Detox nursing is sucking the life out of me

The0Walrus, BSN, RN · Aug 12, 2020

I'm in the psych unit where we specialize in substance abuse patients. UGH! I know what you mean. Unfortunately, it's just what we have to deal with. I just give them their meds and that's it. I try not to overthink it. Most of these patients even return. Maybe it's not for you. It's a really tough job I think. I hate being spoken down to and lied to etc. but unfortunately it comes with the territory.

1999nurse · Jun 29, 2021

I worked in a rehab 20 years ago, and a few months ago started working in a detox and residential rehab program. Our staff and management are so supportive. Our medical director is an APRN and very involved. It probably helps that we only take private insurance and self pay patient's, none that are "sent to us," but I am also happy to say we follow a structure and agree we are all on the same page. Patients are told what we will do (and not do) on admission. If it isn't time for meds, I say NO. If a patient were to be verbally abusive, they would be asked to leave.

It's only been a few months, but I love where I am working and what I am doing. I've been a nurse since 1999. We have a lot of long term skilled nurses, but not all from long term psych or addictions nursing. I care but I can also remained detached.

Maybe that isn't the job for you. I don't know if it's the actual detox or the way it's ran. If you are miserable, there are other things to do. I am glad I have changed specialties and tried things until I found somewhere I feel like I fit in. I could make more money, but I don't care anymore.

good luck whatever you do. I'll keep focusing on the ones I can help, and hope the others remember something I said someday and get help and get clean. It can be a heartbreaking disease. I expect the lies and manipulation. Our system is set up to not feed into it or let it continue. I am happy that abuse from patients will not be tolerated!! Leadership is everything, and having a ARNP who was also a ---burnt out from working in a hospital, ER and hospitalist---- helps.

Melilem · Mar 20, 2022

I have been a psych and detox nurse for 7 years. I don't feel that way. I have had patients abuse the system, lie, manipulate, walk out the door after getting fed/sleep/subutex. That doesnt bother me. This is the behavior of addicts, I figure its very hard for them, and they're here. It's a start. Just like psych, you have to realize that they are not well, and don't take it personally.

On the other hand, you really should get some clinical experience as a nurse before you let yourself get lazy with behavioral health. ? Nows the time, the hospitals really really need nurses. Put in some applications.

dianalee1968 · May 6, 2022

The diseases of addiction (SUD) and alcoholism (AUD) are not easy afflictions to deal with when working with patients for sure. But it's our job as care givers, and as professionals to recognize that behaviors such as manipulation, dishonesty, entitlement etc are all symptoms of the disease and need to be treated as such. Your patients are not well and need firm limits, along with compassion and empathy.
I read one comment here that described personality d/o's as "nasty personality disorders that are so engrained in addicts"...maybe they need to rethink where they would be of the best service. Might not be a psych or addictions setting. People suffering from a Substance Use Disorder don't necessarily have a diagnosis of a personality disorder.

nolongeranurse · Feb 4, 2024

you should quit your job and do something else

Urinegdhands · Feb 25

I laugh at some of these comments. Where I am from our chronic inebriates drink hand sanitizer, lysol spray , aqua velvet, vanilla extract and will leave anything liquor aside to get this other stuff because it has destroyed them. They are still treated as a human as they should be. If they are being to aggressive or physical they are intubated and or put on precedex. It is a tough population to work with.

77Mercy, RN · Mar 12

Urinegdhands said:

I laugh at some of these comments. Where I am from our chronic inebriates drink hand sanitizer, lysol spray , aqua velvet, vanilla extract and will leave anything liquor aside to get this other stuff because it has destroyed them. They are still treated as a human as they should be. If they are being to aggressive or physical they are intubated and or put on precedex. It is a tough population to work with.

OK- I have to ask - where do you come from? And did you actually say that you intubate your patients if they become aggressive or physical?

Are you sure it's the patients that are aggressive or is it the nurses who are aggressive and intubating their patients?

77Mercy, RN · Mar 12

All I know is that when most nurses talk about substance abuse and addicts- it just brings out that judgmental, ***y nurse Ratched side of them and it makes me feel judgy and ***y to my fellow nurses- so I am not any better that any of you.

I think what we need to understand is addicts are not any more manipulative than anyone else.

