Completely lost it today... cool heads needed, please.

[AngelfireRN, MSN, RN, APRN]

Most of you are aware that the clinic I work at dispenses controlled substances. As such, we drug test and have numerous protocols in place to limit the potential for abuse.

Today was sheer Hades.

First, my eleven month old is teething. No one is sleeping. So, I go in with fatigue and a headache on board.

First, a patient smacked me in the nose with a door (not intentional). Poor man, I think he thought I might clobber him once I was able to focus my eyes.

Then another patient, who had failed a second drug screen, was also found to be seeing a second doc and receiving controls from him. Dismissed, per my doc. He attempted to convince me that the Board of Medical Examiners said we were required to provide him with Roxy as a consolation.

A patient called later, upset at having been taken off two of her meds, in accordance with a memo from the ABME. Said that she'd deal with Doc and she WOULD get her meds back. Problem was, she canceled her next appointment. When she said what her plans were, we refused to reschedule her. She had a hissy fit and cussed me over the phone. I wound up yelling at her to never speak to me or anyone else like that again and hung up. I never raise my voice at work. This same woman came to our office and waylaid Doc's wife in our parking lot to demand that she send Doc out to see her. Called me all manner of names. I went out and dismissed her on the spot when I got word if what was happening. Mrs Doc is close to 80, and that was beyond the pale.

And the cap to the afternoon? A lady of color and her son both failed drug tests. When I gave them their warning, she accused me of being a racist and said I might as well bring back slavery. Said they would just go elsewhere. She settled her little red wagon when she got the message that I wasn't going to write her refills if she kept on, per Doc. Then she apologized.

I am yet so frustrated and ill with myself. Yes, they were pains in the rumpus, but does anyone else deal with such, and how else could it be handled? Doc said I did fantastically well...commented on my patience, given the circs. I'm just having a pity party, I suppose.

Thank you in advance.

[TraceyMarino]

Hi: I feel your pain, this can be a very frustating job. I often deal with upset patients, often involving controlled substances.

Advice. You cannot lose your cool. Period. You cannot raise your voice. Period. Docs don't, so you cannot either. The staff and others around you will see your behavior, overhear you, and think you unstable or unprofessional.

There is a double standard in medicine. Yes, I have seen docs lose it with patients, or get tough and firm with patients. As a mid-level, you can be turned in for unprofessional behavior by patients or other providers. I have never been one of those fear for my license people until I became a nurse practitioner. You will have to answer for every complaint made against you.

When patients get verbally abusive with you, or confront you in the parking lot, stalk you, etc, espeically when narcs are involved, you must call the police and file a complaint. Pretty soon, your patients will get the picture. This is the most professional and safest way to handle these issues.

Just my thoughts!

[AngelfireRN, MSN, RN, APRN]

I know that. I know I should not have raised my voice, and I NEVER DO. I was so embarrassed. However, the staff told me that all who heard (I was in the back of the clinic) had no complaints...just wanted to know who got me to the point of yelling. They've been around me enough to know that if it had come to that, someone had messed up BADLY. Even during a dismissal or a failed drug screen, I never raise my voice. I may become aggravated and the good Lord knows I have a mouth on me, but I never yell.

I have the reputation of being tough as nails, but I am always, always nice. I do my utmost to keep it professional, even in such a relaxed place as my clinic.

I did call the local law and inform them of the events. The patient has been banned from the premises.

The gentleman who told us that we were required to dispense Roxy to him also said that he had called the State Board...well, I just spent half an hour on the phone with them, listening to an investigator laugh in my ear. We have a really good relationship with them, and they are well aware of the caliber of folks we see.

Thank you for your thoughts. Today has been much better.

[Psychcns]

Most of you are aware that the clinic I work at dispenses controlled substances. As such, we drug test and have numerous protocols in place to limit the potential for abuse.

Today was sheer Hades.

