Drug-Seekers

Virgo_RN, BSN, RN · Mar 2, 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."

I could not agree with this more. Sometimes, being the patient advocate means saying no.

No, you can't have anything to eat or drink. I know the morphine is giving you cotton mouth, but you need surgery for that open tib/fib, and so I cannot let you have anything to eat or drink. No, not even an ice chip. No, I won't slip you some juice and pretend I didn't see.

No, you cannot get off the hard gurney. I'm sorry your butt hurts, but you came in with syncope and until we have more info, I don't want to risk you falling on the hard floor and fracturing your hip. You'll have to use the bedpan.

No, I cannot give you any more narcotics, since your O2 sats have dropped to 85% on room air and you're snoring while sitting up and telling me that you still hurt. If I give you any more narcotics, you're likely to need Narcan, and that's just no fun for anybody.

No, your child with RLQ belly pain, fever, and increased WBC count cannot have any food. I know, he's starving and hasn't eaten for hours. I know, you think I am cruel. But you see, it's looking like he has an acute appy and needs surgery.

No, I can't let you go out and smoke, you are having a heart attack and need to go to the cath lab.

No, I don't have any pot. Hold still, for crying out loud, I'm trying to hold c-spine precautions while the doctor attempts to sew up the giant bleeding lac on your head. Yes, you did fall down and go boom, and yes, you did have too much to drink, and yes, what they say about head wounds is true. They bleed a lot. In fact, you've lost a lot of blood and will probably need a transfusion.

No, I won't cover up your right leg for you. You are 26 years old and are not in cardiac or respiratory failure. You are able to move all four extremities voluntarily, and are perfectly capable of covering your own right leg. How am I helping you by enabling your helplessness?

No, I am not going to give you 2mg of Dilaudid until after the doctor sees you. Part of my responsibility as a patient advocate is to advocate for the wise use of resources. Our waiting room is full, we need beds, and here you sit demanding 2mg of Dilaudid for the ovarian cysts you were diagnosed with six months ago, and I know damn well you were just at the hospital down the road and received a script for a month's worth of Percocet. In fact, I can see it peeking out of the top of your purse. What kind of an idiot do you think I am?

Of course, in some people's world, these types of patients do not exist, and I am uncompassionate and unprofessional for daring to utter the words "No". What has happened to the nursing profession that we are not allowed to say "No" when it is in the best interest of our patients? Have we sunk so low that all we are is glorified waitresses/waiters, catering to every want, and heaven forbid anyone should ever feel the slightest amount of discomfort?

50caliber · Mar 2, 2010

I could not agree with this more. Sometimes, being the patient advocate means saying no.
No, you can't have anything to eat or drink. I know the morphine is giving you cotton mouth, but you need surgery for that open tib/fib, and so I cannot let you have anything to eat or drink. No, not even an ice chip. No, I won't slip you some juice and pretend I didn't see.
No, you cannot get off the hard gurney. I'm sorry your butt hurts, but you came in with syncope and until we have more info, I don't want to risk you falling on the hard floor and fracturing your hip. You'll have to use the bedpan.
No, I cannot give you any more narcotics, since your O2 sats have dropped to 85% on room air and you're snoring while sitting up and telling me that you still hurt. If I give you any more narcotics, you're likely to need Narcan, and that's just no fun for anybody.
No, your child with RLQ belly pain, fever, and increased WBC count cannot have any food. I know, he's starving and hasn't eaten for hours. I know, you think I am cruel. But you see, it's looking like he has an acute appy and needs surgery.
No, I can't let you go out and smoke, you are having a heart attack and need to go to the cath lab.
No, I don't have any pot. Hold still, for crying out loud, I'm trying to hold c-spine precautions while the doctor attempts to sew up the giant bleeding lac on your head. Yes, you did fall down and go boom, and yes, you did have too much to drink, and yes, what they say about head wounds is true. They bleed a lot. In fact, you've lost a lot of blood and will probably need a transfusion.
No, I won't cover up your right leg for you. You are 26 years old and are not in cardiac or respiratory failure. You are able to move all four extremities voluntarily, and are perfectly capable of covering your own right leg. How am I helping you by enabling your helplessness?
No, I am not going to give you 2mg of Dilaudid until after the doctor sees you. Part of my responsibility as a patient advocate is to advocate for the wise use of resources. Our waiting room is full, we need beds, and here you sit demanding 2mg of Dilaudid for the ovarian cysts you were diagnosed with six months ago, and I know damn well you were just at the hospital down the road and received a script for a month's worth of Percocet. In fact, I can see it peeking out of the top of your purse. What kind of an idiot do you think I am?
Of course, in some people's world, these types of patients do not exist, and I am uncompassionate and unprofessional for daring to utter the words "No". What has happened to the nursing profession that we are not allowed to say "No" when it is in the best interest of our patients? Have we sunk so low that all we are is glorified waitresses/waiters, catering to every want, and heaven forbid anyone should ever feel the slightest amount of discomfort?

