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.
MVCs, esp those going to CT, need to be undressed and any metal taken off that could cause artifact or show up on the scan. Any pt that comes in w a weapon to my ED must either voluntarily or involuntarily give it to security.
This thread is not about medication of drug seekers, it was about how to disarm an unruly pt who happens to have the traits of a drug seeker. There are multiple threads in the ED forum regarding drug seekers and the medication of them.
Specializes in med-surg, psych, ER, school nurse-CRNP.
OK, let me get a few things straight:
1) I never said that I HATE anybody. I said that I could not stand drug seekers. This was a very clear cut case. I think I made my point about that. It was a suspected head injury. He was belligerent. In this ER, you don't get off the backboard, let alone medicated, until you have your scans. Trying to reason with him was like talking to a post.
2)Above all, it was not my decision to treat this guy or not, but my preceptors. He and I happened to agree. He's an MD. I don't really see what a level of education has to do with knowing when someone is being a pill.
3) To the lady whose hubby had the appy, I am so sorry he went through that. I would not have seen him do that for anything. His comfort would have been my top priority. However, in abdominal cases wher the cause of the pain is unknown, some docs wait to treat the pain until they determine a diagnosis for various reasons, some very good. Again, I hate that he went through that, and I hope he's doing well.
I did not start this as an attack on people in pain. I have not seen nearly as much as I'm going to, granted, but I have seen quite a lot, and have developed a fairly accurate sense of who's legit and who's faking. In this case, I was dead on, as evidenced by the nose-in-the-air strut out of the ER after he was offered the Toradol. I startes the thread to ask what were policies and procedures about armed patients. Thanks to those who came to my defense. I appreciate that.
Specializes in Pediatrics; Respitory (Step-down & LTC).
I understand the frustration however, I learned in nursing school that, "pain is what the patient says it is." It is not our position to judge a patient's pain based on how WE think they should be responding. I'm not saying that this was not a difficult patient but someone has to pick the high road. I have found that if a nurse listens to a patient, the demands usually subside. I'm not saying that I would have wanted to "snow" him however, I would have provided the facilities protocol (that may have started with Tylenol and moved on from there) while explaining to the patient that if this does not work, we will work together to get his pain managed. Remember, pain is made worse by anxiety so letting the patient know that they are being listened to often stops the craziness. If he was a head trauma, you KNOW they are not rational etc. and his demands have to roll off you back if you are waiting to medicate pending the result of scans. However, your need to explain yourself with the wording that you HATE drug-seekers tells me that it is a very deep resentment for you. Something to consider. I know that this thread was about the weapon which seems simple, I would not work or school in a place that allows weapons in the ER. I wasn't as if he had to be searched in order to find it, it was in plain site. Not much else to say, it seems very cut and dry to me.
Specializes in med-surg, psych, ER, school nurse-CRNP.
Again, I never said that I HATE anyone. Please read my posts. I did attempt to explain the reason to this man behind our not medicating him right away, and his response was to scream and whine even more loudly.
And I probably will not work in this ER after I have my certificate, unless they tighten security, lest I come out looking like I've been put through the shredder.
For your hospital to say they can not remove the weapon is negligence. I have yet to enter a hospital where weapons of any kind for any reason were permitted. I likely would not have removed the weapon myself, unless it was absolutely clear that there was no danger in my doing it.
I would call security (in the ER there is always security present) then advise the pt that he would have to give up the weapon while he was in the hospital.
I can not imagine what twisted version of "patients' rights" your hospital is thinking about. This is not a matter of patients' rights. It is a matter of ensuring a safe environment within the hospital. Sometimes administration and others have distorted ideas of what they can and can not do. Or what they should and should not do.
Sometimes they put not offending a patient as a priority over things that should be a much higher priority. This is clearly poor judgment by those who believe that they should not or can not require a weapon free environment.
I can not imagine any work place that permits someone to bring in a weapon. Unless it is say a law enforcement officer, or the companies own security staff.
Retail business owners sometimes have a weapon as a security measure but weapons are not to be brought in from outside by customers/clients etc.
You have in every state the right to refuse to have a weapon in your place of business. A hospital is a place of business.
In some places in some circumstances people are not turned away who are known to be carrying a weapon. These places are not hospitals. They are places where the individual is well know by the business and is known to be a stable person, and it is a part of the accepted shared culture.
As a future MHNP student, I'm curious...what do they teach you in grad school? I understand that many APNs cannot Rx a controlled substance (e.g., in TX) but for those who can...if a pt. comes into the ER post MVA, has no broken body parts, no bleeding, so no clear objective evidence of pain, are y'all taught to start with nonarcotic analgesics, or do you defer the patient's request.
