migraine faker at the ED!

Specialties Emergency

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Last Wednesday I encountered the reason for the sometimes crappy treatment I get in the ED concerning my migraines. I actually met a real life in the flesh migraine faker!:( :

I was waiting in the Ed waiting room, waiting for my boyfriend to get off work, and noticed a couple sitting across from me. They were chatting happily, laughing and pigging out on candy bars and chips and cokes. I noticed the hospital bracelet on the girl and after about 10 minutes, I couldn't help myself.... I asked her what brought her to the ED at 3:00 in the morning. She looked at me and says..."Migraine"

I'm in shock at this point but then I get angry!:eek:

I say" YOU have a migraine and you can EAT and DRINK? Isn't the light bothering your eyes? You do NOT have a migraine and you know it!"

I turn away disgusted. Well....guess what...she goes into "migraine mode". Gone are the chips, the chocolate and the cokes, and out come the dark sunglasses, the cold ice pack and she puts her head down on her boyfriend's shoulder and starts to grimace in "pain" :confused:

I start laughing out loud. :chuckle I could not believe it! I still can't!

I have to drag myself into the ED, feeling half dead, wishing I was, and I get the red flag because the staff encounters people like this girl!

When I finish nursing school I want to work in the ED and I'm guessing I can't do what I did Wed, but I think I'm going to have a hard time keeping my mouth shut.

Honestly, I never quite understood how the cynicism towards migraineurs came about until now. Another part of me can't see how the real thing can be confused with these obvious cases of faking it. A dilemna that shouldn't exist I suppose.

How do you handle people like this? Can you get your license taken away?

Cathy

"the point is...as nurses, it's not up to us to make that call if someone is a drug seeker or not...that has been made clear to us in school and in clinical.

do the assessment, give the information (verbal and non-verbal to the doctor), let them make the decision and just let it go!"

i have to agree with traumanursern, if you are just blindly following md's orders you need to go back to school! i work with a great bunch of intelligent docs, but they make mistakes all of the time, i do not work for them, and it is my license on the line if they screw up. your whole outlook is one of the reasons the er/drug seeking problem has gotten to the magnitude that it has. also.. almost none of the crap that i learned in clinicals and in school have i ever used once since becoming a real nurse, experiences is what make you an expert. you can always tell who has real er experience and who doesn't

"and yes sometimes it is too much to bear and does require stronger meds to knock it out. i have been in so much pain they took me back without any wait. this due to the fact my bp was 170/110 and pulse 175. my bp is usually 100/60. and we the migraine suddenly appears, i always have auras, it could be a sign of something more serious happening."

if you came into to my er with those vitals signs we would draw up adenosine and put pacer pads on you just in case we had to treat your psvt, but no, you still wouldn't get any narcs. i have never had anyone with a migrane with a pulse that high. i don't think i've ever had a neurostorming pt. with a pulse that high, only cardiacs, severe pain caused by traumas, etc... 99% of migrane sufferers have auras-still not an emergency, and no the neuro guys will not find anything more serious if you don't go to their office instead of just seeking drugs when they occur. with those vitals it sounds to me like you were really upset about having to wait so long for you narcs/phenergan. oh yeah, that's were i've seen pulses that high-people in withdrawals.

and as i have said many times in all of the other migrane post-i do get them about 1 a year-they are excruciating, but i haven't taken a narc yet, or gone to the er ever, and i have always managed to finish my shift even, the people who are having emergencies need me. why would i seek treatment? sometimes people just don't understand, especially if they do not work in the er, we wear our big girl panties there.

have you been diagnosed by a neurologist, or just assume do to the presentation? if you can work thru a migraine, i would suggest you dont have one.....and your insulting crack about withdrawl was totally unnecessary

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Specializes in Peds.
"

"and yes sometimes it is too much to bear and does require stronger meds to knock it out. i have been in so much pain they took me back without any wait. this due to the fact my bp was 170/110 and pulse 175. my bp is usually 100/60. and we the migraine suddenly appears, i always have auras, it could be a sign of something more serious happening."

if you came into to my er with those vitals signs we would draw up adenosine and put pacer pads on you just in case we had to treat your psvt, but no, you still wouldn't get any narcs. i have never had anyone with a migrane with a pulse that high. i don't think i've ever had a neurostorming pt. with a pulse that high, only cardiacs, severe pain caused by traumas, etc... 99% of migrane sufferers have auras-still not an emergency, and no the neuro guys will not find anything more serious if you don't go to their office instead of just seeking drugs when they occur. with those vitals it sounds to me like you were really upset about having to wait so long for you narcs/phenergan. oh yeah, that's were i've seen pulses that high-people in withdrawals.

