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CASTLEGATES, ASN, BSN, RN 7,435 Views

Joined: Aug 27, '09; Posts: 433 (40% Liked) ; Likes: 490

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  • Oct 15

    Recommending we withdraw care on a patient we flogged for about 2 mos, weeping edema, poor cardiac output, exuding odor from browned extremities, infections in every invasive site. We were on the fence, communicating with family but I had enough. Several of us were pushing with ethics and Dr's to call it and withdraw care.

    This very man returned, walking into our unit bringing all of the staff a nice lunch tray 6 months later, thanking us for saving his life and never giving up. I quietly slipped off to the bathroom and doubled over, gagging. I couldn't eat! I couldn't believe what just happened. I felt so undeserved of the very air he was breathing. I felt incredibly small.

  • Aug 22

    I give everything and anything TOGETHER for these people who are in the throes of withdrawals. It's only for a few days, 'till their system clears. None of those meds mentioned are addictive, or they would be scheduled meds. It's amazing the stuff people can write and not be questioned. Phenergan is not addictive! Hydroxyzine isn't, either! Please look it up and recheck abuse statistics. Better yet, study and take the CARN exam! Make it your business to UNDERSTAND addiction, not treat it as a moral deficiency.

    I slam them with everything my judgement allows, because after all, they're not my own personal supply of meds (so why act like it)? Why be so stingy with them? We recently had a nurse FIRED for not doling out meds as ordered and requested. It's not my job to try to talk them out of their PRN's. Addictions nursing is a field for the very few who truly understand the disease of addiction. Others should move to straight psych wards. Many get into hot water for not giving meds as prescribed and requested (that's a dangerous game with your license being played). Our nurse who was fired did not give the meds the patients were requesting that the providers were ordering! If they say they're sick, then they're sick. The old saying that addicts are bad goes against the very fact that addiction is a diagnosis, not a moral deficiency (so don't treat them by controlling them; work with them)!

    Imagine throwing someone in jail (who has diabetes) for eating a cookie because they had a craving for one! It's just that simple and these meds are there to reduce cravings, help them sleep or feel more relaxed so they can cope. It's a horrible disease and you want to keep them there so they don't leave AMA and potentially die (relapse is a dangerous time when they may, or may not make it back). The reason they don't add other diagnoses for ANYONE in the throes of withdrawals are because withdrawals can mimic schizophrenia, panic disorders, phobias, bipolar, and explosive disorder. We, as med nurses can't expect to "fix" them by controlling what they take in the moments we interact with them. Why not give Trazodone and a little this and that? Why not give a couple, or a few meds at a time? I throw meds at these guys 'till the cows come mooing home and they appreciate my efforts to helping them feel comfortable. Upon admission, I go through their list of meds with them, discuss what effects each of them have, then we decide on what's most likely to snow them (if they're opiate addicts and it's night time). If an ETOH addict is uncomfortable, I throw benzo's at them to stay ahead of the game, so I'm not chasing withdrawals (I'm more careful with the ETOH and benzo's, though but I always stay ahead).

    The nurse who was fired was investigated by the board and found guilty of playing this dangerous medication withholding game. If it's ordered and the patient requests it and the patient says they're having symptoms (the kind we cannot see), then that's a legal basis for a complaint and a case. Anxiety isn't fun, neither is addiction or withdrawal. If I were uncomfortable, I'd play whatever games I had to, in order to gain some relief! It may turn into a game of getting through the med nurse-barrier between me and the meds my prescriber ordered. If I'm comfortable, then I'm more likely to be precontemplatiive about addiction versus sobriety. That's where I need them to be.

  • Jul 5

    if they've had it before and the same dose as before, slam it within the hosp policy or your guidelines and be done. Hospital admissions where the treating diagnosis is not addiction; nurses have no standing to try to treat and control narcs if a patient is in pain. Hanging it in an IV? I'm happy I'm not there!

    If I'm in pain, give it to me over a minute or slam it or whatever...who cares?

    So they get a high feeling at first; big deal. That's what narcs do!

