I didn't become a nurse to feed people's addictions. Do *nurses* have the right to refuse

[Thankgodforativan]

(Disclaimer: So this turned out to be longer than I thought it would, and a bit of a rant. Sorry! But I think this is something that's relevant to all of us).

Some background: I work in a combined med surg ward, so we see a bit of everything. We have a young-ish girl, in her twenties, that has a VAC dressing in her leg following very deep self harm about two weeks ago. Her drug use has also given her 'meth mouth', and she's had at least one tooth removed about a week ago as well.

The issue is that she has a personality disorder, a history of aggression, is a known drug seeker and has had to have her VAC replaced twice now because she keeps sabotaging it - picking at it, poking and playing with it. Before it was put in she was seen physically pulling the edges of the wound apart with her hands also. She demands morphine roughly every hour for "ten out of ten" pain even though you can clearly see that she's not distressed in any way. She is charted for PRN morph and fentanyl, subcut (not allowed to have a cannula).

We always hear about the patients right to refuse; surely nurses have some way of objecting in a situation like this? Panadol (Tylenol), anti-inflammatories and endone all "don't do anything", even though it barely gets to two minutes after giving these before she buzzes and asks for "something better".

It's ridiculous; the patient knows she's playing us for fools and has said as much. Surely there comes a point where enough is enough and we stop giving in to people, especially people who don't want to help themselves. No wonder the state health system I work in is broke; It frustrates me to no end when we can't even afford more then one obs machine on the ward between thirty two patients, yet we will hand out expensive treatments to people who clearly don't want to get 'better', and dole out morphine like it's soda.

I know we need to cover pain relief somehow; I'm aware that vac dressings can be painful. But it's not like she can say we're not giving her anything at all. What are our options here? I'm not the only one with the same concern.

Sincerely, nurse who didn't become a nurse to be a drug dealer.

*edited for spelling.

[CanadianRN2017]

Her pain is whatever she says it is.... Also, being an addict gives her a much higher tolerance for many pain Meds we administer. We are not judge/jury, we are patient advocates... Unless it would be medically unsafe, the pt needs to receive the prescribed Meds. As an advocate you can request psych, SW, evaluations, and make sure the PCP is aware, but always advocate for your pts....

😞

[CanadianRN2017]

Thanks to everyone who replied, but I'm done with this thread. I hoped to actually have a reasonable discussion, but I can see that just isn't possible here.

But it actually has been reasonable, and it is good that you posted as I am sure many others have the same thoughts. 🤕

[Ellie G]

No you don't have the right to refuse. That would be disobeying a doctor's order. This patient has a severe mental illness. Self harm usually is a result of extreme physical or sexual abuse as a child. It is a very difficult thing to treat. I've known people to take it to incredible extremes that resulted in death. I get where you are coming from that you don't want to feel like you're feeding an addiction but this is not the issue here. The issue is that you have a doctor's order and that the patient's pain is not being felt by you.Pain is whatever the patient says it is. Is she having negative side effects? If you truly believe that what you're being asked to do is not ethical then you should speak up in an appropriate manner by taking it to your supervisor or ethics person.

[Rose_Queen, BSN, MSN, RN]

No you don't have the right to refuse. That would be disobeying a doctor's order.

Actually, nurses do indeed have the right and responsibility to "disobey" provider orders when they are not safe. It's really a requirement of prudent practice. Nurses aren't subservient and required to "obey".

However, OP is in the wrong- pain meds should not be held unless the patient's condition warrants it.

[HS2211]

Ive been a nurse for 8 years and im a proud believer of exhausting all other options before giving PRN narcs. Routine i have to give as per order, but PRN's are a different story. We were taught more than pill passing in nursing school. Use your nursing judgement.

[DogWmn]

Their pain is what they say it is, as nurses we are their to care for them not to judge them

[adoyo]

Read all about comments relating to morphine and the likes being demanded by patients as prescribed or a bit more often than prescribed! My practice, as has been mentioned by others, is to give as prescribed, meanwhile, trying to health educate the patient on cosequenses related to drug abuse and discuss the behaviour with the prescriber too. Never refuse to administer medication because you think someone is playing tricks on you! Mind your professional ethics!í ½í¸Ž

[adoyo]

Their pain is what they say it is, as nurses we are their to care for them was grossly swollen since the medication haf gone into d tissues!! Unfortunately I was not in a position to sue her, being in Africa, where suing hardly exixsts!!�� not to judcge them

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I was once told by a nurse administering an ivi on me that my pain was psocho logical! I nearly slapped her on her face as d pain was real and at d end of it , my hand was grossly swollen since the medication had gone into the tissues!!! Unfortunately I was not in a position to sue somebody, being in Africa where suing for such hardly exists!í ½í¹„

[emcadams]

In this situation I would tell the primary that the patients pain is still reported as 10/10 despite giving med as ordered and specifically ask for pain management. In my experience, they will put them on something oral q4 or q6 hours, and take all that other crap off the MAR. Also, if patients are eating and drinking normally, and have not just undergone a significant surgery, there is no need for IV pain medication. Doctors need to stop prescribing IV pain meds when oral can be given. Same with IV vs oral antibiotic. If they need continued IV antibiotic, they should have infectious disease on board.

[skylark, BSN, RN]

So here is another question along the lines of the first one, interested to hear your take on it.

22 year old male, calls an ambulance EVERY NIGHT for sickle pain. Has never shown up for any appointment we make him for sickle clinic or pain management, so has never been formally diagnosed, and his retic count is normal every time.

Demands a stat shot of Dilaudid, then a second an hour alter and then 2 norco and then he skips out.

Returns for the same routine - every - - - darn - - - night.

If not our ER then one of the others in the city, he seems to rotate around, but the ambulance service say that they transport him every evening.

Being a large ER he can see a different doc every night of the week, and communication regarding frequent flyers is non-existent here, both in this dept and between other ERs.

Bear in mind also that he is on his cellphone the entire time, and that non-verbal signs of pain are not present, he is too busy watching netflix to discuss his medical needs.

He gets medicated on the basis that the pain is what the patient says it is.

So do we carry on like this, or do we refuse to treat him until he has been to clinic?

Answers please, this should be fun!

[Wuzzie]

So here is another question along the lines of the first one, interested to hear your take on it.

22 year old male, calls an ambulance EVERY NIGHT for sickle pain. Has never shown up for any appointment we make him for sickle clinic or pain management, so has never been formally diagnosed, and his retic count is normal every time.

Demands a stat shot of Dilaudid, then a second an hour alter and then 2 norco and then he skips out.

Returns for the same routine - every - - - darn - - - night.

If not our ER then one of the others in the city, he seems to rotate around, but the ambulance service say that they transport him every evening.

Being a large ER he can see a different doc every night of the week, and communication regarding frequent flyers is non-existent here, both in this dept and between other ERs.

Bear in mind also that he is on his cellphone the entire time, and that non-verbal signs of pain are not present, he is too busy watching netflix to discuss his medical needs.

He gets medicated on the basis that the pain is what the patient says it is.

So do we carry on like this, or do we refuse to treat him until he has been to clinic?

Answers please, this should be fun!

Not my meme so I'm not responsible for the spelling but the sentiment's the same.

[adoyo]

Pain relief relies soley with the prescriber and nurses can only observe and report their observations t the prescriber to consider an a propriete action- end of the story!