i know you did not just accuse me of being in withdrawals. :madface:and your so smart, yes they did put cardiac pacer pads on and got the crash cart. it's called pain! and again, i have been seeing a neuro! he was at the hospital i went to. he is the one who told me to go to the er, if i ever had a migraine lasting over 72 hours! i'm not a drug seeker and it is "nurses" with your beliefs and attitude, who give patient who are legit a hard time.and in turn give the hospital a bad name. oh but don't worry, we reported my "wonderful" nurse and because it was not the first time a complaint was filed she was...relieved from her duties. :D:d:d

by the way, it is more likely you would have a stroke while having a migraine, which was the concern!

your also so smart, i told you what they gave me demerol and phenergan. i would have been just as happy with tordal. a nsaid, not narc! it works, too!

you are there to help and treat patients, not pass judements.

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Specializes in NICU, Post-partum.
i don't know how you assess but when i assess someone i always ask if they have been seen and treated by their primary physician. it's information our physicians like to know, and myself frankly. so when a patient comes in with complaints of pain, i ask what remedies they have implemented and if there was relief, etc. it's even part of the pain assessment check off in computerized charting. so...the point with my question was part of the pain assessment we do at my er...

if the nurse cannot assess whether someone is a drug-seeker based on their assessment skills and the answers they receive during the assessment, and all the other reasons listed in all of the previous posts then why the heck do an assessment at all? why don't we just stand outside of the er doors and pass out meds based on any given complaint.

as so many have said prior...... migraines are non-emergent complaints. my question inquiring if she had contacted her pcp was a valid one. nurses are like detectives sometimes. you have to ask certain questions to get answers that provide you with the whole picture. it's not enough to say the patient has chest pain but rather the pain began _, it's nonradiating_, it's rated a _ on the pain scale_, and so on. if you weren't taught that in your nursing school or during your clinicals, that's sad if you ask me. asking the patient if they have been seen and treated by their pcp is part of the assessment.....maybe you missed that day in class or something...:chuckle

granted, i do ask these questions...i was simplifying in the process, but the end result is the same...but you don't make a judgment call...that is why physician's make the big bucks...you can't override a decision to not give pain meds if the physician has determined that the patient does have pain unless there is a medical (life compromising) reason to do so...that is why i don't understand why you are taking it so personally.

you do perform the full assessment...both verbal and non-verbal, if the patient has a pcp, tell the er doctor. if they don't have "classic" sx, then that is something you report too. if it's an er dr from a different shift and this person has already been known to be a frequent flyer...you tell him that too.

however, you never tell a patient, 'you are not in pain'...'you are not having a migraine' or treat them with disrespect b/c you say or even know they are a drug seeker.

i'm not saying not to do an assessment and not report findings to the physician...but you don't "skew" your assessment either..even drug seekers can come in with a legitamate complaint.

ultimately, my only point is...that isn't your call as a nurse.

however, i totally disagee with you that migraines are not emergent. if i cannot walk without assistance, if i cannot take care of my children, if i cannot take myself to the bathroom without significant pain and it is 10 out of a 10 scale and nothing i have in my med cabinet, positioning, darkness, etc takes the edge off to make it bearable...that is emergent.

just b/c someone is in pain and not going to die from it, doesn't mean that it's not emergent.

why don't you just tell someone that has a shotgun wound or a stab wound in a non-critical area, why don't you just ask them "is it bleeding much? well, if it's not bleeding and you can still move the limb, you probably didn't hit a major vessel...so just be sure to keep it covered and just be sure to call your pcp tomorrow b/c after all, you probably won't die from sepsis between today and tomorrow..but if you run a fever...come on in hon!"

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I KNOW you did NOT just accuse me of being in withdrawals. :madface:And your so smart, yes they did put cardiac pacer pads on and got the crash cart. It's called PAIN! And again, I HAVE BEEN SEEING A NEURO! He was at the hospital I went to. HE IS THE ONE WHO TOLD ME TO GO TO THE ER, IF I EVER HAD A MIGRAINE LASTING OVER 72 HOURS! I'm not a drug seeker and it is "nurses" with your beliefs and attitude, who give patient who are legit a hard time.And in turn give the hospital a bad name. OH but don't worry, We reported my "wonderful" nurse and because it was NOT the first time a complaint was filed she was...relieved from her duties. :D:D:D

By the way, It is more likely you would have a stroke while having a migraine, which was the concern!