    Hanging it in an iv to avoid a high is an asinine policy. Push it and watch em and if they get a high feeling, you know it's working. Treating addicts is no big deal if you know how to deal with them but it's apparent the label has more power than reasonable treatment. My guess is a place like that is weaning them day one postop if they've got a tolerance. When it comes to pain relief, I don't mess around. If they say they're in pain or an addict that's in pain (addicts have pain, too) then I don't delay, give whatever it takes within the standing and scheduled orders enough to stop their voicing pain. It's soooo easy!


    If they need to address their addiction it will be initiated by them when the time is right and that's where I come in. Post acute admission is the time to address their addiction. Controlling narcs like control freaks in a physical acute setting WILL create more anxiety and therefore more pain. They should read the pain control guidelines. Pain is subjective but when they're obviously calmed, they bother me less then on discharge day we can address their plan for addiction treatment and instruct them how to wean down at home before addiction treatment.

  • Jun 30

    Their first impression will be when you walk into their office, and it's nursing not HR you need to impress to get hired (unless you're new to the field and can't read people terribly well). Rather than doing all the things suggested by a brand new nurse, change your name on your social media accounts to a nickname. Case closed. No HR at any hospitals Ive worked at have made any hiring decisions based on a FB account. (it was a new nurse that wrote the article, most likely reading articles online versus interviewing the hiring deciders themselves--none of it mentions anything about actual hiring decisions, so I don't see any real valid points).

  • Jun 3

    I give everything and anything TOGETHER for these people who are in the throes of withdrawals. It's only for a few days, 'till their system clears. None of those meds mentioned are addictive, or they would be scheduled meds. It's amazing the stuff people can write and not be questioned. Phenergan is not addictive! Hydroxyzine isn't, either! Please look it up and recheck abuse statistics. Better yet, study and take the CARN exam! Make it your business to UNDERSTAND addiction, not treat it as a moral deficiency.

    I slam them with everything my judgement allows, because after all, they're not my own personal supply of meds (so why act like it)? Why be so stingy with them? We recently had a nurse FIRED for not doling out meds as ordered and requested. It's not my job to try to talk them out of their PRN's. Addictions nursing is a field for the very few who truly understand the disease of addiction. Others should move to straight psych wards. Many get into hot water for not giving meds as prescribed and requested (that's a dangerous game with your license being played). Our nurse who was fired did not give the meds the patients were requesting that the providers were ordering! If they say they're sick, then they're sick. The old saying that addicts are bad goes against the very fact that addiction is a diagnosis, not a moral deficiency (so don't treat them by controlling them; work with them)!

    Imagine throwing someone in jail (who has diabetes) for eating a cookie because they had a craving for one! It's just that simple and these meds are there to reduce cravings, help them sleep or feel more relaxed so they can cope. It's a horrible disease and you want to keep them there so they don't leave AMA and potentially die (relapse is a dangerous time when they may, or may not make it back). The reason they don't add other diagnoses for ANYONE in the throes of withdrawals are because withdrawals can mimic schizophrenia, panic disorders, phobias, bipolar, and explosive disorder. We, as med nurses can't expect to "fix" them by controlling what they take in the moments we interact with them. Why not give Trazodone and a little this and that? Why not give a couple, or a few meds at a time? I throw meds at these guys 'till the cows come mooing home and they appreciate my efforts to helping them feel comfortable. Upon admission, I go through their list of meds with them, discuss what effects each of them have, then we decide on what's most likely to snow them (if they're opiate addicts and it's night time). If an ETOH addict is uncomfortable, I throw benzo's at them to stay ahead of the game, so I'm not chasing withdrawals (I'm more careful with the ETOH and benzo's, though but I always stay ahead).

    The nurse who was fired was investigated by the board and found guilty of playing this dangerous medication withholding game. If it's ordered and the patient requests it and the patient says they're having symptoms (the kind we cannot see), then that's a legal basis for a complaint and a case. Anxiety isn't fun, neither is addiction or withdrawal. If I were uncomfortable, I'd play whatever games I had to, in order to gain some relief! It may turn into a game of getting through the med nurse-barrier between me and the meds my prescriber ordered. If I'm comfortable, then I'm more likely to be precontemplatiive about addiction versus sobriety. That's where I need them to be.