As RNs, if our patient reports pain and a narc is ordered, we administer it if it's time, regardless if we believe the pt. is really experiencing pain on a 10/10 for a sprained thumb. I suspect it's a bit different for individuals who are prescribing, though. If you believe a pt. is "med seeking" should that be taken into account when writing your order (e.g., if the individual has been into your ER 5 times over the past couple weeks? I mean, if this individual is med seeking and you prescribe and the pt. drives home and gets in a more severe accident; what's your liability? I suspect it's a real concern for the prescribing practitioner. OTOH if you write an order for ibuprofen or tylenol, then you run the risk of getting sued.
Specializes in med-surg, psych, ER, school nurse-CRNP.
psychrn, it really was not my call, as I was just shadowing, it was the doc's call. There were no orders as yet, we were doing our initial assessment. Per policy, MVAs on a backboard and in a collar HAVE HAVE HAVE to get X rays and CT scans bafore any meds, narcotic or otherwise, are given.
Had I been in an RN capacity, heck, yeah, it would have been totally different, and I would have given what the doc ordered. I could not order a narcotic as an NP. And, I was hoping not to bring this up, but his list of prior visits was as long as my arm. As an NP, when I am one, if I think a patient needs a narc, I will find a doc to order one, no problem.
Again, I never said that I HATE anyone. Please read my posts. I did attempt to explain the reason to this man behind our not medicating him right away, and his response was to scream and whine even more loudly.
And I probably will not work in this ER after I have my certificate, unless they tighten security, lest I come out looking like I've been put through the shredder.
(((HUGS))) I know you feel like your being attacked, believe me I have been there. So, no more from me about the pain medication issue.
Your right, no weapons EVER. It is wrong, wrong, wrong. Your safety is the most important thing and shame on the charge nurse for not reinforcing that and removing the weapon as soon as it was seen.
Specializes in Pediatrics; Respitory (Step-down & LTC).
AngelfireRN, I stand corrected and apologize. You did not use the word HATE. You said that you can not STAND drug-seeking. Bottom line however, your original thread was regarding the weapon and I think we all agree that any facility that would allow weapons is a facility that you should be leaving. Having said that, much of your thread was of this pts. request/demand for pain medication and due to the attention that you placed on this subject in a thread that was supposed to be about weapons in the ER, appears as though you have as much of a problem with this paient's need/want/demand for pain medication as you did of the weapon being allowed in. As Shakespeare said, "Me thinks he protesteth too much." (paraphrase). The situation that we make the most noise about is the one that is really bothering us.
Specializes in med-surg, psych, ER, school nurse-CRNP.
Scuba,
If I came across as sounding like I do hate drug seekers, I did not mean to. The true junkies are the bane of my existence, but that is neither here nor there. My point about the weapon and the demand for meds was the concern that he might eventually employ one to get the other. If you'll notice, this was not his first rodeo, pardon the pun. Never mind that this ER does not have bulletproof glass, he was already BACK THERE and ARMED and ESCALATING, lol. He was IN. That was what was so scary.
Specializes in med-surg, psych, ER, school nurse-CRNP.
And by true junkie, I mean the ones that go through the trash, gather all the used Fentanyl patches they can find, CHEW them, and then pass out in a crumpled heap at the bottom of a stairwell in the parking deck. Then, once you have them extubated, proceed to pick a syringe out of wherever they can, crush a Lorcet that they have cheeked, mix it with spit, and try to put it through their heplock. See? I really have seen some stuff, I wasn't just saying that.
psychrn, it really was not my call, as I was just shadowing, it was the doc's call. There were no orders as yet, we were doing our initial assessment. Per policy, MVAs on a backboard and in a collar HAVE HAVE HAVE to get X rays and CT scans bafore any meds, narcotic or otherwise, are given.
Had I been in an RN capacity, heck, yeah, it would have been totally different, and I would have given what the doc ordered. I could not order a narcotic as an NP. And, I was hoping not to bring this up, but his list of prior visits was as long as my arm. As an NP, when I am one, if I think a patient needs a narc, I will find a doc to order one, no problem.
Thank you. Now I understand you are in a state where you can't Rx controlled substances (as am I) so I hope a ANP who has controlled privileges can chime in because the world of narcotic over- and under-prescription is very problematic for all. And as the AANP and state BONs continue to make NPs more autonomous, we'll be finding that Rxing narcs. will be a part of the autonomous territory. So what to do? I suspect the thought process for treating pain as a NP is quite different from that of a RN in terms of liability, so you have to balance treating the patient's pain with federal/state/local ordinances.
RunnerRN, BSN, RN
378 Posts
MVCs, esp those going to CT, need to be undressed and any metal taken off that could cause artifact or show up on the scan. Any pt that comes in w a weapon to my ED must either voluntarily or involuntarily give it to security.
This thread is not about medication of drug seekers, it was about how to disarm an unruly pt who happens to have the traits of a drug seeker. There are multiple threads in the ED forum regarding drug seekers and the medication of them.