I am glad to see this thread and proud to say that, during my orientation recently, my health system spent almost a whole day on pain management. This included mostly new nurses and those new to the health system. They drilled into us pain assessment and made it clear that inpatient care in an acute care facility does not include diagnosing drug dependency and addiction. Not our job and we couldn't cure it anyway. The docs can make referrals to affiliated practices that handle these issues. Our job is to provide appropriate care related to their hospitalization. We were empowered with the ability to report docs and other RN's who were not taking proper steps to adequately manage patient pain. Of course, the problem is that there are nurses who take out their own issues on the patient, whether that be exercising some control over the patient because they have no control in their own life or the influence that drug addiction (whether theirs or a family member's) has had on their life. Either way, check your baggage at the door. The ED still treats appropriately but patients who exhibit drug seeking behavior (over numerous visits) will trigger a psych consult and outside referral and an in-house action plan. Some need true pain management and don't have the resources and some just don't have the money that week for street drugs. The point made was that, as nurses, we must use our training and think and not just go by the written orders and the canned responses we get from patients. Assess the pain level and treat accordingly. If the doc's orders aren't sufficient, request more or something different (give evidence supporting request) and if he doesn't respond, continue to advocate for your patient. Too many of us don't want to develop or exercise clinical judgement.