Narcotics administration

danggirl · Aug 27, 2012

In my 17 years of nursing I have never once struggled with this issue. Taking care of patients, regardless of what they want or need, has no personal relevence to my life: I mean whether they take a tylenol or dilaudid, how much, and how often is not my personal business. My life is not affected in any way by what my patients take. Professionally, it is only relevent to the extent that I desire and am required to make sure the administration of a medication is not contraindicated or harmful. In fact I always found it quite useful to know that a patient would be wanting their medication on a "scheduled" prn basis...makes organizing my shift easier and I sleep better not having to worry whether or not my patients were comfortable! lol!

However, on a personal level, many of the comments on here are distressing to me. Over the past year I have made multiple trips to the ER, have been hospitalized at least 6 times, and ultimately had 2 surgeries. Over that period of time I developed quite a tolerance to opiod medications. A few times I heard the nurses in the hall saying that I was a drug seeker or an addict (I take nothing at home besides aspirin)...imagine their surprise when I had emergency surgery not once, but twice to save my life. I happen to be guilty of knowing exactly when my pain meds were "due" for several reasons: the half life of dilaudid is only about 2.5 hours give or take; the doses given were only enough to take the edge off the pain so in 2.5 hours the pain was back full force; I was in a constant state of dread worrying that (given the nurses attitudes) my pain wouldn't be controlled. I've learned to have an upfront honest discussions with the physicians and the nurses caring for me so they can understand my history and my tolerance.

I work in an ER setting now so I understand what ya'll are talking about when you discuss "frequent flyers" and I know about whom you are addressing when you talk about the "seekers". The way I look at it is this: that person made the effort to come to the hospital for SOME reason and it is my duty to treat them in terms of the physicians orders. Could be they want to get high BUT there is the same probability that they need treatment. One of my former charge nurses sent a supposed "seeker" away (EMTALA violation) who presented with a severe headache. She said "you might as well leave, we aren't even going to give you a tylenol let alone narcotics"...the guy died at a nearby hospital of a brain bleed.

Anyway, some people watch the clock because their pain really isn't being controlled as well as it should or they are afraid of getting behind and having worse pain. Either way, it shouldn't be anything personal to the nurses. Do your job, take it in stride, assess and document as appropriate and follow the physician orders. I fail to understand why nurses have such a negative view and take opioid administration so personally.

wooh, BSN, RN · Aug 27, 2012

When I had surgery, I asked on the dot. Because the meds weren't actually covering my pain all that well. Complaining about being in pain before the meds were due was a waste of time, so I called when they were due, trying to at least keep the pain reasonably at bay. I waited longer than that and I was in excruciating pain.

Are there seekers? Obviously yes. But I'd rather medicate a seeker that doesn't "need" the medication than NOT medicate someone in pain.

If it's ordered, and the patient is breathing, I give the medication.

cbsncmom · Aug 27, 2012

I couldn't agree with rhondaespo more. I felt so sad and digusted when I read the post by Jory. My brother has been clean and sober for more than 20 years. I seen him suffer some very traumatic things when he was a little boy. Things that would bring anyone to tears. It is NEVER our place to judge, period.

FMF Corpsman, MSN, RN · Aug 27, 2012

Absolutely right Brandon. Thank you.

FMF Corpsman, MSN, RN · Aug 27, 2012

This has been a very enlightening thread and an extremely interesting discussion. As at least one nurse wrote, there seem to be two camps, one who believe you should medicate as long as the vitals are WNL and the pt isn’t somnolent and the others who feel that it is appropriate to withhold medications until...? My own views are apparent in the post I’ve already made, but I’ll restate them for clarity. I believe if a patient is due for medication, anything from a stool softener to narcotics, they should receive them when they are requested. Not on the Nurses schedule, but when they are requested. Pain is pain, whether real or imagined, it is still pain. Pain is subjective, on a scale of 1/10 what may be a 9/10 to your patient, may only be a 3/10 to you, but that doesn’t matter, you aren’t the patient and you aren’t the one in the bed. It is your job to medicate the patient, not judge him or her and you don’t get to decide if he or she is drug seeking either. That isn’t your role in this situation, so just do your job and give them the patient care you were hired to give them, which includes providing them their pain medications that the Physicians ordered on a timely basis.

If you are so driven to judge those who are drug users, go get a job in a Drug Rehab Center where you will do the most good, meanwhile, simply provide the best care you can give while you are at your current job. Your Patients deserve no less. If they are truly in pain that pain will be relieved and if they are drug seeking, their itch will be scratched for another 4-6 hours. As has been said several times already, if they are drug addicts, the minimal time they will be under your care is hardly enough time to Detox and cure them of their addiction, so if you feel so strongly of your views simply document it in the Patients chart or even discuss it with the Physician if you must, and your job will be done when the Patient is D/C. In my opinion the word addict is used much too loosely here. We have to remember who it is that allowed this habituation to manifest itself to begin with here, and approximately, seven times out of ten, that finger will point right back at the medical community. The Patient may not ne a true addict, more of a habituate user. It may appear to be splitting hairs, but the habitual user will have an easier time getting off the drug than a true addict. I’ve seen this from my time working in a Detox Center. Habitual users can usually just be weaned from the root drug where-as addicts need to given other drugs to be detoxed and it requires a longer period of time. Also, their mind set is quite a bit different from someone habitually using a narcotic.

Anyone with a long-term history of Pharmaceutical abuse is under most circumstances an addict, I’m not saying that, but it’s your job to treat them as any other patient. Simply provide them with their medication as it is called for on the Doctor’s Orders. If they say, it isn’t working, treat them as you would anyone else, put a call in to their Physician and follow his or her orders, that is all you can do. In other words, BE A NURSE. If you can stand in front of a mirror every morning and say, “I will be the very best Nurse that I can possibly be today. “ and when you get home at night or what every shift you work, and go over your day and take an inventory to decide what you did right and what you did that you could possibly do better on tomorrow, it’s a good way to finish off your day. I’ve done it for over 25 years and it works wonders. I still do it today, even though I’m retired and out to pasture, it’s still a good way to end the day.

Poochiewoochie · Aug 28, 2012

When I had surgery, I asked on the dot. Because the meds weren't actually covering my pain all that well. Complaining about being in pain before the meds were due was a waste of time, so I called when they were due, trying to at least keep the pain reasonably at bay. I waited longer than that and I was in excruciating pain.

That's what happened when I had my ACDF this year. The medication wasn't strong enough so one time I asked for it an hour early. The nurse said no, it wasn't time so I had to wait. I understand that she was following the doctor's orders but that hour seemed like an eternity.

My worse experience was during one ER visit. I was in so much pain yet I had some nurse tell me what do you want us to do about it. That was before the MRI and everyone kept saying it was just a "cervical sprain" even though I had pain and numbness radiating down my arms. Even my PCP said that. The doctor I saw that night ordered 4 injections and prescriptions for a stronger narcotic and muscle relaxer; he also said I needed an MRI.

It not just nurses that have the "drug seeker" mentality-I've had doctors like that too.

schoolmack · Aug 28, 2012

Thank you! For everyone who had constructive advice and specific examples regarding this topic! I believe there was a lot to be learned here. Some should learn how to communicate civilly on a message board but that's another matter;)

I think it is easier to know how others deal with frustrating situations at work, whether or not narcotics are involved!

I think the main thing I gained from this is that pain is real to the pt whether it is physically present or imaginative.. If they think they're in pain and feel miserable then they are... Abusers or severe sufferers! It is our job and oath as nurses to help the pt be comfortable and feel well taken are of!

The loss of control these pts receive upon admission is my worst nightmare.. I can't imagine being a pt under the circumstances that we put them in! We tell them when to eat, sleep, go to procedures when they can get meds etc... It is a complete loss of personal control!! I truly feel for them!!!

