knew... I don't want to know what they say when they walk out my door either! I don't care anymore.

[CountyRat]

Vsigns wrote, "My nurse thought I was faking it and told everyone at the desk that I was demonstrating attention seeking behavior-and not one other nurse said a word!"

Here's the deal; you were engaging in attention-seeking behavior. The nurse was right about that. Where she failed (miserably) was in failing to correctly answer the key question, "WHY is my patient seeking my attention?" In the same way, we need to remember that drug-seeking behavior is just that, a behavior, it is not a diagnosis. We have to ask, "WHY is this patient seeking this type of drug at this time?" Drug-seeking is not addiction, it is a behavior. Addicts do it, but so do non-addicts who are in pain. Addiction is continued use or seeking of a drug for a non-medical purpose, in spite of negative consequences. If the patient is seeking the drug for medical reasons in anticipation of the positive consequence of improving their wellbeing while recovering from, or coping with, a painful condition, that is not addiction, it is an appropriate, healthy behavior in a patient who is doing what mentally healthy people do when something is wrong with their bodies: they seek the attention of professionals who can provide effective treatment. In cases involving moderate to severe pain, opiods are usually the safest and most effective way to achieve the healthy, medically indicated result of pain reduction. The patient SHOULD seek our attention for that purpose (as Vsigns did).

Why is this so hard for some people to understand?

Oh, PS: I am not a naive newbie who has never confronted drug addiction. I have been a nurse for 28 years, and have cared for many addicted patients. I have also withheld requested opiod drugs in specific instances when, in my judgment, administrating them would be unhealthy rather than therapeutic for the patient. And yes, I have been cursed at, spit on, etc., just like most of you reading this have. I just think that broad-brushing everyone who asks for narcotics in an urgent tone of voice as addicted is simplistic and dangerous. We can do better than that.

[cherrybreeze, ADN, RN]

Cherry Breeze,

I agree with you! I was crying out in horrible unbearable pain and accused of drug seeking and attention seeking behavior. It's as if I have PTSD from that experience. I was also judged at a local hospital ER when I arrived in a scissored, fixed position from an idiosyncratic reaction from 1 dose of Tegretol. I also had chest pain and SVT, PVC etc. They could not get a BP or an IV. Tegretol did not work, just had to wait for effects to stop. I was miserable. I went back on Diazepam 10 mg at bedtime and my spasms are under control. The Dr. came to my cubicle in the ER and asked if I was feling anxious-sorry but what a dumb question. I replied "of course and how would she feel under the same conditions". The Dr. walked out of the room. She then came back and offered Diazepam, I refused and asked to be discharged so I could just go home and take my Diazepam. I have never felt so judged in my life. Why does everyone think every patient is a drug addict??? I understand as a nurse being on the look out and that we-as nurses are in the high risk group-but I am disabled and no longer working. I will leave the judging up to god. By the way I take no pain meds inspite of chronic pain, as I will be judged. I'd rather suffer. My ARNP recently stated that she was so proud of me for not taking any pain meds. My thought-if you only knew... I don't want to know what they say when they walk out my door either! I don't care anymore.

It also never ceases to amaze me how people interpret events after the fact. For example:

Before I got in to pain management, I would get prescriptions for pain meds intermittently (always from my doctor, he was/is very understanding, I would be able to call him and say, "it's that time" and he'd leave a script for me to pick up....after so many years, we have a solid/understanding MD/patient relationship). If he was off or on vacation or whatever, though, I was SOL. His partners would not ever prescribe for me in his absence, even having my chart available and seeing/knowing what the routine was.

A couple of years ago, I went to the ER two nights in a row in severe pain. My condition was diagnosed via surgery, but it's not something they can see if they do an ultrasound......so, they generally always do one, and it looks ok, and they say, "we have nothing to treat, so we can't give you medication." I do understand where they are coming from, being in this profession, but it's frustrating none the less. The ER doc (who I'm sorry to say, was a total witch) asks me, "What do you usually take when you have this pain flare up?" Those words exactly. I said percocet. And we're talking, 10 or 12 pills every month or every other month, so not large amounts. I explained to her how the good doc and I usually handle it, what my history is, how we reached this point. It's been several long years of suffering, this isn't new for me, but it doesn't mean it doesn't hurt. Also, this pain was more severe than what I had dealt with in the past, and wasn't flaring up in the usual fashion, which was the whole reason I was in the ER in the first place. I didn't know if it was something new or different, I just knew I was absolutely miserable.

The nurse comes in a little bit later and gives me two percocet. I hadn't been expecting that, but whatever worked. Generally with abdominal/pelvic pain, they don't give things PO first, at least not in my experience. I didn't know at the time if there was a new problem, like I said.

I got a copy of the ER dictation later on, and this ER doc says, "Patient requesting Percocet." Um.......NOT EXACTLY. That was not the conversation we had at ALL. And any of us can read that sentence, and whether we admit it or not, we KNOW what we're thinking, right? I was so incredibly bothered by this, and thought, ok, now any time I come in after this, they're going to look at my old records (since that's common practice) and see this statement. And how does that make me look......

I ended up being diagnosed a short time later with a whole new/different problem after all. Another surgery. Another chronic problem that can't be cured, but treat the symptoms (I could be bitter, but I'm not....I know that things in life could be a lot worse; I just have a bad bladder and bad *chick parts* ). This was the cause of all this new pain, though. Unfortunately, that info isn't with this ER report. It still looks like I came in asking for Percocet despite having normal diagnostic tests.

Sorry for the long story. It's all just left me a bit jaded......but hopefully, it helps me practice with a bit more understanding and empathy. Of course I've come across the true addicts and seekers (and by that I mean, the ones "seeking" for the wrong reasons.....I liked your post, CountryRat) like we all have, but I've also come across many chronic-painers that all of my colleagues would write off immediately and I would be the one advocating till I was blue in the face. My journey has been worth it, if it has helped me help them.

[vsigns]

I hear you! I won't go to the ER anymore either. Sad-my daughter works in that ER as an RN. She is 28yrs old and feels the same way. If you are a nurse in pain, don't ask for pain meds or you know what they will think... My daughter says she gets patients who repeatedly come to the ER for meds and does not judge, but asks herself why is this patient in so much pain. She gives and tries distraction, music, dimmed lights,- you all know the routine. Sometimes it works and sometimes it doesn't. Lesson #1 A patients pain is what they say it is! Lesson#2 Never forget Lesson#1. Straight from my Nursing Instructors!

[vsigns]

Country Rat- I understand "attention seeking behavior". I guess it was more the way that my PACU nurse said it that infuriated me. I was helpless, I could not move, I asked for help and she was extremely angry with me for being in pain. I think she was burnt out or something and needed to retire. She spoke to me as if I were a child-I am 51yrs young and she was maybe in her thirties. She was verbally and physically abusive to me. I did nothing wrong.

[LilPeonNo1]

I had a friend I had known for years, before I became a nurse. She used to hang out with "bikers" when she was young. She married one of them at a young age and got caught up in the drug scene. During one of their many biker rides, she and her then husband were in a horrible accident. He was killed. She went through many surgeries including back surgeries following the accident and spent more than two years recovering. She was left of course in chronic, and as she described it, excrutiating pain. Having already been involved with drugs prior to the accident, her tolerence to opiates was high. As you can guess, it wasn't long before she was seeking drugs any way she could get them, because the scripts weren't enough to relieve the pain. She was popping pills like candy. We were both about 25 when she met and married her second husband, who was 10yrs her senior, and he loved her very much. He did everything he could to help her get over her addiction by trying to find out some other form of treatment for her pain. Nothing worked. In many ways it was heart-breaking to watch him try. When she turned 35 her husband came to my husband and me and told us his wife was in rehab, she had turned to heroin to relieve the pain. He was devastated to discover this, but was not ready to give up on her. But she continued to seek pain meds and rely on heroin to get her through the day. He finally gave up trying, after he came home one day to find she had hit herself over the head with something like a baseball bat, and told him that someone had robbed them. There were only a couple of small items "taken", like a microwave and toaster oven or something like that, so he was certain she had pawned the items and used the money for heroin. Also, because his television and expensive stereo equipment was not disturbed. After that happened, he gave up all together and let her do whatever she wanted. And, I along with my husband (his best friend) believe its what eventually killed him. He spent all those years trying to "clean her up". Using up his life savings, losing his business and alienating his children. He died a poor man at the age of 54 from a heart condition, and she was left alone. And six months later, we received a call she died from an overdose.

This is a sad, but very true story. I sit here with tears in my eyes thinking of it. My husband and I both lost very dear friends. Even though we took different paths in our lives, K was a good person. One who despite everything, wanted only to be rid of her pain. She finally got her wish.

The real point to all this, is you can try all you want to change someone, but they have to be willing or able to change for that to happen. YOU can't do it for them. If a patient comes to you and even if you know without a doubt that they are drug seeking, it might just be because they NEED it just to get through the day. But, even if they aren't truly in pain, and only they can know for sure, they will get what they want however they can get it. From the doctor, or the streets. When that patient is discharged he or she will do whatever they think they need to do to get what they feel they have to have. So, why get angry, or appoint yourself some kind of Holier-than-Thou, self righteous know it all. Give your patients what they ask for if its ordered. And, don't judge someone else because you might very well find yourself in their shoes one day.

[diane227, LPN, RN]

You know what, it is not my job to drug rehab every patient that I think have a drug problem. My job is to keep them pain free. To assume that this patient had a drug problem is wrong. This nurse needs to learn to be more professional and less judgmental. There is no such thing as "drug seeking". Everyone in pain is drug seeking. Just give them their pain meds, make them comfortable and leave the drug rehab to someone else.

[Connie Elder]

The nurse that did this should be disclipined. She should have to take a culture and sensitivity class that the hospital has. We all face pts. like this who we "think" are drug seekers. What she did was appalling. In my 32 years I have not heard of this being done. I have heard of nurses telling pts. that they are druggies but never have heard of this. To me there are many unasked questions when dealing with a situation like this. Does this pt have chronic pain, has she ever been referred to a pain clinic or specialist, etc? I am a travel nurse and have worked in some communitites where the pt/Dr. have a contract for pain control.

[vsigns]

Everyone reading-I know what this nurse did was wrong. I was in the recovery room after major surgery. I had been on no pain meds prior to surgery or anytime in the past year. Personally, pain meds make me sick and I don't see the draw. That nurse was heartless,judgemental and just wicked to my family. I was trying to get help for excruciating pain-worst I had ever felt. I was never asked on a scale of 1-10 what my pain level was and they did not care. I was threatened if I did not shut-up (exact words) and stop bothering other patients, that my Dr. would transfer me to main hospital, and that "those *******-(nurses at main) wouldn't care if I lived or died!" I asked her to go and get my Dr. because obviously nor did they care. They refused. That same nurse laughed at me when I told her I had SCI. She said "right". I thought to myself-I am living a nightmare. I really did just want to die-I cried for my deceased mom to come and get me-I could bear no more pain. I had already had 3 previous cervical procedures from a rear-end accident. I was the one who was rear-ended. Nope-never saw it coming. I have been banned from nursing school-they will not let me finish 20 weeks to my RN degree. I can only lift 10 lbs now. Everything on-line is so expensive. I told the DON of the program-I can't finish because I am disabled- he said if you were already an RN we could accomodate you and it would be different. It is to dangerous for patient care. I told them, what if I don't go into direct patient care? Not all nurses go into direct patient care-so why can I not finish my education. I can still do some things and want to try. I guess this nurse just got left behind. The DON did not know what to say. Everyone tells me to not give up-I don't think I have a choice.

[GadgetRN71, ASN, RN]

In your initial post, it sounded as though you requested Versed from the doctor as a chemical restraint (based on the context of the situation, patient yelling, disrupting the PACU, etc.), then failed to inform the patient what the Versed actually was and why it was being used. You told the patient that Versed was stronger, which in context would have come across to me as "Versed is a stronger opiate/pain reliever," which it is neither. I am actually surprised that the doctor would order Versed in the situation, especially considering that s/he refused to order Dilaudid, but I'm not a PACU nurse so maybe it's somewhat normal and I just don't know it.

I have seen Versed used in the PACU. Unfortunately, some patients come out of anesthesia combative, pulling out their IVs, trying to climb out of the bed. In these cases, restraint is sometimes necessary. The elderly in particular can get very agitated from anesthesia.

And these patients are heavily medicated from the anesthesia..they are not in a mindframe to listen to patient teaching. Post-op, part of the concern is keeping the patient safe. The side rails on the bed are up at all times, and physical and chemical restraint is used when indicated. Granted, the PACU nurses try to do this as a last resort, but sometimes, there is no way around it.

I am one that thinks that pain needs to be treated though, regardless if the patient is an addict or not.

[morte, LPN, LVN]

I have seen Versed used in the PACU. Unfortunately, some patients come out of anesthesia combative, pulling out their IVs, trying to climb out of the bed. In these cases, restraint is sometimes necessary. The elderly in particular can get very agitated from anesthesia.

And these patients are heavily medicated from the anesthesia..they are not in a mindframe to listen to patient teaching. Post-op, part of the concern is keeping the patient safe. The side rails on the bed are up at all times, and physical and chemical restraint is used when indicated. Granted, the PACU nurses try to do this as a last resort, but sometimes, there is no way around it.

I am one that thinks that pain needs to be treated though, regardless if the patient is an addict or not.

but this wasnt the case here. this patient was complaining of pain and the ()*^% doc wasnt going to order any more pain med, SO.... they chemically restrained him for their own sake, not his......