I can't help but get frustrated at the disrespect I get by pts who come in and don't get the dilaudid or the (30) 10mg norco script they demand...
Ive only been a RN for a year and this is out of control. Yesterday I got yelled at by a pt because she has chronic back pain, frequent flyer and was ****** she got 5mg norco this week instead of her usual 10mg, another one refused all meds but dilaudid and we had to call security because she became irate..
The last hospital I worked at, they stopped giving dilaudid and had signs posted up around the ER stating "we no longer administer dilaudid IV" Some dr's give in and some don't...but most do and that just makes the problem worse!
Just venting because I feel like they come in and walk all over us. We are just waitresses to them and all the hospital cares about is pt satisfaction. I dont care if drug addicts are satisfied or not...
I'm so glad that so many nurses have the same frustration as I do. I realize getting mad doesnt change anything, but Im not going to let some junkie use me and treat me like crap to get their fix.
I do realize chronic pain exists and their are pts who handle it in a healthy way...they go to pain clinincs and try to fix the problem rather than use drugs to cover it up. I guess I just wanted to know the best way to handle these people so I don't go nuts on them myself...lol
Specializes in Medsurg/ICU, Mental Health, Home Health.
I suffer from endometriosis, and I've tried all sorts of remedies for the intense pain I experience on a monthly basis.
Last year, my GYN told me to go to the OBGYN ER (worst pain I'd ever had). The covering doctor suggested Toradol, and if that didn't work we'd try something else.
Well, the wonderful nurse gave me 60 mg IM Toradol X 1, and oh my goodness, it was like a miracle! I know if I ever have the same issue again, I will ask specifically for the Toradol because I know what works.
Does that make me appear to be a drug seeker, because I know what works and would rather have that? Or would I not be a drug seeker because it's not a narcotic?
Don't get me wrong; I'm an adult MedSurg nurse and I sometimes administer enough Dilaudid in one shift to kill a horse. But just because a person walks like a druggie, talks like a druggie, he or she isn't necessarily one.
Does that make me appear to be a drug seeker, because I know what works and would rather have that? Or would I not be a drug seeker because it's not a narcotic?
I wouldn't call you a drug seeker at all. When patients say something like, "Toradol has worked for me in the past," that seems very reasonable -- it's non-narcotic and typically a great pain medicine. It's the people who say things like, "I usually need about 8 mg of Dilaudid for my pain, please push it fast and as close to the IV hub as possible" that worry me.
I wouldnt call you a drug seeker at all. Drug seekers are typically "narcotic seekers" and usually refuse Toradol, motrin, tylenol, or better yet, they are allergic to all NSAIDS. Toradol is a great drug, but it doesn't give that euphoric feeling these people crave.
Just to complicate the subject even further, look up "pseudo-addiction".
That was interesting. Thanks for sharing something worth looking into. :)
But - and I can't speak for anyone else - people with true chronic, painful disorders will know what works and how much works. Those patients inform the nurse and request an appropriate dose....typically.
Seekers demand, whine, and complain and go through all the typical behaviors and key phrases that tip us off.
When a patient comes through that I'm unfamiliar with and starts setting off my alarm bells, I give them the benefit of the doubt. (We typically know our seekers because we see them day after day after day as do our friends who work in other area ERs.) On a rare occasion, my instinct was wrong. Sadly, most of the time, I'm right.
The final determinate is the patient pressing the call bell constantly, writhing in "pain" on the bed, sobbing, screaming, and crying. All of which gets louder when you tell them they're not getting any more dilauded, all their labs and CT are normal and they're going home. When you get the MD to agree to give them a percocet before DC to shut them the hell up, this patient that was racked with pain, jumps up, smiles, swallows the pill and is on their way.
We don't forget their faces since their names often change.
However, I do think that too many nurses (ER as well as floor nurses) are very quick to label patients. Sadly, when we decide to be non-judgemental and not to trust our guts, we too often get burned.
Bad apples will always ruin the bunch.
Sorry. Turns out I didn't have a whole lot to say about psuedo-addiction, but it did give me something to think about.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I wouldnt call you a drug seeker at all. Drug seekers are typically "narcotic seekers" and usually refuse Toradol, motrin, tylenol, or better yet, they are allergic to all NSAIDS.
*** MY favorite- "Vicodin always help my pain" from the patient who just got through telling you she was allergic to tylenol.
Wow. Drug seekers vs. truly sick. Aren't the drug seekers just as 'sick' as the lol with a hip fx? What a way to spend your life - what to get, where to get it, how much you're going to get. Lose your job, your home, your car, your child, your freedom and possibly your life. Sign me up. And just to add insult to injury, the nurses hate you, too. Or at the very least resent you.
No, I don't think they are just as sick as a hip fx. 50% of the people with hip sx die within a year. 50% of drug seeker don't pass away with in a year after being seen in the ER. They can ambulate, they are usually younger, alert....nope. I don't think they are just as sick.
People need to pay due respect to the spidey senses of experienced ER nurses. I know, I get the feeling, I d recognize the walk, the talk, the story of a seeker. Me thinking this, feeling it, and believing it doesn't make me a bad nurse. Not appropriately treating this pt and not erring on the side of maybe the pt isn't seeking until a definitive diagnosis is made, would make me a bad nurse. By the way, the OP was referring to rude, abusive, hostile, demeaning seekers who don't care about the other pts in the ER, yell and cuss and don't care about a visitor here to watch Grandma pass away in the next room or the small kids down the hall. The OP was talking about the seekers that are disrespectful, have no clue of what an ER nurse does or knows, demeans them, and acts as though we are powerless imbeciles that will be subject to their every whim. That behavior is infuriating and sucks your soul clean, making you less of a nurse for everyone else.
Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
The lengths some people will go to....I wasted NINE hours on a person the other day who thought he'd come in and fake a CVA. After the first few minutes he seemed to have a very 'studied' way when answering who,where,when,or when 'trying' to even slightly move his limbs.Developed a "headache" -managed to get four doses of narcotic from the attending. CT was normal.
Needed to pee - "couldn't use urinal", wanted to be catheterized (yeah,right.) And the no underwear under the jean shorts was just plain weird/gross.... I pleasantly said, "I have an idea".Wheeled a commode chair in. Ludicrous,right?! Who gets a man up who is supposedly,by this time,paralyzed x 4!? I calmly instructed him how to get out of bed,exactly as I would any other pt.Was right there beside him should he need me. He must have thought 'the jig is up' because he swung the legs,stood,pivoted,peed,and got back into bed under his own steam. I didn't say one word nor did he about this miracle of miracles!
Updated by me,but told by the pt that he'd gotten only 'some' of his strength back, the ERP felt obligated to send him to the trauma centre where he'd already consulted the Neurology service. So this dude went on to waste even more precious medical/nursing/paramedical resources in a very busy ED.
Over the next couple of days I reviewed this case in my mind because I felt I hadn't dealt with this as effectively as I perhaps could have,feeling that I failed this pt by not sitting down with him to find out what the real problem was and whether we could help.
Fast forward to yesterday morning when,to my utter surprise,I noticed this person standing immediately in front of me in a coffee shop line up! He was alone,well groomed,still had the dark glasses on,and white cane in hand, but moved with supreme assurance as he reached for the coffee,quickly chose a tip from a handful of change,and confidently strode away.
I'd venture a guess he's not even 'legally blind'....
inteRN
78 Posts
I'm so glad that so many nurses have the same frustration as I do. I realize getting mad doesnt change anything, but Im not going to let some junkie use me and treat me like crap to get their fix.
I do realize chronic pain exists and their are pts who handle it in a healthy way...they go to pain clinincs and try to fix the problem rather than use drugs to cover it up. I guess I just wanted to know the best way to handle these people so I don't go nuts on them myself...lol