I have finally worked it out to transfer to hospice. I'll be working part time hours there and still 12 hours at my current job on a heavy med-surg floor.
My question is regarding "pain med seeking" behavior in hospice. Do you get it often? I have the least amount of compassion for these types of patients. That is one of the main reasons I wanted to work at hospice-working with patients who have true need of pain relief, who need me to advocate for them in case they cannot, etc.
Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting.
Please tell me I won't encounter this as much in hospice. That is my true hope in transfering is that I can care for patients as I wish to-and their pain.
i think we have all dealt with those med-seeking patients.
i also think what we're trying to tell you is if a hospice patient doesn't appear to be in pain or is continually asking for more, just give them whatever they want....
am i missing something?
i've read and reread your post.
and i don't think anyone is debating.
but when you come to a forum with a question, you need to be prepared for answers that you may not expect.
but just for the fact that everyone that answered your question, had the same responses, then we all perceived your question the same way.
People suffering with chronic long term pain can act very different than people in acute pain from a surgery, etc. Those with chronic lt pain are less likely to physically show the pain- that is why it is important to believe what they say and look to vague signs that may indicate pain. Are they moving around less, doing less than they normally do, just acting differnt. Also, these patients don't follow textbook dosage guidelines. From their lt pain they may have built up a tolerance and require a much higher dosage, or their pain may be so severe that they require 10x's the recommended dose. It is so important to remember that each patient, each day, and each situation is unique. Especially in hospice- the nurse is the patient advocate.
I have not yet worked in hospice. All my experience is based in Med-Surg. I am moving to hospice so that when I do need to give round the clock meds I can have a clear conscience. And so that I do not feel that the pain meds are abused like it is done so often in my area of current work.
I hope that you can see my true question. I am looking foward to the nursing care of those in need of pain meds to be free of that burden. I believe in it whole-heartidly. That is the reason I am moving to hospice and I wanted a little support from any of those who might have experieced some of what I write.
What you most probably thought from my post was that I was talking about those patients in hospice. I was not. I was directly comparing those in the med-surg setting who are A/O, walk the halls 15+ times a shift, get their Phenergan, Benadryl, Vistaril, and then ask for their IM Morphine because it hurts when they move. Those are the patient's I am directly referring to. On the other hand, those patients who are in pain and don't ask for it but lie moaning in the beds, I educate on the importance of controlling the pain early so as it dosen't get too intense. I am the type of person to advocate FOR pain meds when they are ordered correctly, for the correct reason, for the valid diagnosis, etc.
Have any that have replied ever worked on the type of floor I currently work? Please don't tell me that you haven't seen these types of patients. There are abusive personalities and it dosen't stop in the hospital. I do not feel comfortable supporting drug habits of patients. Even when my patients ask to go out to smoke, I educate them on the importance of not smoking. I assess their needs to find alternatives.
Lastly, I understand that pain is an issue we as nurses are not to judge. I began my nursing career knowing that and I work with that theory every day. Even the "pain med seeking" patients I medicate when they ask for it, every hour if it is ordered and requested. The night I posted I was doing exactly that. I am not one to turn it away. But frankly, it is tiring me out and my compassion for those I work with is slowly deteriorating. I am looking for greener pastures.
I turned to this board for advice and from those of you who tried not to judge ME by my response, thank you. I intend to reasearch hospice, palliative care, etc. For those who are less patient to judge a vulnerable poster, please read this and know I was attempting to clarify and educate myself on an important move both in my career and in my beliefs. I was not presenting a case for debate.
JacelRN
I think you need to continue to ask the questions that are important to you. People are going to have their own opinions ... and sometimes we are going to agree or disagree. From my perspective, yes, I have worked with those MS patients that are very frustrating to deal with .... I am sure many of the nurses here that posted have worked with them also.
You are correct, there is a big difference working with HOSPICE patients over MS patients. SOme of the MS patients are dealing with acute life events and acute pain related issues. However, in HOSPICE, you are dealing with chronic pain issues and end of life transition. I am a true advocate that regardless of the patient's drug history, if they are dying and in pain, then they need to be medicated for their comfort and for the peace. I have been witness to nurses that have under medicated patients that were dying and I thought it was horrible. I am so thrilled that Hospice is available to the dying patient (oh no, am I dating myself .... perhaps).
