Help me with compassion fatigue

toomuchbaloney · Apr 20, 2015

That's the truth itself... the problem is where these boundaries actually are.
I actually love to work with chronic pain patients, at least with those who seem to be at least minimally concerned about their forming (or already well-established addictions) and want to do something about it. I teach them and their families gate theory of pain, the "warm-cool" techniques, guided imaginary, localized stretching and basic relaxing massage depending on the pain's cause. I go through every pain med they are taking, explain things like time of the action start and maximal action and, if they are willing, speak with provider(s) to re-adjust schedule, especially when PT/OT involved. I also teach sleep hygiene and a few other things, among them pain perception ("the pain is what patient says" is what is in the book but it is just not always so in reality, and especially in cases of chronic opioid-attenuated pain). I see at least partial effect (i.e. stopping being "on the clock" callers and no dose escalation) maybe 50% of the time and think that it is at least somewhat positive because otherwise these people would be just given one prescription after another.
I learned all that in the process of beating fibromyalgia without a single pain pill, only by "alternative medicine" means (it cost $$$$ out of pocket, though). I wish I would be able to use other techniques I know such as deep massage, or acupuncture but I definitely can't do anything like it as "just" RN. I do not think, though, that educating and teaching how to use basic pain-relieving techniques can cross any professional boundaries right now except the one I put in my brain myself as "it's just another addict, give'm that shot and get on with everything else". If I can at least attempt to do something I have the right to do and patient wants to try, I'll do it.
And, yes, I know people who hate me with passion for thinking like it and doing it. They know about the hell of fibromyalgia only in theory, though.

I would tend to disagree, I think that professional boundaries are relatively well defined in nursing.

I further think that (too) many employers may not spend much time discussing or promoting these boundaries because they have a propensity for violating the boundaries of the nurses in their employ on a regular basis.

jadelpn, LPN, EMT-B · Apr 26, 2015

And OP, always use your resources. If you are having patients who are chronic painers, then to get them involved in a pain management consult would be in their best interests.

Chronic pain is a weird dynamic. Some are just so scared to have the level of pain for non-function it is imperative that they control the timing. It is an out of control feeling to be in that place. And some are, in fact, dependent on pain meds to function. And withdrawal is not a good place to be. And it is so easy to get hooked. And most do not think that there is a choice between horrible unrelenting pain and IV pain medication. And for some, there may not be. But for others there can be choices.

I get that patients can not go home on IV push dilaudid. And that speaks to the way their pain is controlled long term. And to have resources available to the patient can only help them to succeed in controlling the pain, and regaining function.

RNOTODAY, BSN, RN · Mar 30, 2017

I'd like to add: to the RNs who have, say, a post op addict... the acute care setting is absolutely NOT the time to try to " fix" them , or make them " less" addicted, or most certainly withhold a pain med, or give it late. You are not a substance abuse counselor, an addictionologist, or even an MD for that matter . If they have an order ? Whether you agree or not? You GIVE it... with a smile and the same courtesy as the lady in the next room.. do you actually think the doc doesn't know the score ? It's not the time nor the place !!!