screamin mimi

Yes, treat all patients with respect but I don't have the luxury of treating all people the same. When I have a waiting room full of patients and two patients walk in with the same complaint, I have to make a decision who gets seen first and who gets a room (a very precious thing in my busy ed). Who gets the ekg first, the 85 yo man with cp and sob or the 35 yo man that's been here 3x/ week for 6 months or more. Limited resources and staff mean we have to prioritize.

We obviously need to change our policy. This was the 2nd time this patient did this. I knew of the first time(well documented) and informed the doc who required the patient call a cab. the patient called the cab and then walked right past it,got into his vehicle and left. I informed the doc and the police were called. Is this enough for us to stop his supply? I hope so but I'm not holding my breath! Anyway, sorry, I know this is off topic but I am wondering what will happen to me if I refuse to medicate him the next time. BTW-- this is person who has been in my ED more than once a week for many many months always for "chest pain" which, when he gets pulled back for his EKG is clarified as chest wall pain from "moving a piano" or some other trauma, so he avoids the cardiac workup while getting seen quickly, while everyone else waits. yep, i have a problem with this.

Haven't noticed anyone calling you names or suggesting anything about you as a professional so I'm not sure why you think you are being flamed. And I really didn't think you were referring to me, in particular, with your previous post. I do think you were addressing ER nurses collectively when you suggested that we treat patients "like trash." And that is what I take exception to.

animal1993- It really sucks that the nurse who was supposed to care for you assumed you were a seeker for no reason except that you had a headache (?) HOWEVER No one has advocated treating anyone "like trash" and if you read the previous posts you will see that most take great pains to treat even our more frequent visitors with respect. Again, we are trying to discuss the very real problem (or predicament!) of people abusing the system in order to secure their fix. They do exist and it is a problem. Frankly, I'm getting tired of being told I'm a bad nurse because I'm pointing out a simple reality in most ERs. You have no more right to assume this about me than that nurse who treated you badly did in her assumptions about you.

Oh, I bet ya Florence Nightingale would've practiced some "tough love." The most consistent thing written has been that those abusing the system are taking our energies away from those who really need it. I'm not sure how anyone can take exception to this. I have empathy for those who are suffering which is exactly why I get annoyed with the overly dramatic drug seekers who divert my attention away. Also, this thread is not actually about you personally. Try not to take it as such.

Congratulations! I think you're getting lots of great advice already. I'll add a few and I'm sure reiterate some. It might sound silly but get some good shoes! You'll be on your feet a lot. If you don't already, start exercising, it isn't mandatory but you'll see that while we aren't all svelte, ER folks are generally a bit lighter than our peers. It's because we don't get a lot of down time, we're always moving! Exercising will also be a great way to burn off the inevitable stress that you'll have. Which reminds me: Never come to the ER without food! Bring real food but also healthy quick snacks, like fiberone bars, string cheese, that kinda thing. It's easy, especially when you're new to skip eating. Try not to but when it happens snacks will save you. Wash your hands! You know this but make it a practice. Do it while you're introducing yourself. It might feel rude or awkward to have your back half towards the patient while introducing yourself but they'll appreciate seeing you do it more than you know. Watch your sharps! Like handwashing, this is one of the things that is best to do like they teach it in school. We don't always do it but we really should. Ask questions, of nurses, techs, docs and housekeeping. We're all a team and every job is vital to patient treatment and flow. When a patient dies it's okay to cry. But it's also okay to laugh, joke, whatever you need to do. You'll hear people say stuff you might not appreciate. They aren't bad, just coping their way. Look up medications you don't know before administering them. You'll know them soon. And if a medication order looks strange. Don't give it. Ask the Doc who ordered it. They make mistakes too. ALWAYS check blood pressures before and after narcotics especially in LOLs. Don't learn this the hard way like I did! Check armbands and lab labels, even if you've been with the patient for hours. You get tired, pick up two labels and mistakes happen. If/when you make a mistake, own up to it and find out how to fix it and how not to do it in the future. HAVE FUN!

I don't know if I'm willing to totally give up! I mean, realistically, I think you're probably right that this is a problem that won't be resolved . Increasing access to PCPs could help, maybe education could help, though I'm less hopeful there. I think getting rid of the patient as "customer" mentality and re-educating some our docs on what EMTALA actually requires might help more. A lot of docs, many that I consider otherwise competent clinicians and good people, when asked why they're giving the 6th scrip that month for a frequent visitor, answer "it's just easier." Well, that's just not a good answer!

is it that you just do not accept that there are any people who misuse the er for narcotics? also, i thought you were funny scooty puff jr. as a general rule, to the original poster, treat all your patients with respect but feel free to laugh, joke and curse when you need to. there is nothing wrong or even unusual about occasionally feeling resentful of the people who take your time from those you feel truly need it. at the same time, never let that patient feel your resentment, because you never know what someone else is going through. i only have one "frequent flyer" i will not tolerate and that is because he gets in his car and drives after i give him im dilaudid (no, not with the largest bore needle i can find after wiping it down with alcohol) self-destruction is one thing, but i don't want to help him kill some innocent family out for a sunday drive.

Name calling is really not helpful or appropriate. No one has argued that peoples' pain should not be treated only that we shouldn't feed addictions where they exist. Absolutely, there are people who are labelled drug seekers unfairly. It's unfortunate that you feel you are in that group. But there are, in reality, actual people who misuse the emergency dept to acquire narcotics. Some do so because they are addicted and others for distribution in the community. (Yes, I am making assumptions but as I'd hoped to illustrate with the "duck" metaphor it is based on a reasonable examination of the facts.) We are only helping those people self-destruct (although we might include their families as casualties) by supplying them their drug of choice. "Ratched" does have a certain ring to it, though...

Yes, actually they do teach the definitions of tolerance and addiction in nursing school. They also teach (for those who haven't picked it up from mere observation) that "if it looks/walks/quacks like a duck" it might be a zebra but it's probably a duck. Nitpicking aside, Virgo's point is valid.

Please. Just because someone is frustrated with the VERY real problem of drug seekers in the ER does not mean they shouldn't be working in the ED.In fact, I'd argue that it's irresponsible to council our new nurses to ignore the issue and their own instincts for some pollyanna world view. Nursing should be patient advocates. However, truly advocating for a patient does not mean that we give them whatever they want, especially if what they want can (and will) hurt them. The attitude du jour of the "patient is always right" came out of a right-minded effort towards patient empowerment and education but has gone too far. The patient is not always right. We are medical professionals and as such we are obligated to do what is right for the whole patient. And sometimes that means saying "no."