I didn't become a nurse to feed people's addictions. Do *nurses* have the right to refuse - page 4

(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   hppygr8ful
    I get the humor I do actually especially in some cases addiction humor Last week We were attempting to medicate with a standard PO cocktail Haldol/Ativan/Benadryl and the patient said they would spit it back in my face. The thought ran through my head to catch that Ativan like a thrown piece of popcorn if you get my drift - such a shame to let 2 mg of perfectly good Ativan go to waste. Still our management is into posters with puppies and kittens and inspirational quotes. I mostly take my breaks outside.

    Hppy
  2. by   missmollie
    I think this is a legit question from the op, even if she is venting her frustrations. Often I have several different medications ordered PRN, but just because it's ordered doesn't mean I'm going to give all 10mg of oxy, 4mg of morphine, 650mg of Tylenol, or the 2 fiorcet they might have available. It is up to us to judge and decide how to best relieve pain while also being safe.

    For me, that means coming up with a plan for the patient, with the patient's knowledge. I'll explain what I'd like to do, ask what they'd like to do, and go from there. If Dilaudid is ordered PRN, I'm not going to mention that to the patient. It's my hail mary when the patient isn't responding to other pain medication.

    If the patient is watching the clock and claiming that the pain is a 10/10 and they have regularly been receiving morphine, then it's time to talk to the doctor. Obviously it's not working. Maybe add some tylenol or try a different pain medication altogether. But OP, if you are spending the majority of your time fighting pain with the patient, then you're not doing what's best for your other patients. Give it and be done.
  3. by   Spidey's mom
    Quote from 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.
    This is excellent and I think is what the OP was looking for.

    Thank you for sharing.
  4. by   cocoa_puff
    Quote from Spidey's mom
    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 didn't intend for my post to sound like I thought the OP would refuse to give the patient pain medication. I have struggled with similar things to the OP, and often feel the same way. That I'm just fueling the addictions of my many manipulative, drug-seeking, alcoholic non-compliant patients, and once they leave, they will go right back to doing what they were before (same with my non-compliant diabetics, CHF, and COPD patients). On several of my previous threads I have been accused of being judgmental as well (being told "you have no right to judge these patients! I would never want you caring for me!! How would you feel to be judged like that!). I wrote about how refusing to give pain meds to an addict won't fix their addiction in a general way, not in reference to the OP. I apologize to Thankgodforativan (love the username!) if it came across that way.

    I also come from a family of addicts.
  5. by   Spidey's mom
    Quote from cocoa_puff
    I didn't intend for my post to sound like I thought the OP would refuse to give the patient pain medication. I have struggled with similar things to the OP, and often feel the same way. That I'm just fueling the addictions of my many manipulative, drug-seeking, alcoholic non-compliant patients, and once they leave, they will go right back to doing what they were before (same with my non-compliant diabetics, CHF, and COPD patients). On several of my previous threads I have been accused of being judgmental as well (being told "you have no right to judge these patients! I would never want you caring for me!! How would you feel to be judged like that!). I wrote about how refusing to give pain meds to an addict won't fix their addiction in a general way, not in reference to the OP. I apologize to Thankgodforativan (love the username!) if it came across that way.

    I also come from a family of addicts.
    I was agreeing with you.

    And making a general statement.

    No criticism at all from me with what you said.
  6. by   LuckyMoon
    Quote from AliNajaCat
    Strongly suggest you educate yourself about addiction, mental illness, and pain management for addicts and people who are dependent. Learn the difference between addiction, habituation, and tolerance.

    And while you're at it, repeat after me: "There but for the grace of God go I." A little compassion is in order here. Learn to feel sorry for people with screwed up lives; you'll see a lot of them the longer you're a nurse (new?) and it'll make you a better one.
    While I understand how the situation described by the OP might be frustrating, I finished the post feeling quite sorry for the young woman causing the OP grief. What a sad and miserable situation. I appreciated the above post by AliNajaCat.
  7. by   hherrn
    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.
    This is actually a surprisingly reasonable discussion.

    The subject comes up frequently, and often elicits emotional responses.