Like you, I have valued the opinions of so many of my nurse friends here at allnurses. Sometimes I don't like what they say and sometimes I get irritated at the way they may have read my post, but all in all, I know they mean well and I know I can rely upon them for a truthful and real answer to my question. I hope you get the benefits of that also.
By the way ... good luck with your new HOSPICE venture. Have you taken the position yet?
If someone is in the hospice system than I can't imagine why anyone would care how much pain meds they want. If having 6 months or less to live isn't a good reason to be heavily medicated all the time even to the point of being a little high, than what is?
This is a really interesting topic. I agree 100% with other posters that terminal patients receive their pain meds without question. However, I'm a new grad, and in four weeks on the floor, I've encountered at least one bonafide drug seeker on average each week. This can be evidenced by the fact that they watch the clock, and call me in for pain meds, usually prior to the allotted time. "I must be due now, drool, drool." WHen I ask them to tell me about their pain. " Oh, it's not too bad just now.", or " I can offer you some Tylenol?" " No, don't bother."
I so believe in pain meds, but I do not believe in blindly feeding an addiction. We need to assess the patient's pain, and explore all avenues of pain relief including non-narcotic and relaxation techniques, and I'm not talking in the case of fresh surgical or chronic cases. Just the obvious ones, that are more totally anxious and nothing but the full dose of narcotic is going to do them.
That sounds worse than I mean it to sound, but I've had them regularly since graduation, and these patients just don't compare!
This is a really interesting topic. I agree 100% with other posters that terminal patients receive their pain meds without question. However, I'm a new grad, and in four weeks on the floor, I've encountered at least one bonafide drug seeker on average each week. This can be evidenced by the fact that they watch the clock, and call me in for pain meds, usually prior to the allotted time. "I must be due now, drool, drool." WHen I ask them to tell me about their pain. " Oh, it's not too bad just now.", or " I can offer you some Tylenol?" " No, don't bother."
I so believe in pain meds, but I do not believe in blindly feeding an addiction. We need to assess the patient's pain, and explore all avenues of pain relief including non-narcotic and relaxation techniques, and I'm not talking in the case of fresh surgical or chronic cases. Just the obvious ones, that are more totally anxious and nothing but the full dose of narcotic is going to do them.
That sounds worse than I mean it to sound, but I've had them regularly since graduation, and these patients just don't compare!
maggie- are you working on a hospice floor?
if so, you might want to ignore any med seeking behaviors as their time left on earth is very ltd....
and that is the difference between working hospice vs. any other type of nursing. you tend to overlook any undesirable behaviors and grant them what they wish for.
I also spoke to a veteran Med surge nurse tonight at work and she helped me to see what the other posters were meaning with their replies.
I do understand that we as nurses must look at pain objectively and treat each patient as an individual. I am more at peace with what the others have replied to me and you're right, not everyone is going to agree.
Because I am also a new nurse, 6 months out, I am just beginning to realize all the ethical dilemas nursing has to offer daily. Thank you for taking the time to answer.
I guess overall, I was hoping I could be candid here, not textbook like I was taught in school, but truly honest with other nurses like me, who hopefully felt the way I did about these addictive personalities. It is very difficult for me to be feeling so burnt out already and it scares me. That is why I am moving to hospice; in hopes I can cling to the compassion I feel wanning from me every day I go into work. My post was regarding that issue.
When I shadowed with my nurse, she barely touched the patient, only looked over him and tried not to wake him (11-7am). She counted his respirations and noticed he was tachypneic. She told me she was going to give him some Roxanol. I though "wow this nurse is very intuitive. Will I be able to learn this?" It seems simple perhaps to those hospice nurses who have worked long enough for this to be first nature, but for me, it was a whole different world than Med-Surg.
I completely agree that dying patients should have their pain controlled. I would never argue with that point. It is just going to be a difficult transition for me to make and I suppose I'm a little anxious.