When you get your car fixed and they tell you that it was a really tough job, they had to work on it all day and it is going to cost you $1200.00- they are lying to you. When your husband tells you that you don't look a day older than 25- he's lying to you. People lie to you all day. Your pastor lies to you. He takes your donation on Sunday and Monday night he is at the casino with the church secretary playing Black Jack with you money. It didn't go for Sunday school camp it went to the casino camp! He lies to you all the time and you believe him. In fact you are a huge liar. You lie to yourself and you lie to your husband. You told him that you have been eating salads everyday for lunch but that was just a lie because you have been going to that Pizza Buffet place 3 days a week and taco pizza is not a salad. You know that. You are a liar.

Nurses are no better that addicts -and a lot of nurses are addicts. So please stop telling yourself how bad your patients are and how good you are. Stop saying how they are driving you crazy because they are trying to get Benadryl from you so they can get high. That is just stupid. You think that they are getting high off Benadryl. Really? They can take enough drugs to kill and elephant but you think they are getting high on Benadryl. Stupid.

Why don't you just stop all this ***. Stop the lies. Treat others like you would want to be treated. Maybe if you did that you wouldn't be so miserable and hateful. Maybe the reason that you are having so many problems at work is because of you and the negative energy that you give off. You can't help anyone when you are looking down at them and being an asshole. No one wants your help . You can't even help yourself. You are miserable. You hate your job and you can't cope with anything so you have to put everyone else around you down. Stop it. If you cant handle detox than go work somewhere else but don't blame it on your patients. You are just as sick as them.

77Mercy, RN · Mar 12

I don't have anymore in me to deal with being spoken down to, lied to and yelled at. I'm sure this happens in any unit but does detox carry a bit more of this sort of thing?

If you are going to be a nurse you have to toughen up a little bit. Stop feeling sorry for yourself because you aren't getting your needs met from the patient- nurse relationship. Remember- it's not about you. You are the nurse and they are the patient. They are not there to make you feel good about yourself. If they are rude to you and yelling at you- you need to learn how to deal with it in a professional way. You need to be respectful and professional with them and as you grow as a nurse and a person- you will find people will show you more respect. Sometimes when we are young and new, we just don't get the respect that we think we should. It's not fair but it's a fact of life. This could be a huge learning opportunity for you. Is there anyone on the unit that could be a mentor for you and help you learn how to grow as a nurse? I think all new nurses do go experience frustration and I don't think it matter if you work in a clinic or a prison or a detox center. It is frustrating having to deal with illness, disease, people, other nurses and patients. You are going to be going through some growing pains and you are going to be frustrated sometimes because people do yell and they do lie and it doesn't matter where you work. You have to learn how to cope with all of this and it isn't easy but it isn't rocket science either. It just takes time.

Urinegdhands · Mar 12

77Mercy said:

OK- I have to ask - where do you come from? And did you actually say that you intubate your patients if they become aggressive or physical?

Are you sure it's the patients that are aggressive or is it the nurses who are aggressive and intubating their patients?

I am in AK and yes they do intubate those patients that have increased withdrawals/DT's that are very aggressive. Usually if they have CIWA's over 20 that are uncontrolled from PRN's or the protocol. I do not believe all patients do well on the protocol as a whole and each patient should be treated case by case. I have been working in this department since 2000 and sadly they are never treated well. It is always "if its not me then who cares". I have never disrespected any client/patient and have only had a couple incidents where the police had to intervene and it was usually a violent person on a regular basis. We had no protected nurses station for years and if you didn't set the boundaries right off the bat you could easily get ran over, but as a whole I have never had issues. The hospital does not like to deal with these folks either and will intubate these patients very fast if they cannot handle the protocol. I had to work very hard in outpatient detox to get a personalized protocol set up when I was a administrator but it does get to you after the revolving door just rotates them in on a regular basis.

Urinegdhands · Mar 12

Carolynfward said:

I just started working as a detox nurse 5 months ago, as it was kind of one of the only nursing jobs available right out of nursing school (I am working on my RN- BSN at the same time.) I thought it would be interesting and possibly fun, but NO. It's making me question the decision to become a nurse, honestly. The patients tend to be extremely med-seeking, disrespectful, manipulative, etc. and sometimes their interactions with staff becomes actual verbal abuse. I wind up leaving at the end of the day seething and it's terrible. To make matters worse, we are horribly understaffed and there is not enough support of floor nurses by the higher-ups. Like, AT ALL. I feel trapped at this job because I don't have my BSN yet and I've only been a nurse for 5 months. Can someone who works in detox give me some advice about how to deal with these patients without going home at the end of the day with flames coming out of my ears???

I have worked fulltime/part time/PRN for substance abuse. You have to first remember that they have zero coping skills thus the reason they abuse drugs there are other reasons but overall they cannot cope. You have to one not take anything personal. Be assertive. If you give to one it will spread that you are the one that will cave. You have to lay the line out there and stand to it, but you can be compassionate and empathetic at the same time. I would do anything for these folks but they also knew I didn't take any crap and would have them removed in a heartbeat. We would have them sent to sleep off at the local jail or title them for a mandatory 12 hours. Once they know where your hard line is things will turn around. You can never take it personal. I had my kids get caught under a bridge once trying to take the shortcut home and was met by two previous clients. My daughter said that her mother wouldn't help them if they did anything, when they found out who their mother was they helped them get to the other side and told them never to go that way again. Long story short is that you need to treat these folks like humans but make sure you line is set in stone and never allow it to be crossed because they will keep moving that line. it is a very stressful job if you allow yourself to become overcome with the baloney. Substance abuse is very hard to treat but I personally have many that still let me know they are sober and that in itself is worth it.

Urinegdhands · Mar 12

Nashvillejeanne said:

Maybe I will help to hear a different perspective. I am just a mom and a RN.. but mostly just a mom who lost her oldest son to an OD in the Summer of 2015. My heart broke the day his heart stopped beating. No, it shattered. I have yet to recover. Oh sure, I get up and go to work. I smile. I say I am OK. I lie. I still cry everyday, though not all day anymore. The guilt is overwhelming. I mean literally overwhelming. Why couldn't I save him? We nurses are "fixers". I was supposed to protect him. I was supposed to be able to help him. I could not protect him from this monster. Every bit of my retirement is gone, gone to rehab that did not help. One last relapse took his life one month after he was best man in his brothers wedding. I am grateful for that last happy memory. It is all I have left.

When people learn I have lost a son, and ask what happened. I have learned to be honest now. I find it helps to tell the truth...I still get that "look". I can hear it..."he did it to himself", "it was his own choice", "he was just a junkie"....

"His name is Ryan. He was 30 years old. He started on medication to treat an injury and when he could not get that medication anymore he went to heroin. He tried to get off it and could not. I spent my retirement trying to help him. I was handed a life sentence of guilt and sadness when he died. I have often thought of joining him, the missing him is that bad. It took his dignity, his soul and then his life. He was not a bad person. You would have liked him. His life had meaning. I loved him without judgment. If you know someone struggling do whatever you can do to help them and never give up hope"

Ryan is buried on my farm in Tennessee, under our oak tree. His grave was dug with our own shovel, and prepared by his brother, his cousins and friends, his mom and dad. It was the hardest thing I have ever had to do. We had a home funeral. A sundial is his marker and marks the time till we are all together again.

Visit Ryan at: Ryan P Frye at Virtual Memorials.com and say "hi" Learn more about my journey at:

[email protected]

You have a hard job. Addicts are fighting demons we can not begin to understand. Addicts are people with families that love them, they are more than the disease of addiction.....Remember that as you work with them. You may be the only one they have.

Thanks for all you do...

Just a mom

My heart breaks for you. I have personally lost more relatives from drugs/alcohol as I am from a reservation and it seems to be a "normal" situation. I think being open is so important. No they are not bad people and are loving etc but we need to start being honest with the fact that they have chosen this path of self destruction. It always starts out without intent and can spiral so quickly. I am currently fighting this battle with my older brother and it kills me to see him destroy himself. I do not give money and if he needs anything I can provide it but never for his habits. He knows I love him and we talk about his problem frequently as I try to figure out what he drinks a gallon of liquor daily for. I think if we do not try to hide these things and are open about it but also have to realize we can love someone as long as they know we will always be their supporter it can take some of that heavy off our shoulders. I have done all the things you have as well without prevail so I finally just said I love you but I cannot support or enable your choice to drink any longer when your ready I am here for you. he is more thankful for that and that I never berate him or chastise him. So be proud of being a good mother. The demons are real but we on the outside looking in have to realize that the choices are theirs and as bad as it can be we can love them and support them but cannot force them to change no matter how much we think we can. I hope you do not beat yourself up too much. I am sure it made him proud to have you as his mom because he knew you would move mountains for him , but he just could not find the path.