    In this case, several folks have explained your responsibilities and your options. Some have sympathized, some have been critical. That would be a reasonable discussion.

    Was it a real question? I see you are new to nursing, but did you really not know the answer?

    Were you expecting: "Yes- you have the right to disregard MD orders on admitted patients under your care. Just make a list, let administration know, and somebody will come in and take care of any orders to which you have moral objections".

    Do some searching on this site, and you will see that this issue frustrates many of us, including me. But, I like my job in the ER, and this is one of the aspects that keeps it from being perfect.
  8. by   Tenebrae
    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.
    I recall from way back in my student days a young bloke who had a vac dressing in place and it caused him so much pain he had to be taken back to the OR and every dressing change had to be done under a GA
  9. by   BostonFNP
    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.
    Did you want to have a discussion about the topic or just have people validate your feelings on the issue? After all that is the purpose of ranting in the first place.

    I think we all understand the patient is frustrating; most here seem to also agree that regardless of that frustration, punishing the patient by refusing prescribed care is both unethical and malpractice.

    This patient needs long-term out-patient care; you are not going to "fix" her by refusing her morphine during her inpatient stay.
  10. by   tyvin
    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.
    You didn't like what you heard so now you're done. If you really feel this way why in the world are you working there?

    People have no idea how their nonverbal behavior affects people around them. I can just see you sitting on your I'm so clean and respectable high horse and why do I have to attend to the riff raff of life...that's not a judgement; that 's how I read your post as coming across.

    Next time you see this most unfortunate girl; really look at her; really look at her and see *her*. It's not just physical or mental. I don't mean just look at her, I mean go outside your body and look at her no judgements, no opinion, just look at her?

    I can see her and I feel for her. Would you trade places with her? How did this happen to her? She sounds so young; is there no way that you will help her instead of judging her. I hear suffering.

    If we help just one person in our lifetime, that changes the world. As nurses we change the world with our work. How we decide to change the world defines us as individuals.

    I don't know why you're so surprised that 89% of this thread has taken the compassionate/professional side; we are nurses. You get what you give in all aspects of life. I'll talk to you in ten years and see how your perspective has changed. Good luck
  11. by   Horseshoe
    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.
    There HAS been a reasonable discussion, just not 100% validation of your position. Talk about being on a high horse.
  12. by   historylovinglpn
    I got to a point that I decided, if the doc orders it, I give it. Unless their vitals are off, seem sedated...etc. they get their pain meds. I was in a situation as a patient where a nurse wouldn't give me vicodin after my c-section only Tylenol. So I try to not be "that nurse". Well, one of my residents a few weeks ago asked for vicodin for their back pain. I gave it. A couple hours later this same resident downed more narcs, including ativan, klonopin, more vicodin, etc. his "well -meaning " family had brought in as "extra." And overdosed. We found a regular pharmacy, bottles from different docs hidden behind a wall(our psych patients can go out on pass. seems like he was busy getting scripts while out on pass). AT the end of the day I was questioned about how I should not have given the vicodin. (Well his vitals were fine prior to me giving him the vicodin. He wasn't sedated. I gave it.) So yes, give it as the doctor orders, use your nursing judgement and you may still get yelled at and questioned. It now makes me nervous to dispense narcs. Dispense as ordered, try to be nonjudgemental and help with their pain and at the end of the day you are damned if you do/damned if you don't.
  13. by   Extra Pickles
    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.
    This is very much a reasonable discussion, with you having a viewpoint that is not supported by most of the people in the discussion. That doesn't make it not a reasonable discussion, it means that you brought up a topic to discuss and people told you what their own viewpoints were on it.

    I think it's helpful to read through these kinds of discussions, and if the person with the less popular or maybe even downright wrong position recognizes this during the discussion it benefits everyone. If you don't see why your position isn't well supported, maybe doing a little more reading on the topic would help?

    Don't get angry with people because they take a different opinion or their experiences in nursing don't mirror yours. They are giving you valuable information and it would be wise to keep an open mind, unless you don't plan to be working in nursing for much longer. Benefit from others' experience

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