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| No. 100 | 
Jan 07, 2004, 09:38 AM
Well after your department gets put through a couple of spot pain audits by the health department.
After a few politicians call your administrator to find out why you are not meeting someones "PAIN"
After going rounds with JACHO over how well your documenting pain needs of the populace.. And why some patients were denied.
After dealing with some lawyers over why their clients were denied pain meds or why you had a pharmacy refuse to fill their prescription because the patient altered it and the police were involved.
Yes I would have fought it in the old days amd I did. But you are fighting adainst a stacked deck. Even though you win, you still have to jump through all the hoops put up my politicians, beurocrats, and shyster attorneys.
Then yes I choose to roll over and over and over. Its not worth my time, my frustration, my gray hair.
I will leave it to all you young pups to go joustng after windmills. Its your turn to seek out the dragons and remember there are even more hurdles in your way now than ever before.
Been there done that
I will focus on things more important, like honest patient care.
Doo wah ditty
 | | Advertisement Sponsored Links | | | | No. 101 |
Jan 07, 2004, 10:58 AM
But Tom, you equate rolling over w/ honest patient care. Is it "honest" to show a lack of interest in someone's potential recovery, or ignoring that the patient may be at his third ER tonight, as he is "stocking up" for the holidays (they are stressful you know), and the "candyman" came through each time (he might even be driving himself if we're lucky)...
We could go on and on. But I won't be a (quiet) conduit for a doc and his team of nurses who just want to be "Customer service agents" (I've heard a doc call himself this before  )
I will use my (objective) nursing judgement (and objective and subjective patient cues) to help adequately assess whether I believe my patient is in pain.
And if a "turkey file" might help identify seekers, then I'm for it.
If a guy that came in 3 months ago, and was CAUGHT (by security and the doc, WITH THE DOC'S PEN, after she asked for said pen IN THE EXAM ROOM) forging a script, comes to my ER today, I'll be damned if I give him narcs, PERIOD!!
sean
| | No. 102 |
Jan 07, 2004, 10:58 AM
 FLASH! Originally posted by teeituptom
I will leave it to all you young pups to go joustng after windmills. Its your turn to seek out the dragons and remember there are even more hurdles in your way now than ever before.
Been there done that
I will focus on things more important, like honest patient care.
I can completely relate, teeituptom! Though my hair's not turning gray, it IS falling out! 
This is a great forum, though. No where else can we compare notes and frustrations. And, while we seem to differ quite a bit in our potential solutions, it is obvious to me that you are all some fine, compassionate and caring nurses.
May you all have great blessings and a gentle wind at your back...
ERKev
| | No. 103 |
Jan 07, 2004, 07:04 PM
Well, teeituptom, I been there and doing it for 30 years and have more than my share of gray hair too, but I happen to think that honest patient care is not enabling addiction. If we're going to give up on these people, then we might just as well give them a gun.
| | No. 104 |
Jan 08, 2004, 07:11 AM
Terry if you want to consider it giving them a gun , then go ahead and think that. But I save my energy for the battles I can win.
What can you do with them
Get a psych consult, no, unless they want it.
Call the police, no, violates HIPPA
Refuse to treat their alledged pain, and sit down and consel them that yes they have a drug problem. No, you lose there too.
They c/o to administration
They c/o to the Mayor
They c/o to anyone who will listen.
Thats if they dont yell and scream at you in the ER for discrimination, predjudice, whatever to hide behind the fact, that they have a problem.
Refer them to a 12 step program,,,, " Oh No I dont have a problem with drugs" You just dont want to treat me.
Unfortunately, most ERs arent equipped to or capable to do the kind of counseling neccesary to deal with these kinds of patients. ER docs are stretched enough where for them its also easier to give in to the frequent ER drug abuser. Time for it isnt available when the charts are stacked 10 and 20 back waiting on MDs to see them. And the current laws dont give you any powers to help them. The deck is stacked against you anyway you look at it.
| | No. 105 |
Jan 08, 2004, 09:10 AM
Originally posted by teeituptom
...Call the police, no, violates HIPPA...
I can't believe this...If I have a patient doing anything illegal, WE WILL CALL!
And we have, just last month...A patient purposely threw hot coffee at a dietary employee. The police happily came out and filed a report...
HIPAA will not scare me from doing THE RIGHT THING!!!
sean
| | No. 106 |
Jan 08, 2004, 05:46 PM
Providing false information to obtain a controlled substance is illegal. Yes I do call the police, and yes they are arrested.....and I might say, they don't return. Our state has stricter guidelines than others. They have be have provided false demograchic info to be charged. In some other states they need to only request narcs under false pretenses.
We have a zero violence policy and that includes verbal threats.
