I am an RN in grad school for my ACNP. One of my clinical rotations this semester is in the ER of a local hospital. The other day, I was there, assessing a car wreck with the doc, whiny, crying "Gimme something for the pain, I gotta have something for the pain!" (I can not STAND drug seekers). Anyway, I digress. This guy refused to cooperate with the exam, refused to move his legs, got mouthy, was just a real peach in general.
As we were leaving, I happened to look down and, lo and behold, this guy has a Crocodile Dundee strapped to his belt (a BIG knife, in case you've never seen the movie). I nudged the doc, told the CT tech and the nurse, and told the charge nurse. She refused to take it from him! "We can't do that. He's not a psych case. We don't even search our psych cases."
My qustion is, acting the way he was, demanding what he was demanding, and with all you see in the news about poor nurses getting blown away for not giving people their Lorcets, does this bother you? Would you work here? The nurse that had to take this man to CT informed that charge nurse that if she got cut, she knew who she would be suing, and all the charge nurse said was, "Well, I'm sorry." Just curious as to the ER policies where y'all are.
Why didn't the nurse taking him to CT remove the weapon herself? Easy enough to say they are not allowed and he will get it back when they are done. No further meds or treatments until he complies. If everyone stands there and waits he will get the message, and give it over, with the possibility of morphine in his future.
Unfortunately, if someone has a debate in front of the patient as to whether they can or can't do this the chances of him giving it up "voluntarily" are pretty slim. The nurses need to back each other up.
Please don't think I was profiling, I have seen enough to know when someone is truly in pain. I am not denying he was hurting, but when someone says their neck hurts because they have a plate in it, and you ask them why, and they respond "It just DOES!", then refuse to cooperate or answer any questions until "I get something", it's a pretty clear-cut case. Also, refusing to go to CT until he had meds, then refusing to be still or cooperate while in CT, and just being a drama king in general usually makes me smell a rat. After he was told he would get a Toradol shot, he was well enough to stomp out of the ER in a snit, so that told me a lot.
Ah, you didn't say all that at first. After reading it, I agree, he sounds like he was crying "wolf".
As for the knife, I think you should check the policy manual and see if it addresses this issue. If not, you might subtly bring it up to someone in charge, although doing so might jeopardize your student standing there and make them see you as a pain. Not that you are wrong, just that people don't like being questioned. The ER staff need to kick up a fuss and get some rules in place that protect them.
WOW,..first off,.all pt's become naked asap upon arriving to the ER almost w/o exception, weapons of any kind are never allowed, and if it was a psych pt not only are they placed in hospital gowns asap, they aren't even allowed to keep their belongings in the room! We have armed security in our ER at all times and this would not be allowed,.I wouldn't work at a hospital that allowed this!! (BTW I'm NOT in a big city ER,.it is a Trauma center but we only avg approx. 240 pt a day)
If the patient was involved in an MVA, he should've had his clothes off, a gown on and the knife put away in a safe location regarldess of his aggitated state of mind.
I wouldn't tolerate working in a place that doesn't keep their own employees safe.
I would've taken the knife away from him in a subtle way and said to heck with the charge nurse and the messed up P&P of this place. The could reprimand me all they wanted when it was all said and done, at least I wouldn't have stab wounds when they did :omy:
After spending a year in the ER, I agree with you about that. NO WEAPONS in the ER EVER! It needs to be written up as a policy, then there would be no issues about it.
I'm concerned about an RN recieving advanced training and commenting "I hate drug seekers". You treat the pain they report, you dont withold meds becuase you "think" they are drug seeking. If you feel they are drug seeking get a substance abuse consult. AFTER you have treated the pain they reported!
After spending a year in the ER, I agree with you about that. NO WEAPONS in the ER EVER! It needs to be written up as a policy, then there would be no issues about it.
