Nurse accuses patient of drug addiction! - page 6

A fellow RN on my floor did something last week that continues to amaze and shock me. There was a patient admitted with pancreatitis, receiving the usual for that diagnosis: NPO, IVF, Dilaudid... Read More

  1. by   vsigns
    Country Rat- I understand "attention seeking behavior". I guess it was more the way that my PACU nurse said it that infuriated me. I was helpless, I could not move, I asked for help and she was extremely angry with me for being in pain. I think she was burnt out or something and needed to retire. She spoke to me as if I were a child-I am 51yrs young and she was maybe in her thirties. She was verbally and physically abusive to me. I did nothing wrong.
  2. by   LilPeonNo1
    I had a friend I had known for years, before I became a nurse. She used to hang out with "bikers" when she was young. She married one of them at a young age and got caught up in the drug scene. During one of their many biker rides, she and her then husband were in a horrible accident. He was killed. She went through many surgeries including back surgeries following the accident and spent more than two years recovering. She was left of course in chronic, and as she described it, excrutiating pain. Having already been involved with drugs prior to the accident, her tolerence to opiates was high. As you can guess, it wasn't long before she was seeking drugs any way she could get them, because the scripts weren't enough to relieve the pain. She was popping pills like candy. We were both about 25 when she met and married her second husband, who was 10yrs her senior, and he loved her very much. He did everything he could to help her get over her addiction by trying to find out some other form of treatment for her pain. Nothing worked. In many ways it was heart-breaking to watch him try. When she turned 35 her husband came to my husband and me and told us his wife was in rehab, she had turned to heroin to relieve the pain. He was devastated to discover this, but was not ready to give up on her. But she continued to seek pain meds and rely on heroin to get her through the day. He finally gave up trying, after he came home one day to find she had hit herself over the head with something like a baseball bat, and told him that someone had robbed them. There were only a couple of small items "taken", like a microwave and toaster oven or something like that, so he was certain she had pawned the items and used the money for heroin. Also, because his television and expensive stereo equipment was not disturbed. After that happened, he gave up all together and let her do whatever she wanted. And, I along with my husband (his best friend) believe its what eventually killed him. He spent all those years trying to "clean her up". Using up his life savings, losing his business and alienating his children. He died a poor man at the age of 54 from a heart condition, and she was left alone. And six months later, we received a call she died from an overdose.

    This is a sad, but very true story. I sit here with tears in my eyes thinking of it. My husband and I both lost very dear friends. Even though we took different paths in our lives, K was a good person. One who despite everything, wanted only to be rid of her pain. She finally got her wish.

    The real point to all this, is you can try all you want to change someone, but they have to be willing or able to change for that to happen. YOU can't do it for them. If a patient comes to you and even if you know without a doubt that they are drug seeking, it might just be because they NEED it just to get through the day. But, even if they aren't truly in pain, and only they can know for sure, they will get what they want however they can get it. From the doctor, or the streets. When that patient is discharged he or she will do whatever they think they need to do to get what they feel they have to have. So, why get angry, or appoint yourself some kind of Holier-than-Thou, self righteous know it all. Give your patients what they ask for if its ordered. And, don't judge someone else because you might very well find yourself in their shoes one day.
  3. by   diane227
    You know what, it is not my job to drug rehab every patient that I think have a drug problem. My job is to keep them pain free. To assume that this patient had a drug problem is wrong. This nurse needs to learn to be more professional and less judgmental. There is no such thing as "drug seeking". Everyone in pain is drug seeking. Just give them their pain meds, make them comfortable and leave the drug rehab to someone else.
  4. by   Connie Elder
    The nurse that did this should be disclipined. She should have to take a culture and sensitivity class that the hospital has. We all face pts. like this who we "think" are drug seekers. What she did was appalling. In my 32 years I have not heard of this being done. I have heard of nurses telling pts. that they are druggies but never have heard of this. To me there are many unasked questions when dealing with a situation like this. Does this pt have chronic pain, has she ever been referred to a pain clinic or specialist, etc? I am a travel nurse and have worked in some communitites where the pt/Dr. have a contract for pain control.
  5. by   vsigns
    Everyone reading-I know what this nurse did was wrong. I was in the recovery room after major surgery. I had been on no pain meds prior to surgery or anytime in the past year. Personally, pain meds make me sick and I don't see the draw. That nurse was heartless,judgemental and just wicked to my family. I was trying to get help for excruciating pain-worst I had ever felt. I was never asked on a scale of 1-10 what my pain level was and they did not care. I was threatened if I did not shut-up (exact words) and stop bothering other patients, that my Dr. would transfer me to main hospital, and that "those *******-(nurses at main) wouldn't care if I lived or died!" I asked her to go and get my Dr. because obviously nor did they care. They refused. That same nurse laughed at me when I told her I had SCI. She said "right". I thought to myself-I am living a nightmare. I really did just want to die-I cried for my deceased mom to come and get me-I could bear no more pain. I had already had 3 previous cervical procedures from a rear-end accident. I was the one who was rear-ended. Nope-never saw it coming. I have been banned from nursing school-they will not let me finish 20 weeks to my RN degree. I can only lift 10 lbs now. Everything on-line is so expensive. I told the DON of the program-I can't finish because I am disabled- he said if you were already an RN we could accomodate you and it would be different. It is to dangerous for patient care. I told them, what if I don't go into direct patient care? Not all nurses go into direct patient care-so why can I not finish my education. I can still do some things and want to try. I guess this nurse just got left behind. The DON did not know what to say. Everyone tells me to not give up-I don't think I have a choice.
  6. by   GadgetRN71
    Quote from vernonleon
    In your initial post, it sounded as though you requested Versed from the doctor as a chemical restraint (based on the context of the situation, patient yelling, disrupting the PACU, etc.), then failed to inform the patient what the Versed actually was and why it was being used. You told the patient that Versed was stronger, which in context would have come across to me as "Versed is a stronger opiate/pain reliever," which it is neither. I am actually surprised that the doctor would order Versed in the situation, especially considering that s/he refused to order Dilaudid, but I'm not a PACU nurse so maybe it's somewhat normal and I just don't know it.
    I have seen Versed used in the PACU. Unfortunately, some patients come out of anesthesia combative, pulling out their IVs, trying to climb out of the bed. In these cases, restraint is sometimes necessary. The elderly in particular can get very agitated from anesthesia.

