I didn't become a nurse to feed people's addictions. Do *nurses* have the right to refuse - page 3

(Disclaimer: So this turned out to be longer than I thought it would, and a bit of a rant. Sorry! But I think this is something that's relevant to all of us). Some background: I work in a combined... Read More

  1. by   KelRN215
    Quote from Paws2people
    If she is sabotaging her wounds, VAC, etc, then she needs to be placed on a 1:1 safety. She should be watched 24/7 by an aide.
    This.

    This patient needs:
    A) Pain consult
    B) Psych consult
    C) a 1:1 sitter if she is self-injuring.
  2. by   LovingLife123
    Quote from KatieMI
    When they finally hit the line of waiting time in pain clinic with nobody giving them even a single new script, they go one of three ways:
    - go on street drugs (approximately half of them)
    - wean themselves off (yep... believe me or not)
    - or hit one ER after another, move doctor shop, etc., till they are fed-flagged in state pharm surveillance, after what they go one of ways above.

    I had to observe recently what happened with about 600 patients seen by one incredibly "caring and understanding" doctor who was caught red-handed by DEA. Pretty much all of them were addicted to certain level to opioids and /or benzos; they all were purposefully left on cold air by all local providers for at least 3 months, and local ERs were put on alert not to give these people anything without clear clinical indications such as withdrawal. When after that they started to be re-distributed among local providers, half of them found that their "nerves", "debilitating anxiety" and such disappeared most mysterious way. They just self-weaned Xanax, and were put on much more reasonable doses of pain meds. Honestly, I was feeling angry on those conspiring providers for letting the poor souls to suffer, but once I saw the results of it, I kinda changed my opinion.

    I do not want to say that all of chronic addicts are simulating or something, but sometimes REASONABLE limits are everything that is needed.

    It had the opposite effect in my town. Most went on to Heroin. Now the county is one of the highest in the country do Heroin addiction and overdosing. Three docs were shut down by the DEA all at once. The one addiction hospital is full all the time and can't handle the load. People are dying everyday and babies are born addicted to Heroin. These babies end up wards of the state. It was one big cluster.

    Our government needs to do better on addiction. Period. I'm getting off my soapbox because I could write a 20 page paper on it.

    OP, you are wrong. Dead wrong. That patient deserves you to respect and take care of her like you would any other patient. That includes controlling her pain.
  3. by   cocoa_puff
    Quote from KelRN215
    This patient needs:
    A) Pain consult
    B) Psych consult
    C) a 1:1 sitter if she is self-injuring.
    I'm suspecting borderline personality disorder, that would certainly explain the self harm, prior substance abuse, and needy/manipulative behavior. She definitely needs a psych consult and a 1:1 sitter (and possibly even soft wrist restraints in addition). From my experience with psych patients, they abuse alcohol or drugs because they want the emotional or psychological pain to go away. As someone mentioned before, it's an escape from reality for them and a way to feel something other than the pain they are used to. Refusing to give the patient their pain medications won't fix her problems, although I can understand the OP's frustrations.
  4. by   Spidey's mom
    Quote from cocoa_puff
    I'm suspecting borderline personality disorder, that would certainly explain the self harm, prior substance abuse, and needy/manipulative behavior. She definitely needs a psych consult and a 1:1 sitter (and possibly even soft wrist restraints in addition). From my experience with psych patients, they abuse alcohol or drugs because they want the emotional or psychological pain to go away. As someone mentioned before, it's an escape from reality for them and a way to feel something other than the pain they are used to. Refusing to give the patient their pain medications won't fix her problems, although I can understand the OP's frustrations.
    I agree with your perspective.

    Also, the OP didn't say she wanted to refuse to give pain medication but was asking if there was another way to handle this complicated issue.

    I think that is a legitimate question.

    And I'm outing myself as a member of a family with many drug addicts.

    I know we need to cover pain relief somehow; I'm aware that vac dressings can be painful. But it's not like she can say we're not giving her anything at all. What are our options here? I'm not the only one with the same concern.
  5. by   Thankgodforativan
    Thanks to everyone who replied, but I'm done with this thread. I hoped to actually have a reasonable discussion, but I can see that just isn't possible here.
  6. by   Spidey's mom
    Quote from Thankgodforativan
    Thanks to everyone who replied, but I'm done with this thread. I hoped to actually have a reasonable discussion, but I can see that just isn't possible here.
    I hope you stick around. I think you voice the frustration many of us feel.

    We still must treat our patients and I don't think you were saying not to treat.

    You can ask a moderator to close the thread for you if you wish but I think you brought up something many of us struggle with as nurses.

    Don't even get me started on drug addicts in labor and having to care for a baby going through withdrawal.
  7. by   hppygr8ful
    Quote from Thankgodforativan
    (Disclaimer: So this turned out to be longer than I thought it would, and a bit of a rant. Sorry! But I think this is something that's relevant to all of us).

    Some background: I work in a combined med surg ward, so we see a bit of everything. We have a young-ish girl, in her twenties, that has a VAC dressing in her leg following very deep self harm about two weeks ago. Her drug use has also given her 'meth mouth', and she's had at least one tooth removed about a week ago as well.

    The issue is that she has a personality disorder, a history of aggression, is a known drug seeker and has had to have her VAC replaced twice now because she keeps sabotaging it - picking at it, poking and playing with it. Before it was put in she was seen physically pulling the edges of the wound apart with her hands also. She demands morphine roughly every hour for "ten out of ten" pain even though you can clearly see that she's not distressed in any way. She is charted for PRN morph and fentanyl, subcut (not allowed to have a cannula).

    We always hear about the patients right to refuse; surely nurses have some way of objecting in a situation like this? Panadol (Tylenol), anti-inflammatories and endone all "don't do anything", even though it barely gets to two minutes after giving these before she buzzes and asks for "something better".

    It's ridiculous; the patient knows she's playing us for fools and has said as much. Surely there comes a point where enough is enough and we stop giving in to people, especially people who don't want to help themselves. No wonder the state health system I work in is broke; It frustrates me to no end when we can't even afford more then one obs machine on the ward between thirty two patients, yet we will hand out expensive treatments to people who clearly don't want to get 'better', and dole out morphine like it's soda.

    I know we need to cover pain relief somehow; I'm aware that vac dressings can be painful. But it's not like she can say we're not giving her anything at all. What are our options here? I'm not the only one with the same concern.

    Sincerely, nurse who didn't become a nurse to be a drug dealer.

    *edited for spelling.
    Oh dear Lord here we go again!
  8. by   NurseCard
    OP, I too feel your frustration; I've been there.

    People such as the patient you are speaking of, take up so much
    TIME... time giving them IV pain meds every two hours on the hour...
    time having to call the doctor when this pain med doesn't work,
    or this one, or this one... meds that you are thinking, SHOULD
    be working, but amazingly are not.

    It is very frustrating and I do feel you. Certain types of
    patients, while certainly deserving of the same care and
    compassion as others... DO seriously try our patience and
    compassion! We are human!!

    Better to come here and vent then to take your frustrations
    out on your patient.
  9. by   hppygr8ful
    Quote from Thankgodforativan
    But we are giving her pain relief. As I explained, nobody can say we're not doing anything for her, she just doesn't like what we give her (her words, not mine). She can do whatever she wants while she's out in the community, but surely as an inpatient giving in to her every demand (to the point where she's constantly drowsy) is doing her more harm than benefit.

    Where does it end? And why should my other patients suffer because I spend half my day (not an exaggeration, this is my actual hours as per allocation) dealing with her constant demands for pain relief?
    So what would you do if you refused her pain meds and she went into detox! Why not suggest a pain management consult and a psych consult - since she is going to be there a while. This patient more psych than anything. You are not an addictionologist - and probably not even qualified to be an addiction counselor. I don't mean to be hard but psych and addiction medicine are in factt my specialties. Trust me if you don't give it to her, her friends will sneak something in and then you won't know what she's got on board.
  10. by   hppygr8ful
    Quote from Thankgodforativan
    It's just a username friend. Meant to be a joke, ya know? Humor?

    Incidentally, it comes from a framed picture we've had hanging in our nurses room for who knows how long now of Jesus that says 'and on the seventh day God created ativan'.
    Actually not funny at all and no such poster would be up in our hospital anywhere!

    Hppy
  11. by   Spidey's mom
    Quote from hppygr8ful
    Actually not funny at all and no such poster would be up in our hospital anywhere!

    Hppy
    I guess I won't invite you into our break room.

    Nursing humor . . . aka Gallow's Humor is what gets us through the day sometimes. Never in front of patients but just between us.
  12. by   hppygr8ful
    Quote from Thankgodforativan
    Oh oh get off your high horse. God forbid we ever question anything in nursing huh? It's not my judgement, her addiction and drug seeking are well documented. But hey, far be it from me to question your knowledge.
    But she's not there to be treated for her addiction or psych which is why I suggested consults from both specialties. Contrary to what you may believe addicts are not bad people anymore than non-compliant diabetics are bad people. Best to think of them as sick people who need to get well. I drank alcoholically for 30 years and were it not for some extremely compassionate and informed nurses and doctors I doubt very much I would be alive and sober today.

    Hppy
  13. by   Simonesays
    Ok. I didn't read all of the comments. To a certain extent, I get your frustration. Health care can be a downer sometimes (i.e. the CHF patient who is aggressively diuresed and then proceeds to sneak in an x-large sodium-laden fast food meal). Sigh. However, I would try and think of this situation from the patient's perspective.

    In order to deeply self-mutilate, she would have to be very unhappy. And now this patient is stuck in a hospital where she is away from her friends/family/community. She likely feels a loss of control and disempowered. And, on top of this, she isn't able to "cope" with the situation through drug use. So she picks at her dressing. And she uses her call bell frequently. And asks for her PRN narcotics around the clock.

    As I said, I get that this can be frustrating. But, it's not about you. It's about your patient. So what can you do as her advocate?

    What types of resources are available at your hospital? Do you addictions specialists? What about psych support? Hopefully they are already on board. If not, ask and advocate! What about spiritual health? Or a music therapist? Or even a volunteer visitor?
    Hopefully your manager is aware of the patient's needs already has some strategies in place (i.e. weighing assignments accordingly, switching up staff, etc). If not, talk to your manager too.

    I would also talk to your patient and try to work together to come up with a plan. This might give her back some of her power.

    I get where you are coming from, though. I have worked with lots of similar patients before and remember one in particular who pulled off a complex VAC dressing less than one hour after it was completed because she "wasn't allowed to leave the floor for a cigarette." Again, sigh.

    Last piece of advice: remember to take care of yourself. I don't know if you're burnt out or not but I usually find that if I'm not able to approach a patient compassionately, it's more about my mental state than theirs (not saying you weren't compassionate to this patient to her face or that you didn't provide her with good care).

    Go out with a few coworkers and order a few drinks. No one understands your job better than someone else who is doing it so vent together.

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I didn't become a nurse to feed people's addictions. Do *nurses* have the right to refuse