So, as a nurse it's my #1 priority to serve your narcs on a platter...

Nurses Medications

Published

.... So sick of handing narcs out like candy to haughty, rude entitled ADDICTS. I work in a dam SNF and too many of these people must think my whole world revolves around their scheduled pain meds. Is there a way to stop the madness?? Irdk if your grammy or mom has "had to wait" a whole 30 min extra for pain pill s/he didnt really need. Well, unless getting high is a necessity. How do I get away from this crap? I almost feel like a drug dealer!

Bravo, Esme 12! You put into words exactly what I was thinking but you did it much better than I could have.

Up Vote Up Vote ×
Specializes in LTC,Hospice/palliative care,acute care.

Why isn't a pain management team assessing the needs of these residents? A new rehab /skilled patient s/p surgery should really be on a long acting ATC pain med for a short time in addition to something PRN. If you assess and the use of the PRN is out of control you up the long acting med for a few days.Are you advocating for these patients?

Up Vote Up Vote ×
Why isn't a pain management team assessing the needs of these residents? A new rehab /skilled patient s/p surgery should really be on a long acting ATC pain med for a short time in addition to something PRN. If you assess and the use of the PRN is out of control you up the long acting med for a few days.Are you advocating for these patients?

I don't know what to say... I'm not even sure there IS a pain management team. Advocate on a case by case basis, but honestly I haven't called unless pain meds aren't holding. PRN at this place and am reality-checking on here.

Up Vote Up Vote ×
Specializes in Gerontology RN-BC and FNP MSN student.

Addiction is sad .... I work in LTC and some facilties I've worked at it was a huge problem, along with alcoholism and LOA residents coming back with alcohol, or passed out in the parking lot once or twice. But unfortunately that's our culture. Addiction knows no age or class or boundaries.

However I have known prescribed opiate users who are not addicts, they take their meds and go one to live a healthy productive life. Even 20 years of pain meds as scheduled not abusing them.

We have all types and those in between in nursing. I get where your coming from! :yes:

Up Vote Up Vote ×
Specializes in LTC,Hospice/palliative care,acute care.
I don't know what to say... I'm not even sure there IS a pain management team. Advocate on a case by case basis, but honestly I haven't called unless pain meds aren't holding. PRN at this place and am reality-checking on here.

We don't have a pain management team but we have a quality assurance department. They monitor the use of PRN's for proper documentation and they look at the pattern of use. They will suggest ATC scheduling if the floor nurses have not done so. The next time you have to call a doc why not suggest scheduling the pain meds this way? They may go for it-if you meet with resistance suggest ATC for a certain number of days.

Up Vote Up Vote ×
Specializes in LTC, SNF, Rehab, Hospice.

I have done LTC/SNF for several years and I agree with both sides. There are some docs that don't do the leg work and just give meds and nurses don't follow-up. Some residents do expect their PRN pain meds every however many hours, because a certain shift or certain nurse always just brings it to them. I have seen that happen too many times...idk if they are necessarily addicted, but people in "homes" get very used to routine and when it doesn't occur the same way at the same time everyday, they notice and they get upset. I have seen a few wake up naturally to get a pain med or anxiolytic, just because the think they need it, because that's the way its been for however many months or years even. I have also seen a couple that are definitely addicted, based on their demeanor, body language and speech. I have been there...burnt out, feeling like I "hate" nursing even, just because of the way the residents are towards healthcare and what they think should be done...in my experience, hind sight is definitely 20/20 and I see them as lonely, depressed, only having but so much to look forward to and change is unbearable. When I was in it though, I really questioned my compassion for people and lacked empathy because of it. I needed to get out of the environment for a while to see what was really going on. I feel for you. Being a nurse can be really hard. Being a new nurse is even harder. It gets better...you have to take a step back and just try to make them happy the best you and when it doesn't go "right" for whomever, have patience and understanding. You really do have to be overly sweet...even though some will see right through it haha GOOD LUCK!

Up Vote Up Vote ×
Specializes in dementia/LTC.

I have the same problem when I get floated to the rehab unit in my ltc. When I go through the Mar to make up my shift sheet on med times I keep an eye on prn meds that seem to be given very frequently then when I pass their scheduled meds I ask if they are having pain and want their prn too (if it can be given at that time) or if they want to wait until x time (whenever I will be done w first scheduled med pass)

If I am being pested for prns (and they do not appear to be in immediate distress) at the time I am doing bg & insulins I simply tell them it will have to wait half an hr bc I have to take care of the diabetics before the meal starts in 30 min but as soon a I complete that I will bring then their requested prn w their scheduled meds they have at that time.

I always ask the off going nurse when everyone had prns last so I have an idea of when expect requests.

I have seen a lot of our drs prefer to NOT schedule pain/anxiety meds and deny our request to schedule them. I am not 100% sure why they want prn meds that are being given as often as the pt can have them kept prn but they must have a reason I am not aware of.

Up Vote Up Vote ×
Specializes in Psychiatric Nursing.

On student doctor network , the pain management and rehab section, there is a thread called "the opioid epidemic ". . people are finding that long term treatment with opioids is not effective for chronic pain management. And prescribers who prescribe a lot of them are being questioned. I think the the thread was in response to an article in the NY times.

Up Vote Up Vote ×
On student doctor network , the pain management and rehab section, there is a thread called "the opioid epidemic ". . people are finding that long term treatment with opioids is not effective for chronic pain management. And prescribers who prescribe a lot of them are being questioned. I think the the thread was in response to an article in the NY times.

Thanks... I'm gonna check that out. :up:

Up Vote Up Vote ×
Specializes in School Nursing.

I've been on the ortho/rehab floor of a SNF for about 6 weeks now, and I've had patients (many) who expect their PRN narcotics q4hours from the day they come in (24-72 hrs post-op) to the day they discharge (3-6 weeks). Isn't the pain supposed to get better over time? Many of these patients leave and one of their first questions is "Are you going to give me a script for my pain meds before I go home?". I've never had ortho surgery, so I don't know the recovery time, but 1-2 norco tabs q4hrs for six weeks does seem excessive. I don't judge my patients, if they tell me they're in pain, and it's within the window to give them another dose, I give it.. but I do worry about them when they go home in as much pain as they came in.

Up Vote Up Vote ×
Specializes in MICU, SICU, CICU.

Although I can not prove it, I believe that MDs are being influenced somehow to prescribe unnecessarily high amounts of narcotics to increase pt satisfaction and HCAPS scores.

Up Vote Up Vote ×
+ Add a Comment