First, my eleven month old is teething. No one is sleeping. So, I go in with fatigue and a headache on board.

First, a patient smacked me in the nose with a door (not intentional). Poor man, I think he thought I might clobber him once I was able to focus my eyes.

Then another patient, who had failed a second drug screen, was also found to be seeing a second doc and receiving controls from him. Dismissed, per my doc. He attempted to convince me that the Board of Medical Examiners said we were required to provide him with Roxy as a consolation.

A patient called later, upset at having been taken off two of her meds, in accordance with a memo from the ABME. Said that she'd deal with Doc and she WOULD get her meds back. Problem was, she canceled her next appointment. When she said what her plans were, we refused to reschedule her. She had a hissy fit and cussed me over the phone. I wound up yelling at her to never speak to me or anyone else like that again and hung up. I never raise my voice at work. This same woman came to our office and waylaid Doc's wife in our parking lot to demand that she send Doc out to see her. Called me all manner of names. I went out and dismissed her on the spot when I got word if what was happening. Mrs Doc is close to 80, and that was beyond the pale.

And the cap to the afternoon? A lady of color and her son both failed drug tests. When I gave them their warning, she accused me of being a racist and said I might as well bring back slavery. Said they would just go elsewhere. She settled her little red wagon when she got the message that I wasn't going to write her refills if she kept on, per Doc. Then she apologized.

I am yet so frustrated and ill with myself. Yes, they were pains in the rumpus, but does anyone else deal with such, and how else could it be handled? Doc said I did fantastically well...commented on my patience, given the circs. I'm just having a pity party, I suppose.

Thank you in advance.

Agree with Tracy about professionalism. Your behavior has to be above reproach at all times. I have worked a lot with substance abusers and I try to be clear, matter of fact, non judgemental. I see sub abuse as a coping mechanism that isn't working. I try to be empathic-put myself in their shoes. But I also set limits and try to get people into appropriate treatment when possible. I work in psych so I can ask more about what they are trying to medicate with substances, have thy had therapy, has their drug use got them in trouble. Etc. you have to take a step back from the situation. The tendency is to be drawn in.

[CrunchRN, ADN, RN]

Some days just go like that. Life in the clinic. The only thing I would have done different was as soon as they are inappropriate on the phone I warn them I will hang up if it continuies. Next inappropriate word? Click.

[AngelfireRN, MSN, RN, APRN]

Some days just go like that. Life in the clinic. The only thing I would have done different was as soon as they are inappropriate on the phone I warn them I will hang up if it continuies. Next inappropriate word? Click.

I did. After 3 repetitions of, "Ma'am, there's no need to yell.", and the subsequent barrage of swear words, that was about the time it went south.

[CrunchRN, ADN, RN]

After the 1st I would have said " I am hanging up if you do not peak civilly". And one more word and BAM. I am done. Of course I was in charge of all firings of patients for our Ob/Gyn group so I had to set an example......... You should only have to tell them once.

[nursetim, NP]

A friend of mine used to mess with me like this: "you know what I like about phones? Me: no what? Him: this." And hangs up. That is what I do when thing escalate on the phone. Drug seekers are fun, aren't they?

[Iridescence]

Having an 11month home is probably the biggest part of the challenge. I have an 15 month old, who I leave at *daycare* everyday so I can go to work and deal with many ungrateful a-holes who are demanding an early refill on their Oxy, Phentermine, or Benzo du joir. There are moments (many of them mind you) where I seriously question my purpose in regards to these patients. I think, my god- why am I not at the playground with my babe?

Its hard to remember that there are some very redeeming qualities of your job ie. a very supportive doc, correct?

However, seriously evaluate the situation. How many positive interactions vs negative ones. The nice thing about being an NP with a DEA # is you are highly marketable.

So, my advice is: if you are going to be leave your precious nugget behind for 8+ hrs a day, make sure your work experience is one you enjoy.

i struggle with this everyday BTW. Goodluck