Your also so smart, I told you what they gave me demerol and phenergan. I would have been just as happy with tordal. A NSAID, NOT NARC! It works, too!

You are there to help and treat patients, not pass judements.

YOU go girl, lol! and yes she was accusing you of being in withdrawl, and if she takes offence at our calling her on that,,,,WELL she can "put her big girl panties on" and deal....lol

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have you been diagnosed by a neurologist, or just assume do to the presentation? if you can work thru a migraine, i would suggest you dont have one.....and your insulting crack about withdrawl was totally unnecessary

Pain is a subjective thing so suggesting that someone isn't having a migraine because they can work through it, is ridiculous. I still think migraines are non-emergent.....and sitting in triage for 7 hours could have been spent at home in bed with meds prescribed to treat the migraine. And drug seekers/fakers do come in complaining of a migraines. I think this venting ER thread is interesting for sure and you can tell who's worked in the ED, who hasn't and who isn't even in the medical field.

Unless you've walked in an ER nurses shoes....as the saying goes

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Granted, I do ask these questions...I was simplifying in the process, but the end result is the same...but you don't make a judgment call...that is why physician's make the big bucks...you can't override a decision to NOT give pain meds if the physician has determined that the patient does have pain unless there is a medical (life compromising) reason to do so...that is why I don't understand why you are taking it so personally.

You do perform the full assessment...both verbal and non-verbal, if the patient has a PCP, tell the ER doctor. If they don't have "classic" Sx, then that is something you report too. If it's an ER Dr from a different shift and this person has already been known to be a frequent flyer...you tell him that too.

However, you never tell a patient, 'You are not in pain'...'You are not having a migraine' or treat them with disrespect b/c you say or even know they are a drug seeker.

I'm not saying not to do an assessment and not report findings to the physician...but you don't "skew" your assessment either..even drug seekers can come in with a legitamate complaint.

Ultimately, my only point is...that isn't your call as a nurse.

However, I totally disagee with you that migraines are not emergent. If I cannot walk without assistance, if I cannot take care of my children, if I cannot take myself to the bathroom without significant pain and it is 10 out of a 10 scale and nothing I have in my med cabinet, positioning, darkness, etc takes the edge off to make it bearable...THAT is emergent.

Just b/c someone is in pain and not going to die from it, doesn't mean that it's not emergent.

Why don't you just tell someone that has a shotgun wound or a stab wound in a non-critical area, why don't you just ask them "Is it bleeding much? Well, if it's not bleeding and you can still move the limb, you probably didn't hit a major vessel...so just be sure to keep it covered and just be sure to call your PCP tomorrow b/c after all, you probably won't die from sepsis between today and tomorrow..but if you run a fever...come on in hon!"

Plese don't try to tell me how to be a good ER nurse. My question was a question which is asked every minute of every day in very ER around the world if the nurse is worth her skills. Plain and simple....don't insult my intelligence. BTW: I have refused to medicate a known drug seeker and yes the doctor has then canceled the order. You really have alot to learn about the specialty called ER nursing.

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Pain is a subjective thing so suggesting that someone isn't having a migraine because they can work through it, is ridiculous. I still think migraines are non-emergent.....and sitting in triage for 7 hours could have been spent at home in bed with meds prescribed to treat the migraine. And drug seekers/fakers do come in complaining of a migraines. I think this venting ER thread is interesting for sure and you can tell who's worked in the ED, who hasn't and who isn't even in the medical field.

Unless you've walked in an ER nurses shoes....as the saying goes

if you can concentrate sufficiently to do your job, nope, the h/a isnt that bad.....and if you are trying to "bull " thru a shift and arent competent, shame on you....your self righteous attitude is over the top....and i see you didnt address the crack about withdrawl, perhaps you thought better of it? an apology to that poster would be nice

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Specializes in NICU, Post-partum.
Pain is a subjective thing so suggesting that someone isn't having a migraine because they can work through it, is ridiculous. I still think migraines are non-emergent.....and sitting in triage for 7 hours could have been spent at home in bed with meds prescribed to treat the migraine. And drug seekers/fakers do come in complaining of a migraines. I think this venting ER thread is interesting for sure and you can tell who's worked in the ED, who hasn't and who isn't even in the medical field.

