Need Advice, Pato Nurse Relations

allnurses Guide · Mar 14, 2015

Nurses are to follow MD orders for pain meds unless there is a legitimate safety concern, such as low BP and other indicators. Don't worry about what the nurse thinks. Ask for your meds when they are due. If you are getting push back ask to speak to the charge nurse.

Altra, BSN, RN · Mar 14, 2015

I'm an ER nurse, and I'd like to provide some perspective and pass along some advice that I give to patients with chronic painful conditions.

We do not, by definition, "know you" or "know what works for you". Your med regimen has been derived from an extended period of trial & error by you & the physician(s) managing your condition(s).

The very best person to work with you to proactively plan a course of action in the event of pain exacerbations is your own physician. But this must also be balanced by the fact that new symptoms may need evaluation, to rule out new onset life-threatening bleeding, for example.

This will be the priority of any emergency department provider: to rule in or out, life-threatening conditions. Complete medical, surgical and medication history information is absolutely necessary -- even a lengthy/complex history can be typed so that it fits on a wallet-sized card. The same with a med list. I would also suggest that it may be helpful to bring your actual prescription bottles for narcotics and other meds for which you are prescribed large/atypical doses by your own physician team. As you note in your post -- narcotic abuse is unfortunately a rampant problem and concrete evidence of your current med regimen will be helpful.

When making travel plans, I would suggest including some discussion with your physician team. In the event that you need to seek medical attention while traveling, it may not be realistic to assume that all healthcare providers you might encounter will have exposure to or knowledge of rare conditions such as Behcet's. Ask your physician what is most important for them to know, and add this info (recent procedures, recent lab results, etc.) to your history card.

Hope this helps.

dudette10, MSN, RN · Mar 14, 2015

Do you go to the same ER with your flare ups? Are there veteran nurses there who know you and know that you are knowledgeable of and instrumental in your treatment? If you end up admitted, ask your veteran, trusted nurse to give report about your capabilities, in addition to her usual ER to floor report.

We Have many returning patients in our hospital, and some of us nurses learn their chronic pain needs, and the patients learn to trust us and we, them. I have had one repeat sickle cell patient, and when we work together, it's like a well-oiled machine. Right after a frequent procedure that increases his pain post-procedure, I am right there with his pain med.

develop a relationship with a hospital, and you will probably see some of the issues go away.

Cricket183, BSN, RN · Mar 14, 2015

I am a chronic pain patient (also a RN, although currently on disability). I have Reflex Sympathetic Dystrophy (aka Complex Regional Pain Syndrome) which is a neuro-inflammatory condition that causes severe burning pain, swelling, color and temperature changes to my arms, shoulders, chest wall, upper & mid back. It also affects my heart (tachycardia & SVT) and stomach (gastroparesis). Early on in treatment, there were many times I ended up in the ER with uncontrolled pain, nausea & vomitting, and/or other symptom exacerbations. Although I do not have the allergies to contend with like the OP, I did quickly discover what worked best to help me most. Usually a cocktail of Zofran, Solu-Medrol, Dilaudid, and Clonidine (lessens the sympathetic response). Once we discovered this combo, I worked with my neuro & pain mgt doc to develop a letter that I could present to the ER doctor with this suggested course of action. I have never had anyone treat me like a drug seeker. In fact, I find that usually most nurses/doctors appreciate when I can give them a quick history and share with them what has worked well in the past. (Or maybe they were just to polite to say otherwise to my face, lol!). Luckily, I haven't had to make any ER visits in quite some time. I am doing monthly ketamine infusions and my symptoms have been under good control for the last year. OP, if possible work with your doctor and have them create a letter you can carry with you. Once the ER staff has ruled out any emergency or new cause for your presenting symptoms then they will have your doctor's suggested course of action to follow. It's especially helpful if you are out of town or at an ER that is not familiar with your history.

jadelpn, LPN, EMT-B · Mar 16, 2015

I would have conversation with your primary MD, with the social worker at the hospital that you go to the ER at the most. Talk about what works for your flare-ups. Have a plan in place, and standing orders available at the ER. (Some call it a "contract").

I would also think about home health. A nurse could come and just assess your progress/pain and the like. If you need services at home, you should be able to speak with the hospital social worker to put those in place. Even a pain clinic. The goal is for you to function and be at a manageable pain level, with adequate pain control--so that you can attempt to avoid flare-ups. And home health could assist you in this, speak to your MD.

Meanwhile, get a standing order/contract in place at your local ER, so that you are able to control your acute episodes. Talk about getting into a home health situation, so that you have a case manager and social worker. And above all else, leave no stone unturned as far as consistent treatment that may be available to combat flare-ups beyond the prednisone. And that you are compliant.

To be honest in my years in the ED, the chronically ill patients that we see who have flare ups and require aggressive treatment for acute pain--it is a frustration on the part of the nurse that YOU have to live this way. And mind working overtime to figure out what can be done differently. Don't get me wrong, the ED is full of "junkies looking for a fix" mentality (and I am not saying that is correct)--however, it is more of a "what can we do differently" for our chronically ill patients who have any number of acute flare ups. We have to look at the whole picture--nurse's motivation is for you to function.

Best wishes!

EmergencyRN22 · Mar 26, 2015

Have the ER doc call your Pcp or pain management doc?

We also have frequent fliers who have standing orders, however they have to be acknowledged and signed by the ER dr each visit.