    And these patients are heavily medicated from the anesthesia..they are not in a mindframe to listen to patient teaching. Post-op, part of the concern is keeping the patient safe. The side rails on the bed are up at all times, and physical and chemical restraint is used when indicated. Granted, the PACU nurses try to do this as a last resort, but sometimes, there is no way around it.

    I am one that thinks that pain needs to be treated though, regardless if the patient is an addict or not.
  7. by   morte
    Quote from SquirrelRN71
    I have seen Versed used in the PACU. Unfortunately, some patients come out of anesthesia combative, pulling out their IVs, trying to climb out of the bed. In these cases, restraint is sometimes necessary. The elderly in particular can get very agitated from anesthesia.

    And these patients are heavily medicated from the anesthesia..they are not in a mindframe to listen to patient teaching. Post-op, part of the concern is keeping the patient safe. The side rails on the bed are up at all times, and physical and chemical restraint is used when indicated. Granted, the PACU nurses try to do this as a last resort, but sometimes, there is no way around it.

    I am one that thinks that pain needs to be treated though, regardless if the patient is an addict or not.
    but this wasnt the case here. this patient was complaining of pain and the ()*^% doc wasnt going to order any more pain med, SO.... they chemically restrained him for their own sake, not his......
  8. by   vsigns
    Sometimes-more pain meds cannot be given due to risk of overdose. Sometimes Versed is given humanely-so the patient won't (hopefiully) remember the pain and Sometimes we don't know if it was for the nurses benefit as we were not there. Pain sucks no matter who you are, I can't think of one person who wants to be in it.
  9. by   GadgetRN71
    The PACU patient was acting disoriented and combative though. Screaming and yelling is not the behavior of a rational person in his/her right mind. Now, this pt couldn't help it, but you can not treat them the same as a person with all their wits about them. There's a reason they tell you not to sign any legal documents 24 hours after surgery..

    I guess my main point was, things are done differently in a perioperative environment for good reason. There's a lot more leeway with restraint use, because safety is a big concern. It will do the pt no good if they start pulling out drains, IVs or compromising their incision.

    And like the PP said, we don't know what the true story was because we weren't there.
    Last edit by GadgetRN71 on Apr 27, '09
  10. by   Happygolucky47
    Quote from SquirrelRN71
    The PACU patient was acting disoriented and combative though. Screaming and yelling is not the behavior of a rational person in his/her right mind. Now, this pt couldn't help it, but you can not treat them the same as a person with all their wits about them. There's a reason they tell you not to sign any legal documents 24 hours after surgery..

    I guess my main point was, things are done differently in a perioperative environment for good reason. There's a lot more leeway with restraint use, because safety is a big concern. It will do the pt no good if they start pulling out drains, IVs or compromising their incision.

    And like the PP said, we don't know what the true story was because we weren't there.
    Apparantly, I need to clarify, I reread my post, and you are correct, things didn't sound right to me after I reread it, in the PACU, it is a different world than working the floor, THE patient is coming up from anesthesia, they are disoriented, they are in pain, and they are waking up. I"ve always thought of it as being just below the surface of water and not being able to break thru. I have NO PROBLEM in medicating anyone, and I don't want them to be in pain, nor do I want them yelling and getting everyone else in a tiz. I had talked to the DR, and had asked him for more meds, I understand that the chronic painers have a higher tolerance for narcotics, and I understand that they know what works for them. BUt I also know that when a patient is yelling and carrying on, it's not gonna help with the pain either, when you can't relax, the pain meds won't work as well , it's gonna take more and more and then ....resp arrest, yes that can happen, especially in the pacu, I"ve bagged more than a few people after being over medicated, because eventually the meds catch up, be it in the PACU, or after they are on the floor, amb, wherever,. Giving Versed in the PACU, is twofold, 1) Put them back down and let them sleep thru that initial pain, most people after carrying on like that, and then receiving versed, wake up the second time in better control (which incidently is what happened to that patient) 2) Chemical restraint, well yes it is, however it is a safety issue as well, you can't have them pulling at tubes, and such, nor can you have them thrashing about on the carts, like I said they are disoriented, and in pain. So while many of you are appalled, i'm sorry for that, however I only have the patient in mind, and giving versed in the PACU, while on a monitor and someone to watch over you, watching your airway, to me is a better alternative, than giving more and more narcs. only to send you out of there to somewhere else and have you crash, when all the narcs hit. LIke I said, put them back down, let the narcs they already recieved take affect and when they wake up, they feel better. That's all I'm saying,
  11. by   MichelleB34
    First, I am also disgusted by the actions of your coworker. It is never easy when you have to report a fellow worker. A few years ago there was a male nurse where I work that was either let go or asked to quit. There were a series of inappropriate behaviors toward staff and patients. We dealt with the situations directly with the staff member as they arose. We should have brought them to the attention of our director sooner. We put our boss in a bit of a difficult spot because when someone is let go it is helpful to have documentation of the disciplinary process. ie verbal warning, written warning, etc. Keep us posted.
  12. by   RetiredTooSoon
    Quote from SquirrelRN71
    There's a reason they tell you not to sign any legal documents 24 hours after surgery..
    Our patients were told that they were legally impaired for a minimum of 48 hours post op. It could take that long for the person to recover from the effects of the anaesthetic medication in their system. Even with that 48 hour space, the patient is often still on narcotics, which can also affect one's ability to make legal decisions.
  13. by   morte
    Quote from Happygolucky47
    Apparantly, I need to clarify, I reread my post, and you are correct, things didn't sound right to me after I reread it, in the PACU, it is a different world than working the floor, THE patient is coming up from anesthesia, they are disoriented, they are in pain, and they are waking up. I"ve always thought of it as being just below the surface of water and not being able to break thru. I have NO PROBLEM in medicating anyone, and I don't want them to be in pain, nor do I want them yelling and getting everyone else in a tiz. I had talked to the DR, and had asked him for more meds, I understand that the chronic painers have a higher tolerance for narcotics, and I understand that they know what works for them. BUt I also know that when a patient is yelling and carrying on, it's not gonna help with the pain either, when you can't relax, the pain meds won't work as well , it's gonna take more and more and then ....resp arrest, yes that can happen, especially in the pacu, I"ve bagged more than a few people after being over medicated, because eventually the meds catch up, be it in the PACU, or after they are on the floor, amb, wherever,. Giving Versed in the PACU, is twofold, 1) Put them back down and let them sleep thru that initial pain, most people after carrying on like that, and then receiving versed, wake up the second time in better control (which incidently is what happened to that patient) 2) Chemical restraint, well yes it is, however it is a safety issue as well, you can't have them pulling at tubes, and such, nor can you have them thrashing about on the carts, like I said they are disoriented, and in pain. So while many of you are appalled, i'm sorry for that, however I only have the patient in mind, and giving versed in the PACU, while on a monitor and someone to watch over you, watching your airway, to me is a better alternative, than giving more and more narcs. only to send you out of there to somewhere else and have you crash, when all the narcs hit. LIke I said, put them back down, let the narcs they already recieved take affect and when they wake up, they feel better. That's all I'm saying,
    going back and "touching up" the story, only after someone agreed with you....is a little much.....and you still lied....were i come from that is assault

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