Handling Seekers

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Specializes in med-surg.

Please help - I work on a unit that provides care to a lot of drug-seeking patients. I know I am a softie and tend to give in to the drama, giving them what they want (as long as it is safe/ordered/etc). Many times I can see that they are playing with me (one minute screaming, the next calm as can be [mere moments after their pain meds that they asked for by name are given to them]). I want to be a good nurse, control my patients pain/nausea, but I don't appreciate being played either. Where is the line? I don't want to get into trouble for not controlling pain, but I don't want to be an overquallified drug supplier either. How do I lay down the law, so to speak, and provide tough love when dealing with these patients?

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Specializes in home health, dialysis, others.

Unless you are a on a rehab unit or such, give the meds per schedule, not a moment earlier. You do not want these people going into withdrawal on your shift. When you first enter a room to do your assessment, let them know that "I noticed that your XXXX is written for every AAA hours. Your next dose is due no earlier than YYYY. Would you like me to just go ahead and put that on my schedule now? Please remember that I cannot give it any earlier than it's ordered."

This lets them know that you know the game, and that you won't be coaxed into their craziness. No point in screaming & carrying on, you will be there with it when it is due. If possible, pop your head in about 15-30 min before it's due to tell them you haven't forgotten about it. Best wishes.

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Specializes in ER OR LTC Code Blue Trauma Dog.

I attribute much of the drug seeking behavior on the big pharma advertising campaigns which serves to encourage this behavior.

Just my 2 cents.

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Specializes in Med-surg.

We get a lot of these patients too. And of course the dilaudid makes them itchy and nauseated so they want benadryl and phenergan. My favorite line: "it only works if you push it fast!"

I write down on the whiteboard in the patients room or on a paper towel on their bedside table when the next dose is due. These patients usually try to play staff against each other also so I will put a note by the call light with the same information on it. After a few tries they usually realize that the games aren't going to work.

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Specializes in CVICU.

I work on a busy tele/med-surg floor. When I get drug seekers I let them know up front that I will make every attempt to get them their pain meds on time. I try to keep these guys happy by getting them their pain meds on time. I dont need these types ringing up at the nursing station off the hook bothering me while im doing other stuff. So when I give them their pain meds we both say ok your next pain meds are due at xxxx. I tell them there is no way I can give them early. If I need an order for something stronger I will call the doc and let them know we are waiting for orders. I do my best to be cool to the pts but let them know how the system works on my floor. If alls it takes is me giving pt pain meds on time so that my pts arent squaking at me, ill do it and dont care if they are drug seeking or not. Ill leave that up to the docs to figure out.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

Pick your battles.

Unless you are working in addiction nursing/rehab or the sort - patients seeking drugs (legitimately or not) will be part of your life.

Personally -

I have great respect and appreciate HONESTY from patients and I find being ABUSED, PLAYED and BULLIED to be, at best, frustrating and at worst, it makes me want to provide little interaction or advocacy for the patient. I am honest and deliberate with them - I will not spend my precious time making more out of this with them than it is.

MD orders it and I can safely give it - they get it.

Like the others - I am for the matter-of-fact approach. We can sit and grouse and whatever about all the demands and hysterics and the end of it is - let the patient complain to administration and you will have made exponentially more trouble for yourself than any situation will deserve and you will usually accomplish nothing - except for making yourself upset and being on the radar as "difficult".

Please understand - I do fully support the NURSES right not to be a part of it - just realize that this is a hollow victory and you will find little support for "taking a stand".

I've have the battle scars to prove that I have been on this ground. I even was "not asked back" at one job due to taking a stand and not blindly, silently complying with a "powerful" drug seeker (he obtained by fraud - did not even give correct contact info and would lie and drive after the injections, the m.o. - had an "MD" call the "order" into ER and without seeing ER doctor - patient came in as an "outpatient for injection" and got all "juiced" up from the ER nurse who held lots of liability in the the event of something going wrong - but remained powerless to not comply - had over 300 visits for the "juice" provided from the ER nurses in the same matter in past year) and in the end lost a job that otherwise was pretty sweet. So, I do get the point of not wanting to be played like a harp and then taking a stand. Just realize that sometimes you will not have any support - no matter what. In case you missed the "memo" - the patient is always right. Customer service is everything and administration wants them to come back to our facilities of health and healing ---- you can be replaced, it is harder to keep the patients.

Bottom-line for me.

