Drug rant: Legalized Dope Dealer, RN

COLPN · Sep 25, 2008

Someone works a Disney Land ED, if employed as a nurse at all....

My point exactly.

sfsn · Sep 25, 2008

The main issue for me is not that they are addicts or that they just want drugs or that they don't really look like they are in pain. What gets to me is how they behave and how they treat us.

Someone who is behaving inappropriately (coming up to the nurses station every 2 minutes to ask for more meds or complain, walking all over the department, trying to chat up patients in the bed next to them, going outside to smoke without talking to us first) or someone who is rude and really manipulative (arguing angrily, insulting us, forging letters from their doctors, being excessively dramatic) are just some examples. Those are things that get in the way of how much I feel like helping them and give them the meds they want.

Many of the patients that I see, that seem to be coming in just for the drugs, still manage to behave appropriately enough that I don't have much of a problem with it.

txnursingqt · Sep 25, 2008

i have one thing to say..............chronic pain is not curable.....so, don't expect the emd to beable to cure it. don't come to the er wanting pain meds on a saturday for chronic pain and get ticked because you aren't getting the narc or mg of your preference. don't cop an attitude with the er nurse, because beleive it or not....the emds listen to us and we set the tone for your care....especially if you are faking it...or saying your chronic pain is a 10. when i ask...mamam if you had to give a number between 0 and 10 with 10 being pain for example....your arm was just amputated, what would you say your pain is?.....don't flippin tell me 10....i seriously walk out of the room and think you are a faker.

"and as filling the order as prescribed and move on statement".....whoa!...if you ever said that to me....i would march back to the ed doc, tell him what you just said....and say, if you want to give this patient this med...do it yourself because i refuse to be treated this way from this "drug-seeker"....the doc normally cuts the dose in half....just alittle bit of info for your next er visit dear.....

and oh btw: i live with chronic pain as well.....i live with it....i take my motrin (only) and do some ice packs when there is acuity, or use my hot tub, do stretches daily, wear my orthotics, etc.....i know pain...and work my butt off through it daily. narcotics will not cure your chronic pain....

i am not personally on any pain meds for my chronic pain. i use ibuprofen and a heating pad, so i am not in any way a drug seeker and have never been to the er seeking any pain meds. i do not know where you got that from. i am also very aware that chronic pain is not curable.

and there are times that chronic pain patients are sent to the er by their primary doctor. i know this because that is what happened to my mother last month. she was in the middle of changing doctors to a highly regarded doctor in the dallas area and was not able to get an appointment for over a month and a half. the pain doctor that she had been seeing was in an arguement with her insurance company and he refused to see my mother until this was straightened out. so, she went to her primary doctor and he gave her a prescription for lortab when she had been taking methadone for over a year. she was in such pain for 3 days that she could not even get out of bed, yet she could not get any sleep and was crying in pain. my father had a fit and contacted her doctor office. the nurse there told my father that the doctor did not have time for this and for him to take her to the er. needless to say she is now changing primary doctors as well. she has finally gotten to see her new pain doctor. he put her back on methadone but since she had been off of it for a month she was feeling sick when she took it. she had to call him back and have her medication adjusted accordingly. it has been a nightmare.

my mother and my family are so jaded by the attitudes of nurses and doctors regarding pain meds that this subject just really hit home with me. when you see someone that you love suffering so much and can not get help from anyone, you start to think differently. my mother did not even go to the hospital er because she knew exactly what the nurses would think of her, because she has been there herself as a nurse, but now she knows that not every case is how it appears.

that is all that i wanted to convey. that every single case is not as it appears and if thinking the way that some of you do can be wrong in just one case then isn't that one case too many to gamble with?

i also wanted to direct you to another thread on allnurses about pain where the nurses are much more compassionate. https://allnurses.com/forums/f8/pain-subjective-334424.html#post3118024

nursejennie76 · Sep 25, 2008

I'm reading through all these responses and really hope I never end up in some of your ERs. Some of you have really lost your compassion and objectivity. Maybe it is time to look into a different profession if this sort of thing bothers you to this extent.