Very eloquently stated Virgo RN :yeah:

NurseGloria · Mar 2, 2010

Not one nurse has any empathy for me or for other patients who were really ill and suffering, but falsely labeled?

I never said we should treat patients like customers and always say "yes" no matter what. What has happened to the spirit of Florence Nightengale? Where is your compassion?

I have been abandoned again.

50caliber · Mar 2, 2010

Not one nurse has any empathy for me or for other patients who were really ill and suffering, but falsely labeled?
I never said we should treat patients like customers and always say "yes" no matter what. What has happened to the spirit of Florence Nightengale? Where is your compassion?
I have been abandoned again. .

I have encountered pt. in the ER similar to you who are truly ill and suffering and it is sad and unfortunate. I know some ER docs are more forgiving than others and will do more to treat the pt. than falsely label them as drug seekers. I am empathetic and want to go the extra mile but can only do so much. I treat all my pt in a professional manner and pt. like you are in the minority. There is only so much we can do in the ER and pt. similar to you need to seek a PCP.

The gist of this thread is about pt. who are obviously abusing the system. Unfortunately, this is prevalent in all ER across the country.

Virgo_RN, BSN, RN · Mar 2, 2010

Not one nurse has any empathy for me or for other patients who were really ill and suffering, but falsely labeled?
I never said we should treat patients like customers and always say "yes" no matter what. What has happened to the spirIt of Florence Nightengale? Where is your compassion?
I have been abandoned again. ,.

How *dare* you question my compassion? Ask the patient who is dying of cancer and in my ED for pain control. Ask the little boy with acute appendicitis. Ask the little old lady with the broken hip. Ask the man who fell off the ladder who has a fractured pelvis and a hemopneumo. Ask the young woman with sepsis. And yes, ask the person who has been in my ED ten times in the last two months and has had every diagnostic under the sun and still doesn't have a diagnosis, but continues to report persistent pain. Ask my patients where my compassion is. How dare you!!! :mad:

NurseGloria · Mar 2, 2010

Sorry, Virgo RN. You are obviously very compassionate.

screamin mimi · Mar 2, 2010

Not one nurse has any empathy for me or for other patients who were really ill and suffering, but falsely labeled?
I never said we should treat patients like customers and always say "yes" no matter what. What has happened to the spirit of Florence Nightengale? Where is your compassion?
I have been abandoned again.

Oh, I bet ya Florence Nightingale would've practiced some "tough love."

The most consistent thing written has been that those abusing the system are taking our energies away from those who really need it. I'm not sure how anyone can take exception to this. I have empathy for those who are suffering which is exactly why I get annoyed with the overly dramatic drug seekers who divert my attention away.

Also, this thread is not actually about you personally. Try not to take it as such.

Scooty Puff Jr · Mar 2, 2010

Never mind

animal1993 · Mar 2, 2010

Reading some of these posts reminds me of one of the two visits to the ER I have ever had to make. Thankfully, both of them happened before I started NS, so I did not have the medical knowledge I have now. If I had, I would have realized just how poorly I was being treated at the time.

The first time I ended up in the ER was due to a massive HA. (The worst one I had ever had in my life.) When I was assessed, my pulse was at 48, and my BP was crazy (can't remember the exact #). It was something like 200/110. Let's just say that it was bad enough that the first thing the dr asked my husband upon entering the room was "Has she been showing any signs of a stroke?". I had the usual round of tests, including a CT scan and a lumbar puncture. When the nurse came in to start my IV, she said (quite sarcastically I might add) "So, let me guess. You're allergic to ibuprofen, right?" At the time, I simply told her that I was not (had taken some before coming to the ER as a matter of fact), and I could not understand why she had asked me such a question in the first place. I guess I now know why, huh?