Doctor orders it - I administer on time, in the correct manner and assess the patient before and after. I insist that policy is followed to the letter , i.e. - patient not operate machinery (if they do and I know - that is a police matter and is reported without delay - mitigation of liability - my only defense at that point)

I do not spend lots of time or effort "fighting" this fight. You will be the only loser. Just keep the interactions with these folks on a necessary basis - be candid about the fact that abusive or manipulative behaviors are reported to the MD and your facility and threats or assault will be police matters. Sure, you can "gig" 'em and put the dilaudid in 50ml and run over 10 minutes - but, that will not "fix" them and will add to your workload - so, choose interactions with these patients wisely. Maintain some control and remain uninvested in these patients and their dramas - not worth the effort IMHO.

I just do not have the time to devote to non-sick folks. You do what you can and then get up to fight another day.

We have all been there and do what works for you. It is tough, no matter how you deal.

Good luck.

Practice SAFE!

;)

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Working in the Surgical ICU has the big advantage here.

Whatever a patient's history with controlled substance, I have no problem believing a patient's pain level. Getting hit by a car while crossing the road and having lots of broken bones is going to hurt. You can't fake your way into this unit.

Double for the burn unit. Narcotics flow like water there for some very real pain.

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Specializes in chemical dependency detox/psych.

Unless you are working in addiction nursing/rehab or the sort - patients seeking drugs (legitimately or not) will be part of your life.

:lol2::lol2::lol2:As a RN that works in chemical dependency detox, I found that line hilarious. I think it should read, if you are working in addiction nursing/rehab or the sort - patients seeking drugs WILL be your life. :p That's all I deal with, day in and day out. I always love it when the first words out of a patient's mouth are, "I want Ativan, now!!!"

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Specializes in Psych ICU, addictions.

I usually work on a detox unit...and it's not uncommon for us to have patients who will exaggerate and/or symptoms to get meds.

I tell them I can only give meds when and how they are ordered as in the MAR. Sometimes patients will come at me with "I spoke to my doctor and he told me he's going to change the dosage/schedule/drug or he's adding a new drug"...to which I reply "I don't doubt you, but until I have his written order I can't make any changes--I have to go by what is in the MAR. I'm sorry." Even if they try to tell me, "But the other nurse gave it to me...", I still tell them "I'm sorry: I don't know anything about that, but I need to go by what the MAR says."

As far as PRNs go...just because they're on detox doesn't mean I won't give them PRN medication they truly need--of course I will, especially since the last thing I need is a patient undergoing alcohol detox to start seizing on me. Nor should a patient have to suffer with a headache when there's Tylenol or Motrin about.

If it's clear that a patient's seeking PRN drugs, I'll encourage them to try other non-pharmaceutical techniques first. I usually err on the side of caution and give the PRN when asked...but if a patient is coming up demanding Vistaril for anxiety and they look as relaxed as a well-fed baby, then I will suggest some deep breathing exercises or distraction first, and if that doesn't work to come back and see me. If their vitals are high, I'll tell them to sit (and STAY) in the chair in front of the nurses' station for five minutes and then I'll retake them manually...and most of the time, it's no surprise to see the pulse/BP/respirations have dropped to or near WNL.

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Specializes in Cardiac Telemetry, ED.
Please help - I work on a unit that provides care to a lot of drug-seeking patients. I know I am a softie and tend to give in to the drama, giving them what they want (as long as it is safe/ordered/etc). Many times I can see that they are playing with me (one minute screaming, the next calm as can be [mere moments after their pain meds that they asked for by name are given to them]). I want to be a good nurse, control my patients pain/nausea, but I don't appreciate being played either. Where is the line? I don't want to get into trouble for not controlling pain, but I don't want to be an overquallified drug supplier either. How do I lay down the law, so to speak, and provide tough love when dealing with these patients?

Nobody likes being manipulated, but you really have to take your own ego out of it. As others have stated, if it is ordered and you can give it safely, then there is no reason to withhold it. Communicating in a matter of fact manner what you can give and when, then following through and giving it on time, is going to save you many headaches.

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Agree with the posters who say just give it-as it's ordered, within appropriate time frames, and as long as the pt is stable to receive narcs. When I first became a nurse this problem used to befuddle me too, until a wise nurse told me that acute care nurses are not in the business of detoxing patients; and that quite frankly the drug addiction is almost always a symptom of much deeper problems in the patient's life that we certainly aren't going to fix in the 4 days they're in the hospital. So try not to drive yourself crazy. Give them what's ordered, and be firm and consistent in your dealings with the patient. It's the only sane way to deal with it, really..

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