If they become disruptive, we call the police and have them escorted from the premesis. When they get ornry with the LEC, they end up in crobar hotel on a disorderly conduct charge. Our administration backs us 100% and initiates action to obtain restraining orders when necessary.
I am sorry that you practice in an area where you obviously lack support from your administration, etc. No wonder you feel defeated. Fighting the seeker battle is one thing, but you are right.....without support.....it's a battle you can't win.  | | No. 107 |
Jan 08, 2004, 06:20 PM
Originally posted by teeituptom
...Get a psych consult, no, unless they want it...
...Refuse to treat their alledged pain, and sit down and consel them that yes they have a drug problem. No, you lose there too.
They c/o to administration
They c/o to the Mayor
They c/o to anyone who will listen.
Thats if they dont yell and scream at you in the ER for discrimination, predjudice, whatever to hide behind the fact, that they have a problem.
We got a psych consult for them even if they didn't want it. They signed contracts, and got nothing if they didn't agree, very simple.
I've answered many complaints to admin (never to the mayor, though) about seekers and non seekers. I answer each one the same. I will do my job as best as I can, and if that includes confronting a patient (politely) on what seems to be dangerous, addictive, behaviors, then so be it!
I am nurse, and am responsible to educate to the best of my ability, and treat w/o prejudice. (If the doc orders it, I will give it quietly). But in triage, I must educate as well. I've never been written up, fired, etc.
I've worked 12 step w/ adolescents, I've worked a chemical dependency unit for those same teens. You have to do some confronting, irrespective on "how many charts are waiting to be seen"
If you can't deal anymore, or just want to ignore, then think about different kinds of nursing...I did.
sean
| | No. 108 |
Jan 09, 2004, 05:19 AM
Originally posted by hogan4736
I will do my job as best as I can...
I am nurse, and am responsible to educate to the best of my ability, and treat w/o prejudice. (If the doc orders it, I will give it quietly). But in triage, I must educate as well.
... or just want to ignore, then think about different kinds of nursing...I did.
sean
signing contracts or getting nothing in a government setting would be called extortion.
in a better world, we would have time to educate these patients and the patients (the ones actually responsible for the path they follow) would actually listen and follow thru. you can only talk so much. you hope that maybe one day, one person will hear what you are saying and you will have a part in changing that person's life for the better.
so with that hope in mind, and i think it is in the back of all of our minds, we continue with the task at hand.
and remember, we complain and we vent. this is only meant to relieve some stress, not meant to change everyones opinion. some of the posts i have read... i wonder how many have been honest. i was. i admit that i do get angry and very tired of having to tell people what is best for them, get lied to, cussed out, spit on etc. but i must say. for every 100 of those patients, there is that one nice experience, the child with the "boo boo" that you make all better, the baby that you help deliver, and the mi that you clot bust and the pt is better and greatful that makes it all worth it. just one of those patients a year makes the others seem so small. they are just fun to vent about!
and the bottom line, i don't have md behind my name i have rn. the md writes the order and i (the rn) carry it out. i can argue with the md til i am blue in the face. if i refuse to give the med, there are many other rn's there who will. so, why fight?  | | No. 109 |
Jan 09, 2004, 09:21 AM
Originally posted by teeituptom
Terry if you want to consider it giving them a gun , then go ahead and think that. But I save my energy for the battles I can win.
What can you do with them
Get a psych consult, no, unless they want it.
Call the police, no, violates HIPPA
Refuse to treat their alledged pain, and sit down and consel them that yes they have a drug problem. No, you lose there too.
They c/o to administration
They c/o to the Mayor
They c/o to anyone who will listen.
Thats if they dont yell and scream at you in the ER for discrimination, predjudice, whatever to hide behind the fact, that they have a problem.
Refer them to a 12 step program,,,, " Oh No I dont have a problem with drugs" You just dont want to treat me.
Unfortunately, most ERs arent equipped to or capable to do the kind of counseling neccesary to deal with these kinds of patients. ER docs are stretched enough where for them its also easier to give in to the frequent ER drug abuser. Time for it isnt available when the charts are stacked 10 and 20 back waiting on MDs to see them. And the current laws dont give you any powers to help them. The deck is stacked against you anyway you look at it.
I am with Tom on this one although when I was in the ED I probably would have been with Magik girl or some of the others..The seekers really aggravated me...looking back, it took too much of my energy and time and if I ever return to the ER I will probably do the "roll over" as well.
Give them what they want since the MD orders it anyways and get thm gone so you can get the other pts that have been in the waiting room for 2 plus hours back.
I used to wonder about the MDs..they seemed to be as frustrated as us but many would just give the med and b*** about it the whole time. I would guess that there is a fear that a complaint would be filed and that they would have to answer to it? We had one new doc that refused pain meds all the time the fisrt yr or so then he became like the rest.."rolled over" probably decided the battle wasn't worth fighting?
Erin
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