pain in the ed

Specialties Pain

Published

You are reading page 10 of pain in the ed

MAGIK GIRL

299 Posts

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?:kiss

Erin RN

396 Posts

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

MAGIK GIRL

299 Posts

Originally posted by Erin RN

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

erin, you are wise! what is up with the docs anyway? there was one thread post where someone worked with a doc who treated the seekers with more meds than the appy's or the obstructions! i am glad that i am not an md. too much pressure!:cool:

Terryw

12 Posts

No wonder you can't win. I guess I'm lucker than I thought, being able to work in such a supportive environment. Our docs are all on the same page with this problem. NONE of our docs order narcs for "seekers".

Medic946RN

133 Posts

Specializes in Emergency/Critical Care Transport.

Some of our doc's are non-chalant about this. They give the narcs just to get them out of here. I once saw a doc write the pt's med order as they were being brought back to a room. He knew what the pt was there for. The pt was medicated and gone in under twenty minutes. (Talk about Fast Track!) So we freed up a room, the problem was when the pt came back and another doc refused narcs then the screaming fit, "I gonna sue you!" stuff ensued, so it doesn't pay either way.

What's strange is that our PA's seem to be stricter than the Doc's. They are concerned with being percieved as "candy man" When we get these pt's who come in the ED day after day w/ back pn, HA, neck pn, etc. The PA usually looks up the hx and last visit rx in our computer. If a pt was given 6 percocet in a take home pack and an RX for 20 more and they're back within a 1-2 day period, then that pt gets a Naprosyn and referral to a pain clinic.

angelbear

558 Posts

I understand that there is a huge lack of knowledge concerning pain management. Things like addiction physical and psychological, physical dependence, tolerance, psuedo addiction are all things that are not well understood. Wouldnt it make more sense to educate yourself on these things so that we can truely be the compassionate and caring advocates for our patients that we are meant to be instead of insulting those seeking our help? Is it just me or has alot of the care gone out of health care?

Dave ARNP

629 Posts

You are right Angelbear.

Care went out of Healthcare right about the time we started labeling patients as seekers. Right about the time we stopped admitting patients into LTC becasue they were on the "poision Methadone". Right about the time we decided patients taking Oxycontin were on "Hilbilly Heroin". At the same time, "CARE" was thrown to the wolves, when long time nurses decided to throw all those years of research and teaching to the wind... and profess that they knew a seeker and a fraud, forget about basing care on the patients statement of pain.

I am just thankful that where I practice, we still have nurses who know just what the CARE in HealthCARE is. And that they apply it to every area of medicine, including ailments which will require controlled subtances.

Dave

angelbear

558 Posts

Dave please hold that job for me it is giving me incentive to study.

RainbowSkye

127 Posts

You guys, I think we need to meet somewhere in the middle. Prescription drug abuse is an enormous problem in this country, ruining many, many lives. Please don't think that those of us who believe there are people who are addicted to prescription drugs and will do just about anything to get them are uncaring. You could not be farther from the truth. I do not want patients to be in pain, and I fight to make sure that patients receive the pain medication they need on a daily basis.

However, please take a moment to check out these resources:

http://www.drugabuse.gov/ResearchReports/Prescription/prescription5.html

http://www.prescriptiondrugaddiction.com/default.asp

I don't think that treating one problem while ignoring another (or denying it exists) is true patient caring. One nurse's opinion only.

angelbear

558 Posts

I agree and I dont think any of us want to create or enable addiction it is just that that is its own area of medicine and we have no business in it. In those cases we need to referr for either adequet pain tx or addiction tx

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Originally posted by hogan4736

I disagree

Let's just give the shoplifter the merchandise he wants in the store then...

Or the arsonist a pack of matches, and a can full of gasoline.

A patient on methadone needs inpatient detox, NOT a LTC...

I turned down an admission to my LTC last week. A 28 y/o female that was on IV Demerol q3h for intractable back pain...

She needs inpatient detox (w/ possibly a course of methadone), NOT A LTC!!!!!!

I will not endanger my elderly patients. And please, before you say "how dare you label the 28 y/o," I'll just say:

PLEASE! A nursing home is not the place for an IV opiate addict!

sean

+ Add a Comment