pain in the ed

You noticed!?!?! Funny that the more one is educated (book wise or experentially), the less tolerant one becomes of other's opinions. I'm an agency nurse and the facility I've been working in lately makes extensive use of NPs. I've run into attitudes by far worse than many new residents. Very disappointing...

ERKev

where is the "tape over my mouth" smilie???

First of all I do not think I am wise...I am not the same person I was 20 yrs ago nor am I the same person I will be in 20 years.

In my opinion true enlightenment comes from the ability to hear both sides of an opinion. I am not saying you need to agree with others only that we all have various experiences that have brought us to where we are at today and that needs to be validated.

The ability to state your beliefs..listen and hear others beliefs..and reevaluate your own beliefs and why you feel the way you do, leads to continued personal growth.

Labeling other individuals as being enlightened because they have the same opinion as yourself is as closed minded as a person can get. Listenening, learning and introspection are active ways to continue to grow. An enlightened person is not one that makes a decision and becomes defensive when others ask "Why?". Also an enlightened person is not one that decides how "things" should be and then lives their entire life without reflecting as to why they think this way.

I am also not sure that passive aggression leads to enlightenment.

I don't agree with many of the posts in this thread and yes, I have somewhat of a bleeding heart..I might mention this "tolerance" has developed since leaving the ER..when I was in the midst of it, I was just as frustrated with all the pain issues. Since leaving and reading these posts I have tried to figure out whay I was so "angry" about it....I mean I used to just get steamed. I am still not sure why..I think it had something to do with a previous post that I was angry that these people were "wasting" my time, afterall I had other things to do. I was angry that they were lying to me, I mean can't they see that I am not that stupid..they are insulting MY intelligence and I was really angry that I was going to give them what they came for and they would be back tommorrow for more of the same and I would get mad all over again!!

WOW!! Emote away!! I don't recall anyone saying pain doesn't exist or noones pain but my own is real and needs to be treated...... and at the same time there is a universally recognized phenomena of patients who while having 10/10 pain are making out with there S/O on the gurney, would like another sandwich-- and "could you make it roast beef this time" and "oh, could you close the door while I make a few more calls 'cause I'm missing the party at my friends house". There are indeed people who use emergency depts. as personal entertainment centers, have been let go by 5 providers already and have fired another 5 because they can't get the regular 200mg hit of demerol on a standing order!! I can't believe any professional would want to deny pain relief to anyone or any situation and yet at the same time I have a difficult time with situations where I have actually bent needles trying to find a place to push the next dose around and through large patches of scar tissue caused by......... you guessed it!! It is not one or the other-- it's both and.

Get a grip people. Each of us who has worked in ED need a chance to vent. And to Magicgirl (spelling may be wrong) AMEN Sister.
There are certain physical truths about pain. If someone of average size and weight presents with 120/70 HR 60-80 and resp 12 - 16 and a O2 sat 99 - 100% do not tell me you are experiencing the worst pain in your life. And before anyone challenges me I have suffered with migraines for 33 years, my daughter started having migraines at 16 and my middle son at 5. Yes 5 years old. You can look at some people and see the pain, some only show by vitals. After 10 years I learned our drug seekers well. I was also the one that many doc's asked to go take a look at the patients and chat with them to determine whether pain was real or were they new seekers.
But I digress. We should be able to vent without fear of being judged.
It is hard to have empathy when your sickle cell patient comes in having a "crisis" but manages to stand up and throw a fit because we would not give her a weeks worth of her pain pills after all without them she wouldn't be able to get her crack.

I heard a surgeon walk in and ask a guy that had a hernia repair one time what his pain was on 1-10 scale he explained that 10 is the worst pain you can imagine and 1 is little to know pain.

The guy prior to docs arrival is sitting up in bed and has a visitor and they are talking and he is laughing and he seems fine.

He tells the Doc Oh I guess about 8 or 9

The Doc says let me rephrase the question If I had two bricks and I slammed them together with your bells in between that would be a 10 are you sure you are 8 or 9

I swear the guy grimaced at this description and he said hell no I would have to say maybe 2 or 3 in that case!!!

I guess the guy was just a little short on imagination so the Doc gave him a visual LOL

Well, a doctor (on the nurse's recommendation) at our LTC facility, ordered "Percocet 2 pills q 4 hours A.T.C."

A.T.C. = "Around the clock"

people, this takes away simple nursing judgement,

I will not wake him to give him Percocet

I will question him when he (quite briskly) walks up to the med cart 5 minutes before he can have it, laughing and carrying on, and expressing DIFFERENT PAIN SITES EACH TIME, with nary a sign of nonverbal pain cues (part of the admission nursing assesment)...


Please do not confuse addiction for 10/10 pain...They are different.

Remember 10 years ago, MS contin was used (almost exclusively) in Hospice...Now 75% of my residents are on it...

Can you say tolerance and/or addiction...

Flame away.

sean

Can you say "Customer service agent"

No one on Methadone gets admitted to my LTC...

They need inpt REHAB to get off this poison...

Let me say this...

Much of this debate comes from nurses thinking that many patients are addicted to these meds...Well they likey are...

Does he "need" 6 Percocets per day? Maybe...I'll NEVER truly know...Is he an opiate addict? Unquestionably...

Here's the problem: I have a 21 year old, 100 pound healthy friend...She was in a MINOR MVA (cervical strain only, albeit painful)...Her PCP prescribed OXYCONTIN as a first line drug...No Motrin, No exercise guidelines, just Hilbilly Heroin...

That disgusts me, and should you!

sean

Once again I will ask all posters to show respect for each other. As health professionals we do not like to contribute to addictive behaviour that is deleterious to the person - on the other hand pain is what a person says it is - hence the dichotomy.

We are torn between wanting to help and to act in an efficient and timely manner to relieve pain and not contributing to an addiction that will cause more problems for the patient