I am not a drug seeker. As a matter of fact, when I had my C-sections, the nurses were constantly trying to get me to take the meds my doctor had ordered. But, I did not like the way they made me feel. The nurse that I had in the ER didn't know that, and she didn't bother to try to find out either. She just naturally ASSUMED that I was only there for the drugs. I understand that there are a lot of people out there who abuse the system, but why do any of you care so much that you are willing to treat anyone who comes to you for help as if they are a worthless piece of trash?

animal1993 · Mar 2, 2010

:fnypst:

What is so funny about it?

NurseGloria · Mar 2, 2010

Screamin mimi said, "Also, this thread is not actually about you personally. Try not to take it as such."

You're right. I shouldn't take it personally. I just felt the need to remind people that we need to be careful about assuming somebody is a drug addict when they may really have disease and can't get a primary care doc.

Everybody on this site probably knows that already. When I think about how badly I was treated and for how long, it still makes me feel bad. Persons without health insurance are so vulnerable.

tewdles, RN · Mar 2, 2010

As a side note...

I admitted a patient into routine hospice care this week who had an unfortunate experience with ERs.

He is a youngish man, 52, and very verbally "aggressive" about his pain needs. He had multiple visits to 2 local ERs in the month prior to his cancer diagnosis during the evening hours of the weekends...his pain was (and still is) worse in the evenings and, of course, there was not much support for him after office hours other than the ED. Once he received IM morphine which helped his pain, so he specifically requested that med on his visits. He had no difinitive diagnosis to warrant his pain complaints. He visited his primary MD as often as he could during the week and was being treated for a UTI. He had no Rx for pain relief other than Ibuprofen 600mg Q8hr.

By and large this man received very little assistance with his pain in those visits to the ED. He was given Toradol once which helped some, Demerol which did not help, and morphine on a couple of occasions. Ultimately it was discovered that he had widely metastesized bladder Ca. This explained why his pain was varied and widespread and difficult to control.

One of the things this gentleman said to me, when we put him on dilaudid with fentanyl patches for his pain contol was..."am I going to get addicted? They told me in ER that I shouldn't use narcotics if I don't want to get addicted."

My point in mentioning this is that complacence about the reason that an individual may continue to complain of pain in the absence of a diagnosis can become a trap for us in health care. It is often easier to see abuse of opioids when the behavior is chronic over long periods of time. But, frequent flyers over short spans of time (months lets say) may actually be people with real and legitimate medical conditions which have not yet been properly diagnosed or treated which are causing them great discomfort.

All medical doctors are not created equally when it comes to diagnosis and care of patients. Those people who are cared for by docs who are not providing good comprehensive care may find their only access for relief in the EDs...particularly after office hours and on weekends.

A final note...the aforementioned gentleman finally visited a 3rd ER where he repeated his list of symptoms and concerns. The doc there decided to investigate some of the concerns and it was discovered that the man's bladder was full of tumors. Following his admission to that hospital he was diagnosed with terminal cancer. Today he is angry and bitter that neither his primary doc, nor the ER docs from the other 2 hospitals took his pain seriously enough to diagnose him. He feels that if he had been taken seriously earlier he might have a better prognosis. Surely if he had had obvious symptoms or signs of the cancer (say hematuria) his couse of care may have been different.

Is he right? I have no idea. But he certainly did not have his pain needs met for some time and he certainly was not appropriately diagnosed for a measurable span of time in spite of repeated contact with health professionals. Unfortunately his experience has contributed to a general sense of anger and distrust for doctors and nurses just now. Of course, anger can be just a normal part of his "process" but it has certainly been exacerbated in this case by his perceived lack of care and compassion.

Did the first 2 EDs consider him a drug seeker? From the tales of the patient and his wife, it sounds like it. That staff might wonder what happened to him, or they may just figure he found an ED which would give him what he wanted and are glad not to have to deal with him anymore.

I dunno...there are no easy answers.