  • Feb 22

    Recommending we withdraw care on a patient we flogged for about 2 mos, weeping edema, poor cardiac output, exuding odor from browned extremities, infections in every invasive site. We were on the fence, communicating with family but I had enough. Several of us were pushing with ethics and Dr's to call it and withdraw care.

    This very man returned, walking into our unit bringing all of the staff a nice lunch tray 6 months later, thanking us for saving his life and never giving up. I quietly slipped off to the bathroom and doubled over, gagging. I couldn't eat! I couldn't believe what just happened. I felt so undeserved of the very air he was breathing. I felt incredibly small.

  • Feb 21

    Recommending we withdraw care on a patient we flogged for about 2 mos, weeping edema, poor cardiac output, exuding odor from browned extremities, infections in every invasive site. We were on the fence, communicating with family but I had enough. Several of us were pushing with ethics and Dr's to call it and withdraw care.

    This very man returned, walking into our unit bringing all of the staff a nice lunch tray 6 months later, thanking us for saving his life and never giving up. I quietly slipped off to the bathroom and doubled over, gagging. I couldn't eat! I couldn't believe what just happened. I felt so undeserved of the very air he was breathing. I felt incredibly small.

  • Feb 7

    I give everything and anything TOGETHER for these people who are in the throes of withdrawals. It's only for a few days, 'till their system clears. None of those meds mentioned are addictive, or they would be scheduled meds. It's amazing the stuff people can write and not be questioned. Phenergan is not addictive! Hydroxyzine isn't, either! Please look it up and recheck abuse statistics. Better yet, study and take the CARN exam! Make it your business to UNDERSTAND addiction, not treat it as a moral deficiency.

    I slam them with everything my judgement allows, because after all, they're not my own personal supply of meds (so why act like it)? Why be so stingy with them? We recently had a nurse FIRED for not doling out meds as ordered and requested. It's not my job to try to talk them out of their PRN's. Addictions nursing is a field for the very few who truly understand the disease of addiction. Others should move to straight psych wards. Many get into hot water for not giving meds as prescribed and requested (that's a dangerous game with your license being played). Our nurse who was fired did not give the meds the patients were requesting that the providers were ordering! If they say they're sick, then they're sick. The old saying that addicts are bad goes against the very fact that addiction is a diagnosis, not a moral deficiency (so don't treat them by controlling them; work with them)!

    Imagine throwing someone in jail (who has diabetes) for eating a cookie because they had a craving for one! It's just that simple and these meds are there to reduce cravings, help them sleep or feel more relaxed so they can cope. It's a horrible disease and you want to keep them there so they don't leave AMA and potentially die (relapse is a dangerous time when they may, or may not make it back). The reason they don't add other diagnoses for ANYONE in the throes of withdrawals are because withdrawals can mimic schizophrenia, panic disorders, phobias, bipolar, and explosive disorder. We, as med nurses can't expect to "fix" them by controlling what they take in the moments we interact with them. Why not give Trazodone and a little this and that? Why not give a couple, or a few meds at a time? I throw meds at these guys 'till the cows come mooing home and they appreciate my efforts to helping them feel comfortable. Upon admission, I go through their list of meds with them, discuss what effects each of them have, then we decide on what's most likely to snow them (if they're opiate addicts and it's night time). If an ETOH addict is uncomfortable, I throw benzo's at them to stay ahead of the game, so I'm not chasing withdrawals (I'm more careful with the ETOH and benzo's, though but I always stay ahead).

    The nurse who was fired was investigated by the board and found guilty of playing this dangerous medication withholding game. If it's ordered and the patient requests it and the patient says they're having symptoms (the kind we cannot see), then that's a legal basis for a complaint and a case. Anxiety isn't fun, neither is addiction or withdrawal. If I were uncomfortable, I'd play whatever games I had to, in order to gain some relief! It may turn into a game of getting through the med nurse-barrier between me and the meds my prescriber ordered. If I'm comfortable, then I'm more likely to be precontemplatiive about addiction versus sobriety. That's where I need them to be.