Perhaps Med Surg just isn't my cup of tea. I am hoping Hospice will be better. I start orientation at the end of September. I will have three weeks on the floor and classroom time as well.
i think you are going to be an excellent hospice nurse.
i say that because once you start dealing with the dynamics of dealing with one's mortality and all the issues involved, you can't help but be humbled.
things that you once thought notable, you will now find seemingly trivial.
just remember in hospice, the pain one endures is not limited to physical.
unfortunately, we all know too well about those patients that can deplete every ounce of energy from you....as well as family members.
being a new grad, yes, there's much to learn.
but even for veteran nurses, they too, still have much to learn as it's ongoing; the new and varied experiences that we encounter due to the uniqueness of each patient and situation; new technologies; new theories....you just never stop learning.
and as an aside, the nurse that gave the pt. roxanol for his increased respirations, that wasn't intuition but just a knowledge base of knowing that the morphine would lower his rate; and that when someone breathes that fast, there is a stressor occuring.
trust me, you will learn all of this and so much more.
do not hesitate to come to this forum once you begin your hospice experience. we are all here to help.
Specializes in Happily semi-retired; excited for the whole whammy.
I don't know. I used to think some patients were med seekers when I worked M/S. Then I had a C-section and experienced the pain of the first couple of post-op days. Those nurses would come in with my iron pills right on schedule, but I'd need to ring three times for my Percoset. I needed it. The pain was hellacious. I went home with a scrip for Vicodin, but only took 2 of them, because they made me sleep and obviously, I had a baby to care for. Within a couple days after discharge, the pain was bearable without meds. I tried to be open minded after that experience.
It's amazing what a few days perspective can bring to a clouded issue. I first wrote my post out of frustration, reaching out to other nurses who could relate and hoping that Hospice would not frustrate me in these ways nearly as much. I understand no place is perfect, but I believe my personality and my issues on pain control will be better suited in a hospice care setting.
After re-reading my post, I can definitely understand everyone's initial reaction. I wrote it in high emotion and not exactly explaining the answers I wanted from everyone. Work can do that to me. I find it so difficult at times to keep my sanity.
So in hindsight, I have learned a lot about myself in this time I have had to think over what the issue was and I am less anxious about my move. I will learn the knowledge needed to care for this new populace and I will strive to be the best hospice nurse possible.
Thank you for your candid answers that made me think and also thanks for supporting me even when you didn't agree.
I did not intend to come off sounding overly harsh and critical in my reply. However, the visual I had in my mind's eye after reading your initial post was of a dying pt asking for pain meds, and a nurse hesitating, skeptical, trying to decide if the pt was sincere or just drug seeking. That visual was alarming to me.
Everyone's experiences in nursing and otherwise are different. I have rarely encountered a true drug-seeker in my 12 years as a nurse. It has been much more frequently that I have encountered doctors, nurses, pt family members, and pt relatives who held pts' power of attny who tried to keep pain relief from pts who really needed it.
Quite a few times in hospice, I have dealt w/ pt family members who, due to ignorance, issues w/ power and control, or issues w/ their own substance abuse problems, have tried to prevent their loved ones from getting the pain meds they needed.
As a student, I was paired up w/ a nurse who was assigned a recent post c-section pt in need of pain meds. This nurse did everything in her power to prevent the pt from getting her ordered and needed pain meds. The pt was scared and tearful. When the nurse left the room, the pt grabbed my arm, her eyes wide, and said "please help me." The nurse left before the end of the shift, and I was able to give the grateful pt her prescribed pain meds. I should have gone to the charge nurse right away, but as a student nurse, I did not have the courage to do so.
In LTC, I encountered two pts with fx from falls whom no surgeon would operate on and whom were only given Tylenol, as the doctor feared prescribing anything stronger due to the pts' ages. These pts suffered terribly. I struggled against the "powers that be" to try to get these pts adequate pain control. I really had to stick my neck out, and aroused the anger of powerful people over that situation.
I have witnessed a pt who was admitted to hospice for pain control denied pain meds by a nurse who did not want to give MS Contin rectally, once the pt could no longer take po meds, so she did not medicate him at all. The pt's pain got out of control. He was semi-responsive, but moaning, grimacing and guarding. His V/S had undergone changes indicative of pain. I was an LPN (at the time) and had to step on the RN's toes and call the doc behind her back to get the pts' pain treated. I was not assigned to the pt, but was aware of what was going on. The RN was fired over the situation. She was popular at the facility, and a few people were angry with me after that.