Thanks again to those who took the time to constructively add to this thread.

Poochiewoochie · Aug 29, 2012

Thank you! For everyone who had constructive advice and specific examples regarding this topic! I believe there was a lot to be learned here. Some should learn how to communicate civilly on a message board but that's another matter;)
I think it is easier to know how others deal with frustrating situations at work, whether or not narcotics are involved!
I think the main thing I gained from this is that pain is real to the pt whether it is physically present or imaginative.. If they think they're in pain and feel miserable then they are... Abusers or severe sufferers! It is our job and oath as nurses to help the pt be comfortable and feel well taken are of!
The loss of control these pts receive upon admission is my worst nightmare.. I can't imagine being a pt under the circumstances that we put them in! We tell them when to eat, sleep, go to procedures when they can get meds etc... It is a complete loss of personal control!! I truly feel for them!!!
Thanks again to those who took the time to constructively add to this thread.

I'm glad that some of the comments helped you. I also think it's important for nurses who do struggle with this issue to hear from people who are or have been chronic pain sufferers and what they go through when they go to the ER or are admitted. If more people in the medical field weren't so prejudiced against people who have pain I think a lot of pain patients wouldn't arrive in the ER with a chip on their shoulders because of the way they have been treated in the past. It's not fun being a patient and like you said, we lose our personal control when we are admitted to the hospital whether it be for some illness or surgery.

lifelearningrn, BSN, RN · Aug 29, 2012

This is how I view drug seekers: I don't care about them. I don't care about their health. I don't care if they die an early death.
That is not a popular opinion as a nurse, but drug addiction IS A CHOICE...bottom line....
....So, if they have loaded up on herion before they come in, lied about it, we can't see evidence of it and we give them something else and they drop dead? One less drug seeker as far as I'm concerned.
These people generally don't work, they mostly live on state assistance and they neglect their children and give birth to drug addicted infants. They are the lowest of the low and IT IS A CHOICE.

Wow. Does it make you feel good to be so superior to the subhuman drug addicts?

BrandonLPN, LPN · Aug 29, 2012

This is how I view drug seekers: I don't care about them. I don't care about their health. I don't care if they die an early death.That is not a popular opinion as a nurse, but drug addiction IS A CHOICE...bottom line.If they get admitted to the hospital, it is my job to assess them. If I think they are drug seeking, I'll communicate that to the doctor. you can only ASK THEM what else they are taking, IF THEY LIE TO YOU, YOU ARE NOT LEGALLY RESPONSBILE for what happens to them if they have a drug interaction or if they have taken something before they come in...and anyone that tells you any different, I challenge them to produce an article proving otherwise. Nurses are supposed to ASK but we are not required to be mind readers, nor does the law.Now, after my assessment and report, if a doctor wants to prescribe them a narcotic, I don't care. My last responsibility is to make sure that GIVEN THE ASSESSMENT AND REPORT FROM THE PATIENT, if the dose is appropriate and if an injection, to give it appropriately.That is where my responsibility ends.Do you know why I don't care? I didn't create the system...doctors, lawmakers and hospital administrators did. It's not me that the DEA is going after for over-prescribing narcotics...it's going to be the doctor who wrote them out.Pain is what the patient says it is and until someone comes up with a pain test, I'm not putting my license or job at risk for a drug seeker.So, if they have loaded up on herion before they come in, lied about it, we can't see evidence of it and we give them something else and they drop dead? One less drug seeker as far as I'm concerned.These people generally don't work, they mostly live on state assistance and they neglect their children and give birth to drug addicted infants. They are the lowest of the low and IT IS A CHOICE.

You don't know what kind of a life this addict has had to endure. I personally know crack addicts who have lived lives since childhood that I know I couldn't have survived. And I consider myself a strong person. when you consider the cards that many addicts have been dealt in the game of life, the very fact hay they're still alive and kicking is a testament to their *strength*.