Unless you've walked in an ER nurses shoes....as the saying goes

Taking a patient's complaint seriously and being non-judgmental until you have concrete evidence to prove otherwise is BASIC NURSING CARE.

Doesn't matter if you are a student, new grad, ER Nurse, Med-Surg Nurse, etc. Department has nothing to do with it.

Like I said before, you have never had a crippling migraine where the pain is unmanageable...so you really and truly have no idea of what pain like that is like...if you did, then you would call it anything but non-emergent. No one said you had to be pain free, but it should be tolerable.

You also cannot assume that every drug-seeker is not in pain. Do that, and when they really have something wrong--if you are judgmental during the assessment...you'll miss it and that can cost you your license.

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Specializes in ED/trauma.

No, TraumaNurseRN, they are obviously right, and too smart for me, as I have not much evidence or support to back me up (except for the 20+ docs and nurses working with me this am). Now they are talking about how we mistreat the patients complaining of pain- when did we say that? My mouth hurts from forcing a smile all night and tending to everyone's beck and call. What I think about patient's presentations and what are say are totally two different things. Everyone gets equal care from me, regardless of what I really think about them.

I have also many times refused to give more pain meds even after an MD has ordered them, we ARE allowed to do that. They just get someone else to give it, then they try and get me to fetch them some narcan a little while later-yeah right.

I have to go I think I'm getting a headache, and in just case anyone was wondering- this isn't even the first time I have been called out today, and it won't be the last I'm sure, thank God us ER nurses have developed such thick skin! Somewhere on this site is another post where there are many ER nurses talking about how they get through a shift when they have a crippling migrane, I am not alone on this one by no means!

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Specializes in NICU, Post-partum.
Plese don't try to tell me how to be a good ER nurse. My question was a question which is asked every minute of every day in very ER around the world if the nurse is worth her skills. Plain and simple....don't insult my intelligence. BTW: I have refused to medicate a known drug seeker and yes the doctor has then canceled the order. You really have alot to learn about the specialty called ER nursing.

Understand, that from a legal sense, a hospital can terminate you for doing just that...not your call. If it was a lethal dose of meds, or would compromise the patient...yes, but not because YOU think they are a drug seeker...that is a medical diagnosis and out of your scope of practice.

How do I know this? Because one of our clinical instructors, when going over this very topic, said, "Don't do what an RN at our hospital did"...the RN there was biased against drug seekers b/c she lost her brother, who was a drug addict, b/c of a local Dr. Feelgood. A "frequent flyer" came in, the doctor ordered IV meds, nurse refused, and she was FIRED.

Union hospital....would not back her up...why? Not her call.

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No, TraumaNurseRN, they are obviously right, and too smart for me, as I have not much evidence or support to back me up (except for the 20+ docs and nurses working with me this am). Now they are talking about how we mistreat the patients complaining of pain- when did we say that? My mouth hurts from forcing a smile all night and tending to everyone's beck and call. What I think about patient's presentations and what are say are totally two different things. Everyone gets equal care from me, regardless of what I really think about them.

I have also many times refused to give more pain meds even after an MD has ordered them, we ARE allowed to do that. They just get someone else to give it, then they try and get me to fetch them some narcan a little while later-yeah right.

I have to go I think I'm getting a headache, and in just case anyone was wondering- this isn't even the first time I have been called out today, and it won't be the last I'm sure, thank God us ER nurses have developed such thick skin! Somewhere on this site is another post where there are many ER nurses talking about how they get through a shift when they have a crippling migrane, I am not alone on this one by no means!

i think the two of you are developing thick skulls as well as thick skins....the later is good, the former is not

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Taking a patient's complaint seriously and being non-judgmental until you have concrete evidence to prove otherwise is BASIC NURSING CARE.

Doesn't matter if you are a student, new grad, ER Nurse, Med-Surg Nurse, etc. Department has nothing to do with it.

Like I said before, you have never had a crippling migraine where the pain is unmanageable...so you really and truly have no idea of what pain like that is like...if you did, then you would call it anything but non-emergent. No one said you had to be pain free, but it should be tolerable.

You also cannot assume that every drug-seeker is not in pain. Do that, and when they really have something wrong--if you are judgmental during the assessment...you'll miss it and that can cost you your license.

What?...now you know I have never had crippling pain? hmmmmm....

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