Drug-Seekers

50caliber · Mar 1, 2010

Please. Just because someone is frustrated with the VERY real problem of drug seekers in the ER does not mean they shouldn't be working in the ED.In fact, I'd argue that it's irresponsible to council our new nurses to ignore the issue and their own instincts for some pollyanna world view.
Nursing should be patient advocates. However, truly advocating for a patient does not mean that we give them whatever they want, especially if what they want can (and will) hurt them.
The attitude du jour of the "patient is always right" came out of a right-minded effort towards patient empowerment and education but has gone too far. The patient is not always right. We are medical professionals and as such we are obligated to do what is right for the whole patient. And sometimes that means saying "no."

Sounds just like my ER. Can't stand this kind of behavior and attitude. Love it when they call in asking who the Dr. is or they show up in the waiting room and ask about the Dr. on duty and they simply leave knowing its the Dr. who wont give them their meds.

NurseGloria · Mar 1, 2010

Virgo RN,

I strongly disagree with your statement, "The way I see it is that if addiction is a medical problem, then it is a medical diagnosis that any doctor, including an ED physician, can make".

Then that diagnosis follows that patient everywhere. Chances are that no other doctor will ever take another objective look at that patient again.

And what makes you think any ED doctor is qualified to diagnose addiction based on a patient requesting pain relief for pain caused by disease the doctor is unable or unwilling to diagnose?

A doctor could possibly diagnose "tolerance" based on the patient's reported history. But tolerance is not the same as addiction although tolerance is usually seen with addiction. I was taught that addiction is the psycholgical dependence on a substance.

A surgical patient can require increased doses of pain medication due to tolerance, yet not be addicted by being psychologically dependent on the medication. Don't they teach this in nursing education anymore?

Also, I know for a fact that have people died from opiate withdrawal in jail.

screamin mimi · Mar 1, 2010

Yes, actually they do teach the definitions of tolerance and addiction in nursing school. They also teach (for those who haven't picked it up from mere observation) that "if it looks/walks/quacks like a duck" it might be a zebra but it's probably a duck.

Nitpicking aside, Virgo's point is valid.

NurseGloria · Mar 1, 2010

screamin mimi, Your statement, "Yes, actually they do teach the definitions of tolerance and addiction in nursing school. They also teach (for those who haven't picked it up from mere observation) that "if it looks/walks/quacks like a duck" it might be a zebra but it's probably a duck."

Maybe you'll be a "zebra" someday and some burned out, exhausted ED doctor will ruin you life and cause you much suffering by giving his unqualified diagnosis that you are a drug addict.

Scooty Puff Jr · Mar 1, 2010

Whoa, Nurse Gloria, take a chill pill. :lol2:

Blue Crab Lover · Mar 1, 2010

I worked in the ER for 7 years. It is a battle that will never be won. It is a war on drugs. I give the meds and get them out. They are going to get it anyway so I don't get upset. I'd rather have a druggie patient for less than 2 hours rather than have one on the call bell watching the clock for a whole 12 hour shift. They are sick indeed. However, giving them the drugs everytime they show up with husband and kids in tow is not the answer. It doesn't take a person 5 minutes to tell you about their pain. The seekers mostly always have a long story regarding their pain. A real person in pain says " It hurts here for this long and this bad. Help me. Make it go away. 2 seconds.

Editorial Team / Moderator · Mar 1, 2010

Nurse Gloria, I don't doubt that there are people in real pain. However, there are also those who abuse the ED and use it as a resource for narcotics, whether for their own use or to sell them. We're not saying there isn't pain involved, but we are addressing the very real, very constant issue of drug seeking behavior as it relates to ED abuse.

Let's all stay on track, please. I'd hate to see this thread devolve into bickering.

NurseGloria · Mar 1, 2010

Blue crab lover said, "The seekers mostly always have a long story regarding their pain. A real person in pain says " It hurts here for this long and this bad. Help me. Make it go away. 2 seconds."

A person who really wants to find out why they are having pain may try to give a very detailed account because they hope their symptoms will cause somebody, sometime, someday to figure out what is causing the pain and help them.

I can't believe the prejudice I am hearing toward patients in pain who seek relief an emergency room. I knew this was a problem 30 years ago when an ER doc told me to give a patient who showed up once a month with a migraine, an injection with the largest bore needle I could find. He didn't want her to return.

Of course I gave a proper injection with a needle the size that was appropriate for the medication and patient. Now I wonder how many ER nurses would do what the doctor told them to do.

And as for the nurse who posted concerning a patient who called ahead to see which doctor was working the ER and the one who decided to leave when he found out who the doc was, what would you do if you had previously been verbally abused and denied care by a doctor? You would probably go to a different ER. That is exactly the intention of the abusing doctor.

Why aren't nurses reporting this treatment of patients by doctors instead of becoming hardened and acquiring the same disdain for their patients that these burned out ER docs have? Get a contract from your employer and advocate for your patients while having job security for yourselves.

screamin mimi · Mar 1, 2010

screamin mimi, Your statement, "Yes, actually they do teach the definitions of tolerance and addiction in nursing school. They also teach (for those who haven't picked it up from mere observation) that "if it looks/walks/quacks like a duck" it might be a zebra but it's probably a duck."
Maybe you'll be a "zebra" someday and some burned out, exhausted ED doctor will ruin you life and cause you much suffering by giving his unqualified diagnosis that you are a drug addict. Why don't you change your name from "screamin mimi" to Nurse Ratched?

Name calling is really not helpful or appropriate. No one has argued that peoples' pain should not be treated only that we shouldn't feed addictions where they exist. Absolutely, there are people who are labelled drug seekers unfairly. It's unfortunate that you feel you are in that group. But there are, in reality, actual people who misuse the emergency dept to acquire narcotics. Some do so because they are addicted and others for distribution in the community. (Yes, I am making assumptions but as I'd hoped to illustrate with the "duck" metaphor it is based on a reasonable examination of the facts.) We are only helping those people self-destruct (although we might include their families as casualties) by supplying them their drug of choice.

"Ratched" does have a certain ring to it, though...

NurseGloria · Mar 1, 2010

LunahRN,

What do you think the track is here? An ED nurse complaining about how to handle patients with drug seeking behavior posts here. There are two kinds of drug seekers, those with addictions and those without addictions.

Both kinds of patients need treatment and care. An ED doctor is asked to diagnose a patient in the ED setting, often because the patient lacks health insurance and a primary care doctor.

Some of you ED nurses seem to have solved the problem of patients returning to the ED for narcotics by giving them your unofficial diagnosis that they are all drug addicts. So simple. So easy. So unprofessional.

NurseGloria · Mar 1, 2010

screamin mimi,

more is required than just treating pain. the underlying cause should be found. for a person, such as myself who has fallen through the cracks, that is unlikely.

we need a single payer universal health care system so that the eds are not full of people with undiagnosed pain or treatable addiction.

we have the money to fight two wars. nurses must speak up for patients. don't resort to blaming the victims in order to make yourselves feel better. nurses who went into nursing to help people know the truth. fight for what you know is right!

Editorial Team / Moderator · Mar 1, 2010

I don't see anyone endorsing punitive nursing. Again, no one is denying that there are patients with pain, or patients that need treatment and care. And no one said that they are all drug addicts, either. As I said, I try not to judge and I treat ALL my patients with compassion. Maybe it's because I'm still new, or maybe it's just because that's the way I roll.

This is a very real issue. I'd like to think we can discuss it constructively, but I'm probably wrong.