To the cynical nurse

Nurses Relations

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I work in a cynical ER...really who doesn't?! Last shift being cynical caught up w/ us. I often hear from my co-workers that I am "so naive," regarding the drug seeker patient. I have always interpreted this statement as an insult or perhaps indicating I have a weakness. However, after witnessing a patient who was being treated as a "seeker" turn into a code, I quickly realized I will take the "you are so naive" reputation any day. I guess I just want to remind everyone that we need to remember that our patients come to the ER for help and if they rate thier pain 10/10, we should treat it as just that, because what if it really is a 10/10...

I work with a group of cynical nurses one of whom makes it her life's mission to make me as bitter and cynical as she is. We've agreed to disagree, but I see the glee in her eye when she thinks I've had an experience that should shatter my faith in humanity.

The NP I work with is a mystery to me when it comes to treating patients. Her Rx'ing policies aren't consistent. A pt who came in with a sprained ankle might get Ultram and Rx ibuprofen whereas another pt with the same injury gets Lortab 10 qty 30. Again, a diabetic with neuropathic pains in his lower limbs got Ultram, which she calls just like Lortab. But then a lady c/c sore throat gets Lortab 10 30 qty with refills. I'm like everyone else in that I'll carry out the orders no matter my thoughts on them, but it's starting to bother me.

We had an entire evening seminar after work one day dedicated to recognizing "drug seekers." We are now "highly trained" to spot drug seekers. My problem is many:

- I am a nurse; I don't have time to police patients in regard to their medication use outside my scope. Doing so takes precious time away from nursing patients thoroughly. We have to look up patients who meet certain criteria like no insurance or pain or insomnia as the primary symptom on our state's pharmacy board for rx's filled BEFORE SHE WILL SEE THEM. I could be see other patients or focusing my assessment on the pt's pain in the time it takes to look them up.

- Who are any of us to doubt a person's pain? My co-workers and NP roll their eyes when the pts are in for pain, they huff and sigh when I give report or prejudge that certain conditions are being exaggerated. One time I had a pt with a migraine and one of the LPNs sighed annoyed and said "this idiots here for dumb head. Tell him to take some tylenol and quit wasting our time." The NP overheard this and had her revisit info on migraines, but she herself commented to me that if they thought they were gonna get their high here, they have another thing coming - it probably wasn't hurting that bad.

I don't understand what everyone is so afraid of? I wonder if it is less about patient safety and more about the ego not wanting someone to try and get one over it. If a pt presents c/c of pain and the exam is done and any necessary labs or procedures are done to r/o any differentials and pain is not resolved and still remains at a 10, then it seems to me that the physical exams and actions have supported the order of pain medication that is generally used first line to tx severe pain as the patient has rated it. Repeated visits and f/u are then for following other options and referrals.

My worry is that providers are taking liberties deciding who is and is not deserving of adequate treatment. Most unsettling is that these attitudes are setting the stage for poor or under-delivered care.

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Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
"uncaring" is not synonymous with "cynical".

let's say that i've caught my kid lying...again...and again...and again.

of course i'll become cynical of his ability to tell the truth...but does it make me uncaring?

cynicism merely alerts us to potential situations that threaten a desired outcome.

leslie

Respectfully,you are naive if you think there is anything about the effect of cynicism that could be described by the word 'merely'....it is a destructive mindset which at best,clouds objective,critical thinking; as such,it has NO place in the nursing process. I have formed the opinion over 31 (and counting) happy years at the bedside that cynicism can largely be avoided by 1.) continually educating oneself -seeking new learning,reading,asking questions, broadening ones thinking by being open to new perspectives shared by nursing and medical colleagues, and, 2.) by not falling victim to the mistaken belief that we as health care professionals have all the answers (patients and families are extremely valuable teachers,if we're willing to listen). These are but two of the ways in which we can avoid the narrow,closed-minded,judgmental patterns of thinking (and the resultant behaviour) that cynicism naturally produces. Patients and their families needlessly suffer in such an atmosphere -I've seen it time and time again.

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I've got enough of my own horror stories about one ED in this town to fill a health department and JCAHO surveyors deficiency books. But the situation that always comes to mind (different state/ED) is about an early 40s construction worker who had been in the ED for severe headaches 3 days in a row...they finally did a CT scan and found several metastatic tumors. He'd had a melanoma removed very close to all of this (still had sutures). I admitted him- watched him get tested, and find out he had liver, lung, and bone mets. They offered him some chemo for palliative purposes- nobody expected him to get well. His pain was unreal. :eek:

This was a guy with no history of any type of chronic injuries, he was an active, healthy construction worker, etc. But he would be absolutely leveled by the pain. The PCA concentration was some crazy dose (not the grab and go amp set-ups). And nothing really helped. But he didn't want to be knocked out. The really lousy part of all of this was that he stayed incredibly alert and able to act on his rights until the last few days. He was with us for a month. I pronounced him. He was such a nice guy (like that matters), and close to my age. His family hadn't been around during the worst of it, but they did come at the end. They were really stunned. Who expects to go to the ED (3x) and end up dead in a month? And his pain was so incredibly intense. There were times I'd find him sitting at the edge of the bed rocking, holding his head. He had orders for more, and would take prns at times (and his doc wasn't stingy with the meds)...but he didn't want to miss any of the last bit of time he had. So he decided to suffer, and just 'be'. :crying2:

I've worked drug/alcohol rehab- and even they got temporary meds for acute problems (usually dental).

It's hard to not get hardened....but nobody ever knows when it's going to be something life-threatening or deadly. As has been said before, even the drunks/junkies have to die from something (and it's not always from their drug of choice). I had a guy with a AAA admitted to detox- needless to say he was stamped "return to sender" ASAP. He found out about the AAA with the detox h&p. Another nurse went to get some guy out of a van driven by his son, and that one was dead. :twocents:

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