Get back to us after you have spent a few years in an ER!! Opinions are like butt holes everyone has one!! :banghead: :argue:

TraumaNurseRN · Sep 25, 2008

i have one thing to say..............chronic pain is not curable.....so, don't expect the emd to beable to cure it. don't come to the er wanting pain meds on a saturday for chronic pain and get ticked because you aren't getting the narc or mg of your preference. don't cop an attitude with the er nurse, because beleive it or not....the emds listen to us and we set the tone for your care....especially if you are faking it...or saying your chronic pain is a 10. when i ask...mamam if you had to give a number between 0 and 10 with 10 being pain for example....your arm was just amputated, what would you say your pain is?.....don't flippin tell me 10....i seriously walk out of the room and think you are a faker.
"and as filling the order as prescribed and move on statement".....whoa!...if you ever said that to me....i would march back to the ed doc, tell him what you just said....and say, if you want to give this patient this med...do it yourself because i refuse to be treated this way from this "drug-seeker"....the doc normally cuts the dose in half....just alittle bit of info for your next er visit dear.....
and oh btw: i live with chronic pain as well.....i live with it....i take my motrin (only) and do some ice packs when there is acuity, or use my hot tub, do stretches daily, wear my orthotics, etc.....i know pain...and work my butt off through it daily. narcotics will not cure your chronic pain....

i am not personally on any pain meds for my chronic pain. i use ibuprofen and a heating pad, so i am not in any way a drug seeker and have never been to the er seeking any pain meds. i do not know where you got that from. i am also very aware that chronic pain is not curable.

and there are times that chronic pain patients are sent to the er by their primary doctor. i know this because that is what happened to my mother last month. she was in the middle of changing doctors to a highly regarded doctor in the dallas area and was not able to get an appointment for over a month and a half. the pain doctor that she had been seeing was in an arguement with her insurance company and he refused to see my mother until this was straightened out. so, she went to her primary doctor and he gave her a prescription for lortab when she had been taking methadone for over a year. she was in such pain for 3 days that she could not even get out of bed, yet she could not get any sleep and was crying in pain. my father had a fit and contacted her doctor office. the nurse there told my father that the doctor did not have time for this and for him to take her to the er. needless to say she is now changing primary doctors as well. she has finally gotten to see her new pain doctor. he put her back on methadone but since she had been off of it for a month she was feeling sick when she took it. she had to call him back and have her medication adjusted accordingly. it has been a nightmare.

my mother and my family are so jaded by the attitudes of nurses and doctors regarding pain meds that this subject just really hit home with me. when you see someone that you love suffering so much and can not get help from anyone, you start to think differently. my mother did not even go to the hospital er because she knew exactly what the nurses would think of her, because she has been there herself as a nurse, but now she knows that not every case is how it appears.

that is all that i wanted to convey. that every single case is not as it appears and if thinking the way that some of you do can be wrong in just one case then isn't that one case too many to gamble with?

i also wanted to direct you to another thread on allnurses about pain where the nurses are much more compassionate. https://allnurses.com/forums/f8/pain-subjective-334424.html#post3118024

i'm not sure why you think i accused you or your mother of being a drug-seeker. me thinks you protest too much though.

TraumaNurseRN · Sep 25, 2008

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: :banghead:

Sorry, and thanks for listening! As the title says, I feel like a legalized dope dealer, and it makes me incredibly uncomfortable. Hrm!

TXNURSUINGGT,

This is the original post and unless you work in the ER or are a nurse in the ER you really have no clue what goes on in the ER and our frustrations. Are you saying we should provide narcotics like Halloween candy to drug seekers? Or are you just angry that your mother had to find another primary doctor because the other one refused to give anymore to her and then she went to the ER and they did the same. Has your mother ever looked into a pain managment clinic? Are you aware that many drug seekers visit numerous area ERs in one day trying to get their fix? Are you okay with a drug seeker who comes to an ER 20 times in one year? Are you okay with some drug seekers threatening the nurses unless they get their narcs? Are you aware of the danger ER nurses face daily due to this phenomenon. Our charts are tagged with patients like that. (Sometimes I think or our safety as well) I stand a little closer to the door when I am assessing a drug seeker, or when I go back into the room to tell them the EMD has prescribed Ultram or motrin for your pain. I have been kicked, spit on, cursed at and my life threatened from drug seekers. It's unfair for you to judge our compassion when we vent in this forum. And as I have said before. I'm not here to kiss your orifice I'm here to save it. Chronic pain is not an emergency.....Do you know what Press-Ganey is and how it is affecting the healthcare system?

