This week, I have officially become sick, tired, and disgusted with the drug-seeking behaviors and, in addition, the Press Ganey-brainwashed administration that condones them.
Patient comes to ED for "torso" pain (trying to be vague), straightfaced in a gown standing @ TV in room flipping through channels and going on and on on her cell phone about how someone owes her money. Seeing me, she comes over to the bed, sits down, and says "Go ahead," sticking out her arm while still talking away on her cell. I kindly explain that I need to ask questions and assess prior to pain meds, and will wait until she's finished with phone conversation. Of course, phone is hung up pronto. Upon sticking her arm out for me, multiple track marks, red infected areas that look like brown recluse bites (from dirty needle use), OK. I ask if there is IV drug use, and get a shocked-meets-almost-offended "Oh god, no. I've been in the hospital and stuck so much, they can't ever get a vein."
Long story short, friends show up (that my patient actually wants in the room), and they ask if they can talk to me. I go in the privacy room and they start going ON and ON about the patient's heroin and now pain med addiction, and that she needs help, and we need to make her get help, etc etc etc. During this, I share no info, only nodding and saying, "Ok..." Upon asking patient about contradicting info, she is again very surprised and denies ever having used heroin, as well as everything else.
So, she wants friends in room. Friends go in, and in front of me, confront her. Eventually she admits to issues, and still wants pain meds. Thankfully, goes home with an rx for Motrin. :) STILL. Gave her Dilaudid and Toradol prior to Intervention. And I've given her 10mg Dilaudid over the past 2 weeks in various visits. And we have another patient that comes in with back pain, pain is a 9/10, gets Dilaudid 2mg + Zofran 4mg IV, pain is then 8/10, gets another Dilaudid 2mg IV, pain is 6/10, and is discharged. EVERY TIME. Like 14-15 visits since 8/1/08. Other patients, same stuff. Dilaudid, dilaudid, dilaudid.
Similar patient went to administration because pain was not treated how she thought it should be... doc got chewed a new a-hole, and what good does that do? Do whatever you can to please your patient, even if it means feeding a drug addiction? I honestly HATE this. I chart like the queen b-tch, noting facial expressions, behaviors, grimace, guarding, moaning with no tears, laughing with friend in rm, watching tv and drinking mountain dew though nauseated and in severe abdominal pain, etc -- still, our docs are just as fed up but in talking about this, have literally said, "After Dr. Got-chewed-out got called in to whoever's office the other day, I'll put them in a Dilaudid coma if I have to. Whatever will make the patient happy, right?"
Since when did pain become so freaking terrible? I personally would rather be in some pain than be completely numb to my life as a whole. Me and most of the ER staff:
Sorry, and thanks for listening! As the title says, I feel like a legalized dope dealer, and it makes me incredibly uncomfortable. Hrm!
Here's a good one... next time you're about to push 2mg of Dilaudid IV - confer with your ER attending and ask if you can mix it in a 50 cc bag of NS and run it in over 30-60 minute (on a pump with a pt lockout). You could justify it by saying the slower infusion would give you more opportunity to monitor for side effects...!!!!!
Heh, heh, heh, heh.....
I like your thinking on that but don't think the docs will go along:bow:
Specializes in ED, Tele, Med/surg, Psych, correctional.
Our hospital (not just the ER) instituted a policy regarding the adminstration of Dilaudid. It is part of the IV administration guidelines now. The first dose of Dilaudid can only be IV push in the ER. After that, any and all subsequent doses msut be given via soluset mixed in a 50ml bag of NS to run over 20 minutes. It was done to cut down the chronic abuse of the drug and was initiated and approved through pharmacy. The doctors don't have a choice...the policy is the policy and it takes the pressure off of them when dealing with a harassing drug seeker. Sorry ma'am...it's hospital policy..I'd give it to you if I could but it's out of my hands.
After that, any and all subsequent doses msut be given via soluset mixed in a 50ml bag of NS to run over 20 minutes. It was done to cut down the chronic abuse of the drug and was initiated and approved through pharmacy. The doctors don't have a choice...the policy is the policy and it takes the pressure off of them when dealing with a harassing drug seeker.
How easy it would be if these drugs were legalized or at least decriminalized. Society as a whole would be much better off.
Would you be cool with your doctor or nurse pilot or police officers taking legalized drugs? I would not be.[/quote']
Just because the drugs are legalized doesn't mean that individuals in certain occupations could take them and still work. Employers could still implement strict policies regarding the use of drugs in the workplace (as many places do now). People could choose between their careers or their drugs.
People do that already.
I know many MDs and Nurses that take prescribed Scheduled II, III, IV drugs and work and function just fine.
