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Discussion

Humph!

Just venting. Yes, I know, it's part of our ethical boundaries to not pass judgements on patients.. But some shifts, especially trying when it seems like a whole group of individuals show up together with the same situation.. I don't like dealing with the ethical struggle that comes with this particular area of nursing.

Tonight's theme was long documented history of active heroin use.. Work up negative.. All requesting and getting ordered the iv dilaudid/Benadryl combo.

You have providers who will give a pt whatever they ask for for no documentable medical reason. I struggle with this because I feel like I'm doing something wrong.

I'm not judging the patient and their personal struggle. I know addictions and dependence are real.. I struggle because I feel like I'm not helping the patient. I just became so frustrated tonight. I don't like feeling like a drug dealer.

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    I feel like this happens often at my work. You actually explained it perfectly. Sometimes I feel guilty that I get 'annoyed' by it but I'm glad I'm not the only one.

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    I don't feel guilty. We are not helping them by feeding their addiction. Those are the patients who end up face down dead in a ditch somewhere because the hop from ER to ER and get all the drugs they want, plus a bunch of RX to boot.

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    I'm beginning to think maybe finding some prn work at a jail would help polish up my skills in dealing with this. I have several coworkers who do that and they always seem to handle these folks well.

    I tried a different approach last night. While I didn't get an angry response, I was kinda taken back with their reply. I was asked if I treat all my drug addicts like this.

    I tried to be upfront. Let them know I reviewed their chart. This offended them. I told them what meds they were getting and the med was piggybacked. I let them know I was not going to be pushing the meds directly through their cap. Again, I was taken back by their response. This was an admitted iv drug user, attempting to make me believe they didn't understand what pushing the drug directly in their iv meant.

    I understand withdrawal symptoms, especially opiate withdrawal, is painful. What I give them will relieve this discomfort.. But I'm not comfortable medicating someone in such a way to give them that euphoric rush they are craving.

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    Yes there are a lot of crazy patients. No stay in the ER where you will have more experienced nurses there to help you. At a jail it is just you.

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    Trust me a jail will not increase your compassion.

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    Wait a sec, you are treating narcotic withdrawal s/s with Dilaudid? Or are they coming in with abd pain and then ending up with a negative work up?

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    • Author

    It's vague complaints.. Like my thigh hurts. My hand hurts....typically..

    Some do say they have a kidney stone and there's no blood in urine, negative ct.

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    While it is annoying....... I just don't let them zap my energy. I am not going to cure them in the span of the ED. If the MD orders it....I give it. I don't have time to get involved in their drama. If they want the med they will take it the way I give it.

    It is not for me to judge whether or not their pain is real.....it just isn't. The med is ordered I give it, they just suck up all my time. I give them what they want and let them move on....I really don't have time for their crap. I used to think they all called each other and planned to come when the ED was at tit's busiest so everyone could bear witness to their drama.

    I sometimes think it coincides with running low on funds until the next disability check arrives. I worked with a nurse once that said she treats them like a bank robber...just give em the money so they will go away and nobody gets hurt.

    But ethical issue for me? NO....nothing ethical about it......the MD orders it I give it so they can get out of the ED and on to the next ED. What if just that one time they really needed it.....that would bother me as an ethical dilemma....not treating someone's pain because I thought it was make believe and it turns out they really had a legitimate complaint. Delay in treatment would be an ethical dilemma.

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    If the MD orders it....I give it. I don't have time to get involved in their drama. If they want the med they will take it the way I give it.

    exactly. I'm not going to cure them.I will give what's ordered, and if they don't like it , they usually leave.

    I will not push the drug fast. You are not here to get high on my account. I do know that eventually, they will leave/be discharged/leave AMA . This will not be forever.

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    • Author

    THANK YOU! That's what I needed to hear.

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