  • Dec 10 '17

    I agree. If she felt it right to withhold, then that's her professional judgement at the time. Education is another thing; judgement from knowledge-base, where the RN was at the time, with the tools she had at her disposal, is the key (and the quality the hospital expects via training). It's not her fault...I like it when they put the onus on us (personally); it forces me to make it my business to learn my specialty. After all, patients come to hospitals 'cause they need nurses (not MD's). This is our time--things are changing. Not so long ago, there were no specialty certs. Mark my words, APRN's will be doing surgery within the next 20 years or so. Remember when Doctorate's were PhD's, now they're practice DNP's? We're moving into the fast lane, so buckle up! I worked in an ICU that leaned heavily on RN's...We did all Hosp codes w or w/o MD's; tons of things other hospitals (I later learn) wouldn't fathom leaving up to RN's. I do understand places can vary, just like experience.

    Acute withdrawals {which I was assuming they were in--(again assuming also they were in a hospital type setting)} for me, isn't the time to wean. I try to keep 'em there, keep em comfy, so once they're out of acute withdrawal, we can deal with the PAWS and really "talk." It's not easy understanding addiction, what makes a difference (a real difference), and what's just a treatment nuisance. It's hard not buying into the "bad addict" thinking. I stick to acts that will make the difference, allowing meds they want because after all, it is THEY who need to make the decision. I can't force 'em (it will never work, anyway). My one or two petty things won't "fix" an addict. It's deep within, where they change. I try to connect with that part, soon as I can. I love the manipulative one's (especially when I'm suckered) Every once in a while they get me & I've got a big S on my forehead keeps it fun & interesting!

    I can't understand how phenothiazines could be (physically) addictive...I wouldn't know those withdrawal symptoms (or treatment thereof), if I was hit in the face with 'em Anything, including ibuprophen is psychologically addictive, however.

  • Oct 31 '17

    1. Go to 12 step meetings and learn everything you can. You must be able to associate with how they're feeling in order to be effective. Read and watch videos, including relapse prevention. Most places about half the staff are in recovery but the other half has taken it upon themselves to understand addiction. I'd say most likely those interviewing you will be in recovery (if I were a gambler).

    These units will be chaotic and staff will be off kilter so you need to appear as the stabilizing force. If you've got issues, they will be exposed by patients and staff over time. But it's all good! One happy dysfunctional family!

    I wouldn't worry about what to say or do to get the job; either you're a good fit for them or you're not. Just relax and be you! Rarely have I met an addictions NP who didn't walk on water.

    Oh..the pay; they're likely not playing around with that! It pays well because addictions NP's are highly sought. Pretend the pay doesn't excite you at all if it's that high (don't squash a blessing in the making).

    Finally- Pt's are rarely violent; more often they run out for a drink or a hit or something (unless you have something to do with their life...reporting to a PO, jail, etc). Go with your gut; it's like any other psych NP job or rotation you've had. Basically they're adults stripped down to babies because what helped them function is gone and their skin is super sensitive to anything you do or say. Pretend they've all got PMS x100 and that will make sense.

    Again, you're at a huge disadvantage if you don't know about the 12 steps and can redirect them to do xyz when they act out, worry, obsess, etc. That's the most powerful tool I've found. When they stress, act, react, I say stuff like "Stress is worrying about what might or might not happen...so what's happening at this moment?" "We're talking in the hallway; that's what's happening right now...one day at a time, one minute at a time and let tomorrow worry about itself, you worry about your recovery and everything will fall in place as it's meant to be...come on, you know that already, why are you listening to me?"

    Sounds silly but it works every time. "First things first" "One day at a time" "When in doubt, do nothing" "The therapeutic value of one addict helping another is without parallel" "Insanity=repeating the same thing expecting different outcomes" "Addiction=continuing the same behavior despite increasingly negative consequences" (tell them to get and call their sponsor)...blah blah blah!

    Little sayings will trigger hours of discussion, education or memories and you save yourself a lot of time!

    That's just me, though! Turn it over; Pray and let the rest go! you'll get the job if it's meant for you. If you turn it over and don't let go, you're upside down!



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