Having trouble dealing with drug addicts. Any advice?

[nurse94]

I work in a community hospital on a pediatric floor. Like many community hospitals with a peds floor we take adults to keep our census up at times. It seems like almost on a weekly basis we get a drug addict just looking for us to feed his/her addiction. I think this problem has become tougher to deal with than ever now that we concentrate so much on pain and treating it. I don't know how it is in other hospitals, but in mine it's required to rate a patients pain and treat it. It's really taboo to challenge whether or not the patient is really in pain. You can pretty much know without a doubt that a patient is faking pain and yet You still have to medicate them.

I was wondering if a lot of nurses out there are experiencing this frustration. And it is extremely frustrating for me. Especially when I have really sick kids on the floor and I'm having to medicate a grown up drug addict every two hours. I mean these people literally watch the clock and call right on the minute. I even have a frequent flyer that sets an alarm on his cell phone for when he can have his next dose. If you're in that much pain, do you really need a reminder to call for your pain med?

If anyone has any advice on how to deal with this frustration, please share your thoughts. I would really appreciate it. Thanks.

[Daytonite, BSN, RN]

I was only a few years out of nursing school and working on a busy medical unit when the hospital decided to assign 4 beds on our unit as alcohol/drug detox beds. That opened the door for any psych admissions including people with intractable pain and headaches, and we got plenty of them. I guess I don't have to tell you how much time these patients take up.

This is how I reasoned this out so I could get on with my work. I followed the doctor's orders. Whatever these patients were allowed for pain I gave them. When it was appropriate to question a dosage I did, but as I am sure you are finding out, some of these people can tolerate huge doses of stuff. Like you, we also had several frequent flyers.

I found it much easier to be aware of when each patients next dose was due. The way to build trust with them was to be there and ready with their next "fix". And, no matter how disgusting I thought their habit and behavior was, I worked very hard not to let them see my true feelings. I worked the heck out of my professional face. Also, I learned very quickly that many of these patients have increased emotional needs. If I had a few minutes I would pull up a chair and sit and talk with them a little. If I noticed they were on their call lights a lot I tried to spend a little more time with them. I saw it as a way to make my shift go a lot easier. But, now, many years later, I realize that I was meeting their needs as well. I was trained, basically, to be a technical nurse and dealing with a patient who has emotional needs is very different. Ask any psych nurse.

You are not going to treat anybody's addiction in the venue in which you currently work. You need to face the reality that treatment of their addiction is out of your control. Our only choice in this situation is to be non-judgemental (hard in this case, isn't it?)

I hope that your experience with these kinds of patients give you the opportunity to grow and increase your skills as a nurse as it did for me. Some of my frustration in working with patients like this is what led me to go back for my BSN. :redbeathe

[pricklypear]

I deal with the frustration by, as Daytonite said, realizing that it was not my job to deal with these people's addictions. I gave what was ordered, when in was ordered. If they carried on about how "it's not enough," I would call, even at 2am if necessary. I wouldn't let a surgical patient suffer with insufficient pain control at 2am, the addicts don't get any different treatment. I get frustrated when their needs take away from my other patients, but they are usually satisfied to get their meds when they want them.'

You have to remember, some of these "addicts" actually do suffer from severe chronic pain. Sometimes they behave like what we call a drug-seeker. They are usually very defensive from having spent years trying to convince people (like us!) that they are truly suffering from pain.

[pebbles, BSN, RN]

As previously mentioned, building trust is an important one. If they are rude to you, try a "contract" approach - "I'll be polite to you if you're polite to me. I'm trying my best to take good care of you. If your pain isn't under control yet, we'll work on it." Then follow through. Call the doctors to get pain meds increased if need be. Make sure you anticipate when the person needs the next pain med.

Sometimes education is involved too - some patients need to be told that we can't "erase" ALL of their pain, we need to get it controlled enough so they can ambulate, db&c, etc.

Our hospital has a Chemical Withdrawal consulation nurse who we can consult, she goes to talk to the patient about his past history, the way he is using drugs now, and assesses whether he is really having an addiction. She is really great at talking to people about addictions without sounding judgemental,and offers them treatment. It's up to them to make the call to the treatment centre. You might check with your manager about resources such as this, or even if she could get someone to come in andinservice the ward nurses about how to deal with these types of patients. I don't think you should be left trying to care for these patients with no teaching or assistance, given that you guys are a pediatric ward to begin with. It's a whole different kettle of fish to deal with drug-dependednt adults, and your manager has to realise that!

Sometimes, when you have earned the trust of a patient and have a quiet moment to talk to him, it's nice to talk about the drug useage. As him about his pain, how bad is it, what makes it worse, do the meds help, etc. Sometimes that can be an opener for him to talk about how his drug use is out of control, and you have a valuable opportunity there. Just make sure he knows that you aren't going to hold the drugs from him if he talks about a drug dependency. Often people who've used a lot of drugs in the past will honestly need more narcotics to kill the pain than other pts.

Good luck! :)

[traumaRUs, MSN, APRN]

Good suggestions. I would also involve your case manager. They can coordinate care and ensure that the patient gets the proper outpatient care and follow-up.

[Tweety, BSN, RN]

Good suggestions.

Any way you can just let go of it all and just medicate him/her when the time comes and not let it bother you. You're not going to be able to fix the addiction in your shift, so why not just follow doctors orders and get through your shift peacefully and let go of all that other stuff.

[prmenrs, RN]

That is a lot of very useful advice. If your unit (or facility) had a standard of care as applied to this category of pt, utilizing the concepts the other posters have expressed, it would go a long way towards making their hospital stay more effective and pleasant for all concerned.

Best of luck instituting some changes!!!

[z's playa]

Great educated responses ! I have to say this is by far one of the most impressive threads regarding this rather contraversial topic. I hope I can be as professional as all of you demonstrated here today when I get out there. :)

Z :balloons: