Med Seeking Patients

[RNSuzq1, RN]

Hi All,

I've been at my current hospital for over a year and seems like we're getting more and more "med-seeking pt's" on our med/surg floor. This is a term frequently used on the floor for pt's that have had ever test known to man with no real disease found, so they are usually diagnosed with "chronic pain from unknown origins" and all are frequent visitors. Most are followed by a Pain Clinic, but when the Clinic is closed, they all show up at the hospital for their meds.

We were taught in Nursing School that everyone experiences Pain in different ways and to go by what the pt tells us, not judge their pain on their appearance or demeanor. However, we have this group of frequent visitors, all middle-age to older women that are obviously drug addicted and cause all sorts of problems when they're on the floor.

They insist on knowing what prn meds are ordered, how much, how often, etc.

Most look like someones sweet old Mom or Grandma - very nice to start with (honey this, honey that), but they watch the clock all night and if we don't get them their morphine/dilaudid (whatever) within minutes of them asking for it - they'll hit the call bell every minute - yelling, screaming, swearing until we get them their meds.

We have a lot of terminal/hospice pt's on our floor. We usually have 7 pt's each - a combo of hospice and med/surg pt's. It's really upsetting to be in helping one of my cancer pt's who is "literally" dying in pain and get 10 pages in a row from one of these med seeking folks telling me they're going to "die" if I don't get them their morphine RIGHT NOW!!!

When I go in their rooms, they're usually watching tv, in no obvious pain, but their typical response is - I don't care that you have other pt's, I'm having 10/10 pain (it's always 10/10 pain) and expect you to give me my medicine when I ask for it. As soon as they get the meds, their eyes roll back, they usually say something like - now that's more like it and start slurring. I'm starting to feel like a drug dealer and I don't like it.

One of my Charge Nurses said most of them should be in Mental Health, but they don't have the room, so we get them. I really like this floor, but the verbal abuse we get from these pt's is just too much to handle on a daily basis. My question is - how do I deal with them without losing my cool? Nice, doesn't work - they don't care if you're nice, they want their meds when they want them and don't care if you're busy with other pt's. Any suggestions???

[Daytonite, BSN, RN]

It's just wrong to classify someone who has pain due to an unknown reason as being less deserving of care than someone who has pain due to a known medical disease. That's being judgmental. Until you've been in chronic pain, are getting less than adequate relief, have tried everything and only meds are working, you have to be a little more tolerant of people with "chronic pain from unknown origins" before saying that they "are obviously drug addicted" with an attitude. So what? They are patients in need of help just like your cancer and hospice patients--and I am a cancer patient who has a long history of back pain problems that were not helped by epidural injections or other therapies. Remember what you were told in school. You wrote it in your post: everyone experiences Pain in different ways and to go by what the pt tells us, not judge their pain on their appearance or demeanor. You may disagree with the way they ask for their medication and the way they respond to it. OK. So what? It's part of the job. You deal with it by taking a breath, smiling and being as polite, caring and civil as you do with any other patient. You just carry out the doctor's orders as written. The doctors know these patients better than we do since they are in chronic pain.

I've had cancer patients who were just as nasty and acted out as badly as any drug abuse patient. I've also had drug abuse patients that were as sweet as could be. And, I worked on a drug detox unit. Guess you haven't experienced any of that yet. People are people. They come in all shapes, sizes and behaviors despite whatever diagnoses they have.

[Thunderwolf, MSN, RN]

I think we need to realize that there are patients that come into the hospital for "pain relief" for various different reasons....some legit and some not. It is just the way it is.

Much has to do with the patient's initial intent and expectation set regarding medications and pain relief, much has to do with that patient's experience of pain, much has to do with patient ability/inability to cope and adapt with chronic pain, much has to do if there is a comorbid depression (or any other psychiatric/physical concern), much has to do if there is indeed a psychological/physiological dependency to certain pain meds..and yes, much has to do if said patient cheeks/palms the meds to sell them afterward on a smoke break. Patients with reported chronic pain are a complex population...no one answer, no one approach. To say that all hospitalized patients with pain come in for treatment "are legit" or to say that that all patients with pain come in are "not legit" really misses the big picture. The reality is that you will see both or a mixture of the two on your floor.