You can: Continue in your current spot - knowing that the "druggies" will get their fix from you and those like you. Give it to 'em and smile. Knowing that any attempt to "fix" 'em will just cause you grief" - could hurt you in any number of ways - and stress you out. Big risk and abuser of your time for ZERO reward.
Hmmmm.....
You could: Fight 'em at every turm, take on the doctors and get frustrated beyond words. You are seething and they are complaining and will be back for another day to "get what they came for".
I'm not trying to be offensive - but really - WHO IS IN CHARGE???
Seems a bit easy now.
I do not make enough to deal with that kind of crap. I may be busy.
I say give 'em the meds, let any judgement float out of your head and focus on the good spots in your career. IT IS JUST NOT WORTH IT - FIGHTING WITH A DRUGGIE ...makes you the victim.
Think it over.
One patient should not take up a third of my shift.
I don't make enough to leave every shift battered.
"Here is your diluadid". Have a nice day!!!
Perspective is EVERYTHING!!!
Practice SAFE!!!
Sure......but it is nice to "vent" in a ER nursing forum!!!!!
Some nights are just sooo busy and bad, you don't have time to mess with the "trolls" (as one of our MD's would say)and just give em what the want to save yourself the strife.
LOVE the policy about Dilaudid. One of our MD's wrote an order for Dilaudid 2mg and Phenergan 25mg IN 1L NS over 1 hour. Boy was that FF migraine lady M-A-D. She was gonna call admin. but what would have been her complaint? We offered her narcotics, didn't we? (HAHA)
I think the worst part of it for us nurses is that we are the middle man. The MD evaluates the patient, tells them "we'll get you some pain meds" without specifying what kind. So WE get blasted when we come bouncing in with Toradol 60 IM. I am now requesting that my MD's personally go and talk to the patients if their medication orders don't meet patient expectations. I refuse to be the go between, and I hate being cussed out for the MD's discretion. It is not my job (oooh forbidden phrase..hehehe) to justify the MD's pain medication orders for BS complaints. I no longer allow myself to get stressed out by these dindongs. The language starts flying at me, I walk away.
Seeing these people makes me truly appreciate my life. What a sad way to exist.
Does anyone else cringe and get just a little nauseous every time they hear the schpeel:
"Pain is the 5th vital sign and needs to be addressed every 2 hours at minimum ON ALL PATIENTS, and if medicine is given, followed up on within 1 hour....."
Pu-leez! Gimme a break...Seriously!?
(Wheres a big ole "rolling the eyes" icon when you need one?)
I can't take it.... I'm just gonna say it
SINCE WHEN ARE PEOPLE NOT ALLOWED TO EXPERIENCE PAIN!?!??!?
When did our society suddenly turn into a bunch of wusses???!?!!
what!? did she just call them wusses???
Thaaaaats right I said it. I'm sick of patients wanting medicine for every sniffle, cough, itch, and twitch!!! Heaven forbid your experience in the hospital is anything other than a painless anxiety free eutopia!!!!!!
Super-nurse pain managment scenario:
"Oh...Mr.Johnson, I know I just asked you this a couple hours ago...but are you in any pain NOW?"
"No dear... I'm doing fine"
(multiply this event by 6....then finally....the next morning....)
"Mr.Johnson. Your vitals look great. Granted I know that what you're here for has nothing to do with pain, you haven't been in pain all night, or your entire admission come to think of it, but by golly I'm going to continue to ask you because I'm required to fill this little box in my charting with a number.....are you in any pain?"
"No dear....well... just a little headache maybe. Didn't get much sleep last night"
HOLY CRAPOLA! WE GOT ONE! SOMEONE'S IN PAIN! THIS CANNOT BE!SOUND THE ALARMS! SOMEONES IN PAIN! SOMEONE'S NERVES ARE BEING OVERLY STIMULATED! GOT FORBID! BRING THE TYLENOL! BETTER YET, BRING VICODEN! THAT'LL FIX EM UP GOOD!
WHEW! GOOD THING WE CAUGHT THAT! WE WOULDN'T WANT ANYONE TO BE IN PAIN!!
lol.... oh dear I'm losing it.... The point is....its ridiculous. It probably all started from one loud obnoxious druggie who wasn't high enough and slowly turned into a whole protocol of ALL pain being thoroughly managed!
Somethings gotta give here! We're all going crazy! The bad ones are ruining it for everyone! We're afraid to undermedicate for fear that it might be legit, lawsuits, whatever...but the system is so abused it makes me sick!!!
