drunks

allnurses Guide · Aug 2, 2005

Here all ETOHers the PD get come in and get a medical clearance, once they can walk and talk they get protective custody. Most don't get an IV anymore, just time to sleep it off until they can walk. They hate PC, because the county facility got moved way out on a rural road and its a long walk back to town.

If they need babysitting, they get restrained and/or sedated - nobody has time to babysit. We have a lock down room, but the regs are if the door is locked someone has to eyeball the "secluded" patient 1:1 for the first hour.

The security guard doesn't "qualify", even though most of them are ex-PD themselves.

Don't take their shoes off if you don't have to. Half our ETOHers end up in hall beds anyway, no privacy so they don't get stripped down except for their shirt.

Blunt but courteous. Don't get sucked into tit for tat conversations. "I'm your nurse, not the police. I'm here to help you, so please knock off the (insert whatever you're being yelled at about)" "That's up to the police, I'm here to see if you have any health concerns". If conversation is impossible, don't bother.

Being a Christian, I just keep telling myself Jesus died for him too. Helps me keep a human face on them. I've found that humming hymns to myself also helps my attitude, and :imbar really ticks off the really nasty ones :rolleyes: Security just laughs at me these days, but they're always there to help.

flashpoint · Aug 2, 2005

"Drunks" are human beings and deserve the same respect as anyone else coming into emerg.

This is true...however, most of our chest pains, hot appys, respiratory distress, sore throats, spained ankles, lacerations, etc do not make suggestive comments, pinch, slap, bite, or expose themselves to us. Nor do most of them become violent, pass out, wet themselves, throw up on themselves and not know or care, or become so belligerent that we cannot care for them. I've never had a chest pain patient spit in my face and tell me he is going to sue me. I've never had a patient with a hot appy ask me if I like him and ask if I will suck his **** after he is discharged. Yes, they are human beings and yes, they deserve respect, but do do the ER nurses.

I know you are expressing your opinion, but just as you are allowed to vent that all patients should be respected, others should be allowed to vent that the drunks can frustrate staff beyond belief...

teeituptom, BSN, RN · Sep 3, 2005

After all these years Ive learned to handle them well. and quietly, and easily. I love to watch the young nurses try to get a handle on the situation, I think its funny. But give them time they will learn, maybe.

Jen2 · Sep 3, 2005

I am usually pretty assertive with them. I tell them exactly what I need them to do and what I expect from them. I usually say. "Mr or mrs. so and so I am your nurse this evening and I understand that you are intoxicated, I need your help in order for me to take good care of you." This statement usually results in a "Yes maam." For the most part, I find when taking an assertive approach, and letting the patient know that they need to work with you in order to recieve adequate care, they usually become compliant. I always offer to call someome for them and in most cases all they want is to be able to go outside and smoke, so I'll have security take them out to smoke after I get the O.K. from the doc.

However, my E.R. is right on campus of a huge University and we dread football season. Many of are intoxicated patients are students and I find them more noncompliant than the older chronic alcoholics we get. They usually come to us via EMS S/P altercation and unresponsive. As soon as we tell them that if they cannot respond to any of our questions we will need to put a breathing tube in to secure their airway and a foley, they suddently wake up and begin to respond. I know it's probably not the most ethical thing to do, but the docs do it and it gets them to respond and realize that the situation is serious and not a game.

That's all I have thus far. I am new at this game. I also had a girl the other night come out of her room, pull her pants down and proceed to urinate in the hallway. Got her back in her room and the next time we turned around she was in her bra and underwear walking up into other patients rooms. We put her back in her room again and had security set at bedside and badysit her the rest of the evening. We are fortunate to have enough security guards that we can have them sit at bedside and badysit if needed, which also helps a lot.

papawjohn · Sep 3, 2005

Hey Y'all

I know the ER folks get a particular experience with ETOHism. There is a specially wonderful experience waiting for some Nurse, however, when they have some medical/surgical problem that gets them admitted and treated.

Try a good case of DTs on for size, the next time you're planning on a quiet night in your ICU!!!!

Best Tx I've ever gotten orders from a Doc in a Pt with ETOHism is IVFluids that have 5% ETOH. This Doc was a recovered drunk himself. (Once while drunk he rode his horse INTO THE ER of the community hospital in Tenn where I used to live. That story outlived him!!!)

He'd order A5D5 (Alcohol 5%, Dextrose 5%) "titrate to tremors". Never had a case of DTs from his Pts.

Papaw John

Wise Woman RN · Sep 3, 2005

"Drunks" are human beings and deserve the same respect as anyone else coming into emerg.

Thank you... My father was an alcoholic. He also gave 25 years of his life to the Army, in WWII and Korea. He was a very smart man, well respected, but developed alcohol dependence late in life... when he collapsed and was taken to the ER, the staff was mean and rude to him, although he was not combative. He was, however, very frightened... They were very rough with him when taking ABG's, which are painful at any rate, and they were calling him names like Pops and Old Man... I finally had to say to them that although my father is an alcoholic, he is also a human being... and to please remember that when treating him... I know he wasn't being difficult because I was with him... it hurt me to see nurses behaving that way towards any person, let alone that it was my father...

Brotherbob, BSN, RN · Sep 3, 2005

I use to think that if I had grewn up in other circumstances this could be me.

Maybe I have less sympathy for these people now than when I started in ER. It worries me a bit. I do not want that to happen.

Luv2BAnurse · Sep 3, 2005

Therapeutic communication.

I am sensing that something is upsetting you.... blah blah blah.

OF COURSE you will probably get a sarcastic reply to that, but if you truly care...

you will find in most cases that the person will talk to you, especially since you are alerting them to the fact that they are involved in their care, and you are concerned. Bear in mind that you are not a substance abuse counselor (thank God for those) and that you are helping within your parameters. It isn't easy, because they (alcoholics) are selfish and self centered to the extreme. Yes, I know...not every drunk is an alcoholic....but they're quite demanding, more so it seems when we are already stressed and overworked. If a request they have is within reason, grant that request. Amazing what a little bit of understanding can accomplish. You have to be firm, and keep them focused on what they are supposed to be doing. You must set boundaries. Remind them firmly, but politely who you are and what you are there for. Explain specifically what you can do for them and do not allow them to cross the boundaries..neither should you.

Hope this helps.

thank you all for the posts to date, however i was wondering if anyone had any work-related tips on how to deal with the drunks (sorry... human beings) when they get unruly, agressive, etc.
some of the docs order ativan when they are acting up. others expect us to babysit them till they pass out. the babysitting duty is usually what puts me over the edge.
this is the usual chain of events:
1.person passes out in public
2.concerned citizen calls police (this step is optional. can go straight to police step)
3.police roust said person and forces them into ambulance.
4.ambulance brings said person to ER. neither crew nor the person is happy about this.
5.person wants to leave ER but cannot d/t being severly intoxicated.
6. person is now completly pissed off and becomes obnoxious towards anyone and everyone.
7.person eventually passes out and when relatively sober given a dose of anti-seizure meds then d/c'd
8.repeat with the same person 3-7 times per week till they vanish for a period of a few months.
any tips on handling step 6?

TinyNurse, RN · Sep 17, 2005

I also have a ton of compassion for these people....some hospitals hang banana bags, but for the most part, the patients are left to sleep it off ( after the beligerence and awful behavior)

You are on the right track, develop some understanding, and then let them sleep it off.

Trauma Columnist · Sep 17, 2005

I work a level one, inner city trauma center and we always have at lesast one and sometimes more ETOH's. I am one of the case managers and so here are some tips:

1. Keep things matter of fact.

2. Explain things once.

3. Warn once, then restrain for your safety and theirs.

4. Strip them (this should be number one). If they are habitual drinkers, my experience has taught me they can have weapons or syringes on them.

5. Provide adult diapers (everyone should do this).

6. Warm blankets. (These are human beings).

7. IV of banana bag and one liter of IV fluids (if their lungs are clear of course).

8. Don't overlook medical causes for "acting drunk."

9. Check a blood sugar.

10. Check for trauma.

11. Please be compassionate!

angel337, MSN, RN · Sep 17, 2005

This is true...however, most of our chest pains, hot appys, respiratory distress, sore throats, spained ankles, lacerations, etc do not make suggestive comments, pinch, slap, bite, or expose themselves to us. Nor do most of them become violent, pass out, wet themselves, throw up on themselves and not know or care, or become so belligerent that we cannot care for them. I've never had a chest pain patient spit in my face and tell me he is going to sue me. I've never had a patient with a hot appy ask me if I like him and ask if I will suck his **** after he is discharged. Yes, they are human beings and yes, they deserve respect, but do do the ER nurses.
I know you are expressing your opinion, but just as you are allowed to vent that all patients should be respected, others should be allowed to vent that the drunks can frustrate staff beyond belief...

i totally agree with you. unless you work in the ED it can be difficult to understand how it is working with patients that are combative, belligerent and obscene. i personally don't think my job or any job pays me enough to be spit at and physically harmed. i usually get security to help me restrain the ones that are obviously out of control and if its too bad (depending on the problem) i get the doc to medicate them and i stick a foley in and let them sleep it off. this works for my ED. i have other patients (like the acute MI's) that need my attention. i refuse to spend all shift feeling sorry for ETOHer's that take advantage of everyone they come in contact with.

Shamira Aizza · Sep 17, 2005

"Drunks" are human beings and deserve the same respect as anyone else coming into emerg.

Drunks are human beings...yes.

They do deserve the same attention to wellbeing and medical care.

I was originally going to say that I don't believe they deserve the same 'respect as anyone else,' but I thought about it for a moment and I have to agree.

I agree because most 'anyone else' (with a few exceptions) doesn't come in reeking of vomit, ammonia, and Jack Daniels and demanding Red Carpet service and making a general nusiance of themselves. So for that reason I will give "drunks" the same respect as anyone else. When the "drunks" exhaust their 'respect capital,' then they should expect little else than to be treated in the same manner in which they treat others. Remember, cops treat them differently than 'anyone else' at routine traffic stops. If I get pulled over for speeding, I get a ticket. If a drunk gets pulled over for speeding, she/he gets arrested. We are all created equal...we don't all maintain ourselves equally.

I lasted about 6 weeks in the ED...after seeing some of the same people multiple times for BS complaints within the first 2-3 weeks, I told my supervisor that I couldn't see myself maintaining the necessary compassion for them, and I resigned. I loved the urgent cases, but felt it was unhealthy to work in an environment where I was angry every time we had to 'pretend' along with the drug and attention seekers.