Narcotics and resentment

cleback · Aug 23, 2017

I feel like, for one, it's a lack of options besides narcotics. Nonpharmacologic interventions are either not available or too time consuming to be practical (eg massage) and are often limited to heat or ice. And now even heat and ice need a MD order. Secondly, I feel like providers are hesitant to change narcotics, so it's a struggle to be a patient advocate at times, particularly if it's the middle of the night and you have to call the oncall. Thirdly, I feel like health professionals do a poor job managing expectations. I feel like patients expect zero pain, which isn't realistic. Perhaps the expectation mismatch also contributes to the providers reluctance to increase doses. as prescribing narcotics gets more regulated, I imagine the reluctance will increase.

In short, there are multiple barriers. Sometimes I feel like the patients get the brunt of the systemic frustrations.

Marisette, BSN, RN · Aug 23, 2017

I think there is a problem with opiate obuse in the country at this time. Recently, the president approved of more funding to address the problem. I work triage, for a large population of "uderserved" patient's. Almost every day, I get calls from patient's asking, sometimes begging for controlled substances. Recently, suboxone clinics were added to our services, and these clinic appointments are filling fast.

I can understand the need for good pain management, and certainly for the terminally and some chronically ill . However, we, the public, often times think that a pill is the answer to every ache, and condition. Some of these medications were intended for short term use and somehow became long term use. Some of our patient's demand the medication stating "its' the only thing that helps my pain" without realizing that obuse may lead to addiction. Some of the insurance carriers now require prior authorizations for pain medication to decrease incidence of addition. Sometimes, patient's who cannot get prescribed pain medications turn to street drugs like heroin as a last resort for their addiction.

It's a difficult balance. Physician's are held accontable for distribution of controlled substance by drug monitoring boards and now many of the insurance companies. I think we are in need of more pain management research and protocols for prescription dispensation because for whatever reason, our current method is not working. As a nurse, I find it frustrating to hear the patient's continue to call and request these medications when the physician has refused the refill request and they have been instructed to limit their use to prescribe amounts. This is, of course, in the outpatient setting, not sure if I would feel differently in acute care.

Sour Lemon · Aug 23, 2017

Has this been discussed here before? Pardon me if it has, but I've long wanted to discuss the subject but don't feel it's appropriate at work.
Tell me the following examples don't sound familiar to many of you!
Scene 1:
Nurse aid: "Nurse, Ms. Doe wants pain meds"
Nurse: "She can't have them yet!"
Scene 2
Reporting nurse: "Yea he's 'round the clock for the pain meds"
Scene 3
"You know when they say they're allergic to tramadol and ask for 'The D' they're addicts"
These are just a few examples of how we see fellow medical professionals appear to vent their frustrations toward the demand for pain medication. I can't help but feel there is often a great deal of resentment between patients and nurses when it comes to pain management. It's safe to say the vast majority of nurses want their patients to be comfortable. Often times this is not possible, even after asking for new orders and exercising other techniques to facilitate pain relief. I have my own opinion but I'm curious, what do you all feel the root of the resentment and/or frustration is?
P.S. Some of you may have never seen, heard of, or felt this way about pain management. Your contribution to the discussion may be limited to shunning others. Florence would be very proud of you for being the perfect nurse and you therefore don't have to contribute to the conversation :-)

The simple answer? Addicts put their own needs above everyone else's ...and when they're not getting what they want, when they want it, they can become quite volatile.

I honestly don't mind these patients because they only care about one thing and it's easy enough to deliver. They can be obnoxious, at times, but I'm not someone who takes things personally.

Nurse Kyles, BSN, RN · Aug 23, 2017

I feel like there is a lot of pressure on nursing staff due to survey results. At my facility, we are extremely liberal with our pain medications. Dilaudid, morphine, oxycontin, oxycodone, tramadol, norco & nucynta are all extremely common. Each patient has at least 4-5 of those listed pain medications on their profile. We give multiple different pain medications, many times simultaneously, and still it doesn't seem to be enough for some. These pharmacological methods are combined with non-pharmacological techniques such as ice, repositioning, distraction, rest, ambulation, massage etc. Our providers are usually very open to switching up medications based on patient preference or suggestion of the nurse. With all of these pain interventions, I feel like we are really trying our best.

When a patient complains that their pain wasn't managed properly or indicates poorly on the survey, the manager automatically blames the nurse that they did not do enough for the patient. I personally have been called in the office and reprimanded for only giving 4mg of morphine instead of 6mg without ever asking my reasoning for giving that dose. In attempt to raise our survey results, my facility has resorted to have every single person who goes in the patients room "assess" for pain. This includes CNAs, Pharmacists, kitchen staff and even housekeepers asking the patient about their pain level. I think it is crazy to have housekeepers "assessing" pain!! I personally feel like we need to have frank conversations with patients about realistic pain management goals. I know that I do always try to develop a plan and write the plan on the white board. Unfortunately this doesn't always translate to perfect survey results, which is how success is measured at my facility.

caliotter3 · Aug 23, 2017

I've told my doctors how I was treated by a pharmacist one time and how that experience causes me to refuse a prescription for a controlled med no matter how badly I may need it. The only way I will take anything is if I am in the ER and they give it to me without sanctimonious lecturing. The frustration goes all the way around. Each scenario described is familiar to me in my practice.

Here.I.Stand, BSN, RN · Aug 23, 2017

In attempt to raise our survey results, my facility has resorted to have every single person who goes in the patients room "assess" for pain. This includes CNAs, Pharmacists, kitchen staff and even housekeepers asking the patient about their pain level.[/Quote]
What in hades do they think will happen with the survey, when the already-busy nurses will be even more tied up by the housekeeper/CNA/dietary aide/etc notifying them of their "assessments??" That is one of the dumbest ideas I have ever heard.