[RNSuzq1, RN]

Hi Daytonite,

I've wanted to ask for advice about this for quite awhile, but wasn't sure how to word it. Obviously, even after a lot of thought, it just didn't come out right.

I didn't mean to lump all the chronic pain pt's together - it's just a certain group we have that are beyond rude to the entire staff and other patients. Last week I went in a room to help the CNA change someones diaper - another pt followed me in the room demanding to know when when he could get his morphine again. My pt was exposed when he walked in (we quickly covered her up), I asked him to go back to his room and I'd be in to talk to him in a few minutes. He got angry, said he wasn't leaving this other pt's room until I gave him morphine - the Charge Nurse ended up getting Security to return him to his room.

I love being a Nurse, I don't want to see anyone in pain. I'm not judging them, if they say they need something and it's ordered, I give it to to them, if it's not helping them, I call the MD to see if there's something else we can give. Might not sound like it, but I'm a very compassionate person.

My main reason for writing was to get some advice on how to deal with angry, beligerant pt's. I love helping people, but it's really difficult to stand there with a smile on my face while someones calling me every rotten name in the book. I've noticed that some of the long-time Nurses have developed "tough, no-nonsense" attitudes that pt's quickly pick up on and they never catch any grief - but those of us new to Nursing haven't grown a thick skin yet and the verbal abuse is hard to take. I know - people are people and it's just part of the job, I was just hoping some experienced Nurses had suggestions for how to diffuse these type of situations.

[vashtee, RN]

I hear you, susan. I think you should work on developing your "tough, no nonsense" attitude so you aren't bullied.

[amy0123, BSN, RN]

SusanNc, I totally agree with what you are asking. I would like to know how to diffuse a situation like that too.

I've had a patient, sickle cell, claiming 10/10 pain, 36yo. He would always walk into the hallway and stand behind me (startles me at times) and demand pain medicine (30min before it was due). He would never sleep at night and dance in the hallway, stand against the wall in the hallway shouting or moaning loudly, walking naked in the hall, repeating sexual phrases, harrassing the other female nurses by calling them all kinds of sexual names. The charge nurse got security to settle him in his room, however that did not stop him. He told me that if he doesnt get his pain medicine, he will just go to another hospital across town to get it. He would visit us once a month and stay a week at a time.. He wasn't the only one.

[nurse grace RN, BSN]

I can share your frustrations in caring for patients that get labelled " med-seeking". We have quite a few frequent fliers at my hospital and it is hard to learn to deal with their behaviors: nasty,rude, sexually provocative, melodramatic, etc. I always remember 1 thing... LOOK BEYOND THE BEHAVIOR , SEE THE PERSON. There is a sick person there, whether it is physical or psychological or both. It may be due to substance abuse, poor life style choice or who knows what. But, think about how you would feel if that were you! or your MOM,DAD,SPOUSE,CHILD etc. You would want a caring, compassionate nurse to care for you, wouldn't you? I know how very demanding that they can be and unrealistic. I also know that there are other nurses who handle them---but, I have also had co-workers come right out and say that they didn't care about them , have purposely made them wait for medication, and have gotten the doctors to decrease medication just to be mean! I try very hard to always be pleasant to the patient, I explain matter of factly that : no, they are not due yet for their medication but I will give as soon as it is time, or I tell them that I can only give them what the doctor has ordered, but, I can ask the doctor for something else if what they are taking isn't helping. I find that being firm and matter of fact helps and you can never resort to their level by showing any anger or by raising your voice. I also find that if they are on a regular diet, a cup of juice and graham crackers as a peace offering doesn't hurt. I have only been a nurse for 32 months but I worked for several years as a bar tender so I had other experiences with bad behaviors. You will get better at handling the difficult patients, it takes time and experience. I think you will do fine, just remeber that no one can ever judge another persons' pain.:cheers:

[Ninja Nurse, ASN]

I am so happy to have read your reply. I am just starting out with my pre's and have been a bartender for 13 years!! Most of these posts reminded me of "unruly" customers. Unfortunately, they would just get tossed out of the bar for rude behavior. But it's nice to know that I can carrying some of my bt skills with me to nursing. Also, a while back, I had to remind myself not to judge others especially those with addictions. It is my "current" job to feed them alcohol day after day after day! Thanks for those encouraging words.:yelclap:

[KCRN63]

When pts are angry, try listening with them Anyone in the hospital is experiencing loss of control. That increases anxiety and makes people cranky. I have a real hard time listening to nurses who talk about Drug seeking pts. These pts usually have a history of invisible diseases. Try living with an invisible disease. It is the hardest thing you would EVER do. To go home at night and have fatigue to the point it hurts to breathe. That bone aching exchaustion that does not go away because of the sleep disorder NO ONE CAN SEE once again. The only thing that helps is a pain med. To relieve the pain so you can work and simply function. Chronic pain pts do not react to pain like pts in acute pain.That is why they can sleep while you go get their pain meds. Sleep is a coping skill. When you think a pt is complaining of being in pain or you think she is a drug seeker, shame on you, and get to know your pt better. what is the pain like, what helps, what makes it better, how does she function with the pain, be compassionate. Their reactions are reactions to the knowledge that the nurses think they are drug seeking and that is very unfortunate. I hope no one that rolls their eyes at a pt for asking for pain meds ever has to ask for them herself. I am a nurse and have been for 23 years and have fibromyalgia. I found out that is what I had 9 years ago. I also suffer from narcolepsy, Raynaud's and alpha wave anomaly sleep disorder. Therefore even though I sleep many hours, it is not restorative. I see nurses judging pts every day and it is the hardest thing I have ever witnessed. Freq Flyers that have invisible illnesses, like me. No you did not here the term fibromyalgia many years ago. Thank God we have wonderful scientists out there that are discovering things on a daily basis. What else didn't we know 20 years ago, but we except those advances in healthcare?

You can prove a pt had fibromyalgia now with a finctional MRI. You feel the pain in your muscles however it is actually a nervous system syndrome. Actually it involves the nervous system, and the HPA axis. The nervous system amplifies every sensation you have.

Also when you take narcotics frequently, you have to take them or you experience withdrawl. You become dependant on them but that does not mean you are abusing them. THE GOAL IS TO MAKE THE PERSON IN PAIN MORE FUNCTIONAL.

OK, Hope I did not hurt anyones feelings, but I have seen and experienced more than my fair share of ignorance out there about these diseases. I have found when someone is judging another person they are usually very ignorant of the subgect at hand. I just want nurses to stop and think how they would want to be treated if they had pain. thERE

[iluvivt, BSN, RN]

I concur with all the responses to the original post. You guys ROCK!!! To the NURSE who is frustrated I am 99% percent certain you have never had a painful surgery. I am 99% percent certain you have not lived with a chronic painful debilitating illness or disease! I am 99% percent certain you have not lived with s/sx that no one could readily diagnose. You need to believe people when they report pain to you. Perhaps they sense your irritation with them and maybe their rudeness will dissipate. Let them know you will do your best to keep them as comfortable as humanly possible. That is nursing...juggling all those things.....they are in bed depending on you and they are very focused on their problems and issues.... not yours... and your problems are not theirs. They are there to get quality nursing care!!!!!

[canoehead, BSN, RN]

To the OP- You are asking good questions that no one has all the answers to. don't let the PC police keep you from asking your questions. Evaluate every patient individually, without prejudgements, and remember that even people in real pain can be inappropriate. You can react to inappropriate behavior, AND treat illness, and keep your self respect.

Have you considered putting the meds in a piggyback bag instead of pushing from the syringe? I would also advise being johnny on the spot for the clockwatchers so they trust you and you don't get the dogging that can be so frustrating. It can be a vicious circle.

[RNSuzq1, RN]

Canoe,

To the OP- You are asking good questions that no one has all the answers to. don't let the PC police keep you from asking your questions.

Canoe, Thanks for your response. Even though I rewrote my post, trying to explain the real reason I was writing (dealing with angry patients), I still got some negative replies. One poster was telling me how judgemental I am (which I'm not), then turned around judging me - she's never met me, doesn't know my current health situation, yet she's 99% sure I've never experienced severe pain. An extremely insensitive and hypocritical attitude towards someone that came in here asking for some sincere advice.

So Canoe, Thanks for your help - wish everyone would be as tactful when responding to posts.