Several years ago, I had a very botched oral surgery and was in indescribable pain, which my dentist refused to treat. I called another doc and got an Rx for pain meds. When I went to fill the script, the pharmacist took it upon herself to call my doc and have him cancel the script. I had been given the same script a couple of weeks earlier (for another extensive oral surgery) and this pharmacist decided that I was drug seeking. I was in total shock that a pharmacist who knew nothing of my medical condition or procedures I had had, could actually call a doc and have him D/C a script he had just written for me. I was in incredible pain. I ended up going to an ER, waiting four hours, and paying $300. for a shot of a local anesthetic. When I saw another dentist the next day, he told me that the other dentist had accidentally cut into the pulp cavity and dentin of my tooth, something known to be excruciatingly painful. I also had a severe infection, and had to have three more oral surgeries to correct the damage my original dentist had done.
Another situation that comes to mind-
When I was working as an RN consultant for an adult day care center, I observed a little Spanish-speaking lady who always hobbled to the back room to lay down, and did not participate in activities. I got a co-worker to translate, and learned that this lady had severe pain in her hip, for which her doc had prescribed Celebrex, which was having no effect. With further questioning, I learned this lady had been treated for colon CA the previous year and had been declared "cured".
I made some calls, and with her permission, got her in to see another doc for tests the next day. Turns out the CA had metastasized to the bone, specifically the hip. This lady's metastatic CA bone pain was being treated with Celebrex! After receiving adequate pain control, the change in this lady's affect, participation in activities, and life in general were remarkable. Although she had learned that her CA was back and had spread, she seemed to be a much happier person, because she was no longer in pain.
Many more stories come to mind, but I think this post is long enough. You see, I need to rest. I just had two complete tooth extractions, with sinus membrane displacement and a bone graft the day before yesterday. Luckily, I found an oral surgeon who prescribed Vico-prophen for me, which I am taking q 3.5 atc, wa. My surgery would not have been so extensive, had I sought treatment earlier. However, with the pain I went through last time, I have become very fearful of dental procedures, and put off seeking treatment too long.
A friend of mine also experienced a dental procedure where her dentin and pulp cavity were inadvertently cut. She said it "hurt more than having a baby." She has six children.
So, you can see why I reacted so strongly to your post. I have very strong opinions concerning issues of pain control. After reading your subsequent post, you sound like a very thoughtful and intelligent person, and that you will be an excellent hospice nurse.
People who have a hx of drug abuse often require higher than usual doses of pain meds to obtain adequate relief after a surgical procedure. I have found this to be true in hospice, as well.
As stated before, I have rarely witnessed drug seeking. What I have witnessed (and experienced) a great deal of is pain-relief seeking.
I have finally worked it out to transfer to hospice. I'll be working part time hours there and still 12 hours at my current job on a heavy med-surg floor.
My question is regarding "pain med seeking" behavior in hospice. Do you get it often? I have the least amount of compassion for these types of patients. That is one of the main reasons I wanted to work at hospice-working with patients who have true need of pain relief, who need me to advocate for them in case they cannot, etc.
Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting.
Please tell me I won't encounter this as much in hospice. That is my true hope in transfering is that I can care for patients as I wish to-and their pain.
Thank you for any replies,
JacelRN
Hi I work in a hospice in Chicago, Illinois. Patients must have a terminal diagnosis of 6 months or less to be admitted this is the medicare guideline and most insurance companies guide line. Dying has many distressing s/s that need adequate pain and symptom control. Does it really matter if a patient is med seeking at this point in their care. Addiction becomes irrelevant what matters is comfort, and care. Death needs to be peaceful, meaningful, and with dignity and closure for all involved. My experience has not been with patients who seek drugs regardless of their past alcohol or drug problems. They are dying, they need them. I have seen family members and friends steal or take patient meds for the wrong reason and know of 2 RN's who have been fired for the same. Hope this helps. Thanks, KIM:)
leslie :-D
11,191 Posts
i think we have all dealt with those med-seeking patients.
i also think what we're trying to tell you is if a hospice patient doesn't appear to be in pain or is continually asking for more, just give them whatever they want....
am i missing something?
i've read and reread your post.
and i don't think anyone is debating.
but when you come to a forum with a question, you need to be prepared for answers that you may not expect.
but just for the fact that everyone that answered your question, had the same responses, then we all perceived your question the same way.
lesie