pain in the ed

I just have to say it. Sorry but I have to say it.

I feel sorry for my patients who are in pain. Pain is subjective and I will administer the patients pain meds based on what they say it is.

BUT-

In healthcare their is an allocation of resources. My TIME is a scarce resource. So when a person who has chronic pain issues and has PRN narcotics ordered starts DEMANDING that they need their pain medication NOW, and will cause such a ruckus if it is not delivered within minutes of their request it may become a problem. The problem may be that the little old lady down the hall has developed a heart arythmia or pulmonary congestion. She may not be screaming for help- in fact she may just lay there getting worse until you the nurse intervene.

That poor little old lady needs help now. She may not have the ability to call the NM and start screaming for help NOW. So then I have a decision to make. Sometimes my decision is not a popular one. Sometimes the person who can scream, can be demanding will do so at the expense of another, more fragile, more vulnerable patient. Hence- this nurse, or anothe nurse in the same position may feel frustrated. Resources should not be doled out based on the aggressiveness of a patients' demands.

There I have said it. I hope to not appear unsympathetic to our patients who are in pain. And although pain is the 5th vital sign, it may cause a life altering condition and not a life threatening condition. And I as a nurse will put a life threatening concern first. So some patients may have to be in pain a little longer than we both would like. We both end up frustrated, but sometimes that is just the way it is.

i thought this was a site for nurses to vent... instead we are getting sniper'd in the back by our own!!!
i have not read one thread here that assumes patients don't have pain --- do those of you lecturing us about perception ACTUALLY work in an ED?!?!?!
on a personal level - i can tell you that i see approx 20 patients a few times every wk....either w/ an etoh of 300 and out of their narc's - or just out of narc's - these patients have been placed in a PAIN PROGRAM by US - when i mean us i mean us caring/compassionate ed nurses who want them to get the best pain med and f/u possible - and guess what happens when we call their pain management doc - he tells us - don't give them anything - they were given new rx two days ago !!

before we start to judge i think you should contemplate where nurses are coming from w/ their views and perhaps allow for the possibility that they are not speaking of every patient but maybe only a few.......

Couple of things to think about:

1. Although pain is not "life threatening" in itself it can be indicative that something life threatening is going on..hence the 5th VITAL SIGN.
True Story: We had a guy some in to the ER that was a "frequent flyer" complaining of abdominal pain. Of course we all rolled our eyes, saying, "whats new". We gave him Donnatol and Lido..of course the pain was still 10/10 again rolling of the eyes..we knew he wanted the "good stuff". The staff taking care of him put him on the low priority list due to his past history and our predjudice against him..Finally after sitting in a room for several hours the MD scanned his belly just in case. He was perforated and had to go and have an emergency appy. The surgeon screamed at us when she came in over the amount of time we had basically let him stew. He ended up in the ICU for over a week with a systemic infection and brought a suit against the hospital maintaining that IF the ER staff would have taken him seriously then he would not have become septic. Would he hve? It is unknown BUT try to defend your actions in depostition on that one..."Um well he is usually full of crap so I figured this time was no different...A plantiff atty would tear you a new one for that. Now I know I am going to hear variations of the little boy that cried wolf here but a BIG part of nursing and critical thinking is based on remaining OBJECTIVE to the patient at hand. That is part of our responsibility as healthcare providers. By not doing so, the staff in our ER put a patient at high risk..not something any of us were proud of.

2. As far as the patients that come in over and over for narcs and the fact that we as nurses think it is bull..the MD is ordering these. If the supply dried up they would no longer come. Maybe rather than complain and complain about the patients go speak to your MD group or refuse to give them. I have seen more than one nurse say, "NO". I told an MD "No" once since the pt was so completely gorked and her resp were so slow in my judgement it would not have been safe to give her anymore. After I told the MD her vitals etc he agreed.

I no longer work ER and am glad when I read these types of theads. I used to be the same very judgemental and the pt basically had to "prove" to me that he/she was really deserving of that pain medication. It is sad really. Bottom line is the seekers are not going to go away so I agree with the NM "give em what they want and get em out"..wasting emotion and time on being "mad" at the pt only serves to take away from the nurse.

Erin

as far as pain indicating a life-threatening emergency - that would be detected on a physical exam which a nurse should do on every patient

but when your patient rates their pain a 10/10 - you have to pull them off their cell phone while their laughing w/ their friends to assess them, they ask for food and drink, they want to go smoke, and on physical exam they have no tenderness/rebound/guarding........

Firstly, I do work in ER. I cover patients for my practice and spend a good portion of my time there. A few times a month, the MD I work with and myself are the sole providers in ER doing complete coverage. So I DO have plenty of ER expeirence.

Secondly, I do not understand the presumption that just because a person is able to function in an outward apperance (meaning laughing, talking on the phone) they are not in pain. Chronic pain suffers have learned to cope with their pain and many times they appear this way, even though they are in extreme pain. Yank their family out of them room and talk to them one on one. Their change in presentation can be amazing. Jane Doe who was laughing, chatting and eating can suddenly BE your typical person in pain. Not because of a "show" but because they are coping for their family. Many pain patients have isolated their families by their constant complaints of pain, and this is one of their mechanisms.

Finally, and ONCE AGAIN until you are in their body do not persume you can tell someone what's going on. That's part of the reason we call it the PRACTICE of medicine. If you weren't just practicing, then you WOULD be able to tell me what's going on.

Dave, who will gladly order medication based on what the PATIENT says their pain is.

That explanation deserves a kiss!



Thank you for being the kind of practitioner you are to your patients!

Dave...you are my kind of guy! Thank God someone was paying attention when pain mgmt. was being taught!

(PS-Want to come to PA? We could use you in my area!)