I'm concerned about an RN recieving advanced training and commenting "I hate drug seekers". You treat the pain they report, you dont withold meds becuase you "think" they are drug seeking. If you feel they are drug seeking get a substance abuse consult. AFTER you have treated the pain they reported!
I agree completely, no weapons-ever, ever, ever. Too many emotions flying in the ER.
However, I also feel strongly that you are way to easy to dismiss pain in a post MVA. So what if he is drug seeking, are you a cop or a nurse? If he says he is having pain, then he is having pain. My husband was taken to ER in a fetal position and they refused him pain medication until I had a hissy fit. (Didn't tell them I was a nurse, none of their business) They gave him IV Toradol and he was able to go to sleep. Was he pretending about his pain, too? Turns out his appendix was ready to explode, they did a CT and took him for emergency surgery within 2 hours. I can't stand it when nurses decide they should be the ones deciding if a patient is having pain or not and whether or not to treat that pain. I would rather assume that everyone is in pain and give drug seekers meds than think for 2 seconds I went home without treating someone who is really in pain.
I agree completely, no weapons-ever, ever, ever. Too many emotions flying in the ER.
However, I also feel strongly that you are way to easy to dismiss pain in a post MVA. So what if he is drug seeking, are you a cop or a nurse? If he says he is having pain, then he is having pain. My husband was taken to ER in a fetal position and they refused him pain medication until I had a hissy fit. (Didn't tell them I was a nurse, none of their business) They gave him IV Toradol and he was able to go to sleep. Was he pretending about his pain, too? Turns out his appendix was ready to explode, they did a CT and took him for emergency surgery within 2 hours. I can't stand it when nurses decide they should be the ones deciding if a patient is having pain or not and whether or not to treat that pain. I would rather assume that everyone is in pain and give drug seekers meds than think for 2 seconds I went home without treating someone who is really in pain.
I'm sorry your husband was so sick, but it's possible that they didn't medicate his pain due to it being undiagnosed abdominal pain. A lot of docs won't give pain meds in that case, due to it masking the pain and making diagnosis more difficult. Of course, once a dx is made, then they should be medicated, unless the surgeon/anesthesiologist has other plans.
How strange. In the several ER visits I've made, all the hospitals had signs posted that very clearly stated no weapons were allowed in the hospital. But that being said, the guy was in a car wreck and certainly wouldn't have been able to just drop his weapon somewhere. It should have been taken from him and kept somewhere for safekeeping until his discharge. After this experience, if I were you, I would avoid that place for employment.
With everything we have available to diagnose head injurys, MRI, CT...I think this logic is outdated, even if still being used.
2)he was refusing rx, except for the pain med, which he was DEMANDING
Hmmm, Could it be there WAS a head injury and he was confused? Why not treat the pain and see if that helps the attitude.
3) as soon as he realized it was not forth coming (would be getting Toradol, and not an opiate) he took a hike...
I would leave a place that refused to treat my pain after an MVA as well. Have we learned NOTHING from the death of that poor woman lying in pain on a hospital triage floor in LA?
sounds like a drug seeker to me, .......
So what if he is? He was just in a car accident, of that we are sure. Even if he is a drug seeker, how can you say with 100% certainty that he is just seeking drugs and not in pain. You aren't in his body and therefore cannot say there is not pain. How would you feel if it was one of your loved ones?
I worked in corrections as a nurse and know that the world is made up of people who abuse the system, I am not naive. However, I still say you treat the pain they say they are in, not what YOU think they need. To do otherwise, in my opinion, is cruel.
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canoehead, BSN, RN
6,909 Posts
Why didn't the nurse taking him to CT remove the weapon herself? Easy enough to say they are not allowed and he will get it back when they are done. No further meds or treatments until he complies. If everyone stands there and waits he will get the message, and give it over, with the possibility of morphine in his future.
Unfortunately, if someone has a debate in front of the patient as to whether they can or can't do this the chances of him giving it up "voluntarily" are pretty slim. The nurses need to back each other up.