Vito Andolini · Sep 25, 2008

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!

The doctors need to rear up on their hind legs and let Admin know who's the doc and who isn't. If they prescribe more than the DEA thinks is kosher, they will be out of a job, facing big trouble from the law. Now admin wants to tell them what to prescribe? I agree, the situation is ridiculous.

But if no one stand up to such lunacy, such misguidedness (if that's a word), it will not change. Who employs the doctors? Are they contractors? Employees? Self-employed? Attendings? Residents? Why are they impotent? If they all stand together, it will be easier than if only 1 lone one digs his or her heels in.

alphabet · Sep 25, 2008

Come back after 30 years of nursing and tell me you still feel this way....

kimbernurse · Sep 25, 2008

Okay, guys. Bottom line here is we have a CNA and a nursing student telling us we are a bunch of uncompassionate witches. What I don't think they are getting (and why would they, they have the combined experience of like 4 years and don't work in the ED as NURSES)is the WAY THE ER FUNCTIONS. OUR MAIN FUNCTION IN THE ER TO TREAT ACUTE CASES, THEN CHRONIC ONES. THE ER IS NOT THE MOST APPROPRIATE AVENUE TO TRY TO MANAGE CHRONIC CONDITIONS. I do not lack compassion. I am not a narc nazi or anything. I will gladly give dilaudid to anyone writhing in legitimate pain, chronic or not. Keep in mind, however that your ACUTE pain is more worrisome to me than your chronic pain is. LOOK UP THE DEFINITION OF TRIAGE. The sickest people that can be salvaged will be treated first. I am sorry if that means your mom has to wait 2 hours in the lobby to be seen. LIFE OR LIMB--that is the attitude ER nurses must have day in and day out to preform our jobs. We are really concerned about your mom, but even more so about the acute pain someone is having that may mean you're dying or may loose body parts. And unfortunately there are people out there that do abuse the system. The doctors have to be on guard, as someone else said in their post, because the DEA is monitoring what and how much narcotics they are prescribing. We are venting about the frequent flier drug seekers that verbally and sometime physically try to abuse us if the doctor doesn't give them what they want. I think you both may need to read back through this thread because I don't ever remember it being an "anti-pain medication" thread or "if-your-in pain-your-a-drug-seeker" thread. You make it seem that all ER nurses hate all people complaining of pain. Give us a break!! And again, when you become an ER nurse, you can then judge our levels of compassion.

ThrowEdNurse, BSN, RN · Sep 26, 2008

It's an addiction. They won't stop until they decide they want to help themselves. Do what you can to send them in the right direction, but many people have to hit rock bottom before they decide to enter into a program of some kind. Addiction is a disease. Treat it that way.

And if you knew anything about triage, you would know that an addiction would be very low on the priority list....just below toothache and right above script refill, but alas, when will you graduate???

COLPN · Sep 26, 2008

And if you knew anything about triage, you would know that an addiction would be very low on the priority list....just below toothache and right above script refill, but alas, when will you graduate???

Did I say anything about bumping them to the front of the list to be treated immediately?? No I didn't.

ThrowEdNurse, BSN, RN · Sep 26, 2008

My point exactly.

Yeah, it's so judgemental of me to assume you that your pts all behave like Minnie Mouse when you post items like you do on threads such as this. How terribly wrong of me!! I should have my nursing license revoked for being so callous to drug seeking, Medicaid/Medicare abusing, time wasting, selfish, abusive, morons. (Except that I won't...why? Because, a NURSE knows the purpose and importance and the function of any basic triage system. ) And that's what they are. This thread is not about people who truely experience terrible, unmanageable pain. RN's are here, venting about DRUG ABUSING, jerks who refuse to attempt to manage their pain appropriately then proceed to abuse the ED and the staff to get a fun high. So until you leave Disney Land and attempt to nurse anyone more challenging than Mickey with a splinter, you can take your self righteous attitude and shove it up Daffy's Duck. It's not that small a world.