The patients who's pain is ALWAYS a ten as they lie there hardly able to maintain a sat without O2 supplementation because of how much medicine you've already given them for all their other 10's that they managed to open their eyes to tell you? Pain of unknown etiology x 20 admission history?
Yeah.....
Legalized Drug Dealer... Thats exactly what we are. I've given that answer more than once when asked what I do for a living. Cuz sometimes you have those nights that that's really what it feels like. Dang docs write for Q2H PRN Dilaudid orders for these druggies....just give em a freakin PCA for Godsake!
Disclaimer: Come on, we're nurses here, you know I'm not talking about the people who are really in pain. I'm not talking druggie psychological pain. But real pain. I'll happily run in the room Q1H PRN to help them out. And yes we CAN tell the difference. It just ****** me off that the druggies waste so much of our time... and they're almost always so dang RUDE about it too! The attitude of entitlement as they take advantage of the system.
*sigh* No clue what I just said up there.... but whatever it was, it felt good to get it out.... good ole allnurses.com forum venting therapy :typing
Does anyone else cringe and get just a little nauseous every time they hear the schpeel:
"Pain is the 5th vital sign and needs to be addressed every 2 hours at minimum ON ALL PATIENTS, and if medicine is given, followed up on within 1 hour....."
Pu-leez! Gimme a break...Seriously!?
(Wheres a big ole "rolling the eyes" icon when you need one?)
I can't take it.... I'm just gonna say it
SINCE WHEN ARE PEOPLE NOT ALLOWED TO EXPERIENCE PAIN!?!??!?
When did our society suddenly turn into a bunch of wusses???!?!!
what!? did she just call them wusses???
Thaaaaats right I said it. I'm sick of patients wanting medicine for every sniffle, cough, itch, and twitch!!! Heaven forbid your experience in the hospital is anything other than a painless anxiety free eutopia!!!!!!
Super-nurse pain managment scenario:
"Oh...Mr.Johnson, I know I just asked you this a couple hours ago...but are you in any pain NOW?"
"No dear... I'm doing fine"
(multiply this event by 6....then finally....the next morning....)
"Mr.Johnson. Your vitals look great. Granted I know that what you're here for has nothing to do with pain, you haven't been in pain all night, or your entire admission come to think of it, but by golly I'm going to continue to ask you because I'm required to fill this little box in my charting with a number.....are you in any pain?"
"No dear....well... just a little headache maybe. Didn't get much sleep last night"
HOLY CRAPOLA! WE GOT ONE! SOMEONE'S IN PAIN! THIS CANNOT BE!SOUND THE ALARMS! SOMEONES IN PAIN! SOMEONE'S NERVES ARE BEING OVERLY STIMULATED! GOT FORBID! BRING THE TYLENOL! BETTER YET, BRING VICODEN! THAT'LL FIX EM UP GOOD!
WHEW! GOOD THING WE CAUGHT THAT! WE WOULDN'T WANT ANYONE TO BE IN PAIN!!
lol.... oh dear I'm losing it.... The point is....its ridiculous. It probably all started from one loud obnoxious druggie who wasn't high enough and slowly turned into a whole protocol of ALL pain being thoroughly managed!
Somethings gotta give here! We're all going crazy! The bad ones are ruining it for everyone! We're afraid to undermedicate for fear that it might be legit, lawsuits, whatever...but the system is so abused it makes me sick!!!
The patients who's pain is ALWAYS a ten as they lie there hardly able to maintain a sat without O2 supplementation because of how much medicine you've already given them for all their other 10's that they managed to open their eyes to tell you? Pain of unknown etiology x 20 admission history?
Yeah.....
Legalized Drug Dealer... Thats exactly what we are. I've given that answer more than once when asked what I do for a living. Cuz sometimes you have those nights that that's really what it feels like. Dang docs write for Q2H PRN Dilaudid orders for these druggies....just give em a freakin PCA for Godsake!
Disclaimer: Come on, we're nurses here, you know I'm not talking about the people who are really in pain. I'm not talking druggie psychological pain. But real pain. I'll happily run in the room Q1H PRN to help them out. And yes we CAN tell the difference. It just ****** me off that the druggies waste so much of our time... and they're almost always so dang RUDE about it too! The attitude of entitlement as they take advantage of the system.
*sigh* No clue what I just said up there.... but whatever it was, it felt good to get it out.... good ole allnurses.com forum venting therapy :typing
I am sorry to disagree with you but you CAN NOT always tell someone's pain level. I believe it is absolutely ridiculous for anyone to suffer in todays world. People are so afraid that everyone is a drug seeker and thinks that about everyone when that is not always the case. Both my mom and I suffer from terrible chronic pain and have dealt with the BS thoughts of doctor's and nurses our whole lives. My mom is now on disability and trust me she would not be there if she didn't have to be. She was a nurse and loved her job.
I don't know how anyone can sit there and say "we can tell the difference" because there are times when you can not. There are many times that I talk and laugh through horrible horrible pain...I have to, otherwise I would not be able to make it through life. Pain unfortunately has become a norm in my life but that does not mean that I should not seek to have taken away.
I also find it very insulting when people talk about the "druggies" out there and refer to them as the uninsured and low lifes. I am not saying that you did this I am just talking in general here. There are also doctors, nurses, lawyers, politicians, etc who abuse drugs but that it is ok if they have the money right?
Sorry for the rant but it is not any nurses job to decide if someone is a drug seeker or not. Fill the order as prescribed and move on!!!!!
Specializes in ED, Tele, Med/surg, Psych, correctional.
I am sorry to disagree with you but you CAN NOT always tell someone's pain level. I believe it is absolutely ridiculous for anyone to suffer in todays world. People are so afraid that everyone is a drug seeker and thinks that about everyone when that is not always the case. Both my mom and I suffer from terrible chronic pain and have dealt with the BS thoughts of doctor's and nurses our whole lives. My mom is now on disability and trust me she would not be there if she didn't have to be. She was a nurse and loved her job.
I don't know how anyone can sit there and say "we can tell the difference" because there are times when you can not. There are many times that I talk and laugh through horrible horrible pain...I have to, otherwise I would not be able to make it through life. Pain unfortunately has become a norm in my life but that does not mean that I should not seek to have taken away.
I also find it very insulting when people talk about the "druggies" out there and refer to them as the uninsured and low lifes. I am not saying that you did this I am just talking in general here. There are also doctors, nurses, lawyers, politicians, etc who abuse drugs but that it is ok if they have the money right?
Sorry for the rant but it is not any nurses job to decide if someone is a drug seeker or not. Fill the order as prescribed and move on!!!!!
I would never let anyone suffer and I don't think any nurse on this board would either for that matter. HOWEVER, I DO have a problem with walking into a room to inject someone with HEAVY DUTY narcotics IV push for their 10 out of 10 awful pain and have to interrupt them from the cell phone conversation and Burger King brought by their visitor in order to do it. Trust me when I tell you I have seen people in awful pain...I have seen those who writhe in pain unable to function and I have seen those who silently suffer..the ones that you know are really, truly in pain but "don't want to bother anyone". I go the extra mile for all of my patients who are truly in pain...but when I have to wake you up to give you Dilaudid I think there's a problem...if you are going to argue with me and tell me that someone who is in the worst pain of their life "20 out of 10" is capable of falling asleep with the TV remote in their hand after asking for pain medicine 1 minute earlier then you really need to re-evaluate your thoughts. They ARE drug addicts and they come into our ER every week for the same vague BS complaint and demand the same HEAVY DUTY narcotic "because that's all that will work". I didn't become an anesthesiologist...I'm a nurse.
SINCE WHEN ARE PEOPLE NOT ALLOWED TO EXPERIENCE PAIN!?!??!?
When did our society suddenly turn into a bunch of wusses???!?!!
what!? did she just call them wusses???
Thaaaaats right I said it. I'm sick of patients wanting medicine for every sniffle, cough, itch, and twitch!!! Heaven forbid your experience in the hospital is anything other than a painless anxiety free eutopia!!!!!!
News flash for these folks ...
LIFE is not a painless anxiety-free Utopia.
And this is what disturbs me most. The true seekers/addicts ... I understand that addiction is a disease that will always be with us.
But those seemingly otherwise functional people who CANNOT COPE with life's little "emergencies" ... these people DRIVE ME INSANE.
Maybe I'm getting a little cranky ... but if you are 25 years old and require
1. Your mommy at the bedside
2. A 10-minute coaching session on coping skills
3. EMLA cream
to get through an IV stick ...
God help you when you have a real life crisis. :stone
Probabaly going to get into trouble for this, but here goes anyway...
Wouldn't it be great if the nurses were supposed to be as pain free as the patients? I have chronic pain issues, sometimes drive home crying b/c working exacerbates it so badly, but GOD FORBID that I take more than fifteen minutes to get pain meds into a patient's room, even if I can't walk without it hurting. I wish I would have bought stock in whoever makes Advil and Aleve years ago, so that I'd at least be getting a return on all that money I'm spending on it!
[/quote']
what!? did she just call them wusses???
twinmommy+2, ADN, BSN, MSN
1,289 Posts
I like your thinking on that but don't think the docs will go along:bow: