A fellow RN on my floor did something last week that continues to amaze and shock me.
There was a patient admitted with pancreatitis, receiving the usual for that diagnosis: NPO, IVF, Dilaudid and Phenergen. Apparently she was asking for her meds as soon as they were due, if not sooner. Nothing new under the sun for pancreatitis.
Was she drug seeking? I don't know, but I don't think it matters. I know I've never had pancreatitis so I don't suppose to know the agony involved. I imagine it's a painful experience. With those cases, I give the meds if they're ordered, due and there are no contraindications. No problem, right?
Well...
My coworker had the bright idea of printing out information on drug addiction, highlighting parts of it and placing it on the patient's bedside table as she slept.
I most likely don't have to share that the patient was very upset. Oh yeah, did I mention that the patient is a hospice nurse? The patient stated after the incident that if she wanted to abuse drugs, she didn't have to come to the hospital. She had easier access to much better stuff.
I cannot understand how or why anyone could think that this is acceptable!
But ya know what? Nurse Nancy doesn't think she did anything wrong.
I'm going to add that this is the same nurse who told me in report that a patient suffering from a stress-induced flair-up of oral herpes virus "need[ed] an HIV test." Hmm, okay. The patient was septic with S. pneumoniae and intubated for a while. Yeah, I think my body would be stressed too...especially since I have HSV! Does that mean I need an HIV test?
Just so y'all know, management is aware and has spoken to her. Patient relations is also involved.
I just had to see if other nurses were as horrified as I am concerning her behavior.
Pain is very subjective, so again I say it's hard to say how to really measure pain. I use vital signs in my practice as a way to gauge whether or not my patients are in great pain or not. I deal with addicts so I have to be very careful on how I care for them. Now I realize that most people out there are not addicts and they should not be judged as such, however, if there is a nurse who continually sees a "frequent flier", sometimes it's hard not to think that they are anything but.
Specializes in Wilderness Medicine, ICU, Adult Ed..
No one seems to be addressing any addiction issues here....like I said before I am an addiction recovery nurse. If there are nurses who for whatever reason might be saying their patient is drug seeking, it's quite possible they are!!!! I have seen enough addicts in my time, and they will plainly tell you that they will try and get whatever they can get their hands on. I have had many people tell me they are in such great pain, yet when I take their vitals, nothing is suggesting that they are in such great pain. I hope someone else can recognize this as well......
Addicts also feel pain, and when they do, they should receive medication appropriate to the level of pain they are experiencing and their medical condition. Their addiction makes managing their pain more difficult, but no less important.
Specializes in Retired OR nurse/Tissue bank technician.
It has constantly been addressed in school as well as inservices that people tolerate pain differently, and it is better to give the meds than to make the patient suffer. Even physicians don't seem to get this. And, coincidently, this was a hospice nurse...shows that you never know who you are speaking to. Her attitude was wrong.
We were taught to also recommend the patient take pain medication regularly for the first 2-3 days, even if the pain is mild, rather than waiting until the pain was out of control before asking for analgesic.
After my own surgery I requested pain meds q4-5h when I was awake. My pain was quite tolerable and sometimes not even really there, but I didn't want to wake up in horrible pain or let minor pain get out of hand. The surgeon was amazed at how well I healed and returned to normal activity; most patients with the same surgery have lifestyle limitations for up to 2-3 weeks, I was more or less back to normal within 4 days. While part of it was definitely his skill, a good bit of it was also me taking the pain meds regularly those first 48 hours or so.
I've done the same with family and friends; I've told them to use the analgesics regularly the first 48 hours or so and then just to take them as the pain increases. Most have found they use far less analgesic than if they had waited for the pain to get to a certain point.
While I didn't necessarily counsel my pre-op patients to take meds q4-6h whether they needed them or not, I did suggest they take the meds on a fairly regular basis for the first couple of days and then switch to taking the pills when the pain was starting to increase. I usually heard back from the surgeons that the patients had very good pain control at home and healed up nicely.
I say, call Joint Commission on her. She shouldn't be practicing giving flea dips at a kennel, let alone nursing ill humans. I'm sorry, I don't think I would've had a problem ripping that teaching pamphlet out out her mitts and letting her have a piece of my mind!
Specializes in Retired OR nurse/Tissue bank technician.
oh dear, a little illegal, much? you lied to your patient! if that were i, i would be raising a stink later......But the patient should have made arrangements with the medical staff to be properly medicated.....in the pacu is CERTAINLY not the time to send someone into withdrawl
Technically, she didn't lie; she simply said the Versed was a stronger drug than Dilaudid. She didn't say it was a better painkiller. It was strong enough to knock him out at the count of 9; I'm guessing that's a more extreme response than the Dilaudid would have given.
Ethical? She gave the medication as per doctor's orders; the safety and comfort of her other patients had to come into account, as well; waking up in a loud, chaotic environment can cause issues for post-op patients.
Specializes in Retired OR nurse/Tissue bank technician.
The whole asking for a specific drug is a red flag makes me so mad! If you have been fighting cancer for months or have had sickle cell your whole life then you know what works!
There's a huge difference between a patient with a life-long/long term, documented illness and someone who comes in to the ER screaming that they need Dilaudid and nothing but Dilaudid for back pain-then are seen on the floor playing horsey with their grandchild (read that in another thread on this forum)-or who are screaming for Dilaudid for knee pain when they can hop out of a seat, run across the room and then jump up and down at the nurses' desk, complaining about the wait without even a flinch or limp.
Or the patient coming with with '12 out of 10' chest pain, demanding high doses of morphine, whose skin is pink, resps are normal, ECG and labs the picture of perfection and multiple previous work ups show no other underlying disease.
There's also a difference between, "when I had surgery in the past, the doctor and I found that X drug didn't work well, but that Y drug did; I'd be willing to sign a consent form to let you access those records to help plan my care as effectively as possible" and "I've got horrible, crippling stomach pain and the only drug that works is Di...Do...Dilad?...Dilaudid! Nothing else works; my stomach feels like it's ripping out of my gut!"-all said while munching down a bag of Doritos and guzzling a Coke.
Specializes in ICU, APHERESIS, IV THERAPY, ONCOLOGY, BC.
:uhoh3:The posting " Nurse accuses patient of drug addiction" is a wake up call re. the limited knowledge of pain, and narcotics. Considering the patient with pancreatitis, yes, they are often in pain, they are NPO and many patients depending on their LFT's are given a modified TPN for nutritional support. I dont know if the patient's pain score was high on a scale of 10, but over a period of time, with ongoing pain, patients do develop a plateau where narcotics over a period of time require adjustment. Pancreatitis is also a demoralising illness and the patient feels rotten - treatment times can require extensive time and all meds need medical adjustment by appropriate pain specialists.Patients with pancreatitis are subject to depression, secondary to their illnes. The cardinal rule of pain is that as health care professionals, the patient must be respected and their level of pain acknowledged and treated accordingly., For those who want to learn more, there are many pain management courses and ongoing ed. re. pain, narcotics, adjuvents and how they work. Although street drugs remain a scourge to society - which provokes unease and healthy suspicion, we need to resource our health care education and when necessary, refer to knowledge sources. it is equally easy to observe a patient re. pain relief - if relief is not apparent after 2-3 hours, the MD needs to be informed and the problem addressed. The core issues affecting our judgement remain frustration, fatigue and lack of time to practice care with objectivity. Joy
This is indeed horrific and a total breach of ethics on the nurses part, not to mention her "Scope of Practice". A nurse is supposed to have at least some degree of compassion and competency, and nurse nancy sounds as if she is either very jaded, very stupid or perhaps she acted out on some measure of personal experience. There are a lot of nurses out there practicing who've got or have had their own issues with drug addiction, and perhaps she saw herself mirrored in the patient's situation. Whatever her "reasoning", her actions were totally uncalled for. As many other posters have pointed out, it wasn't her business to comment on the patient's motives; but more to the point, provide treatment options. She apparently hasn't a clue as to the implications of her actions. Such as practicing medicine without a license. But I am certain, that the facility has considered this and it would not surprise me at all to find out her license, which she apparently took entirely too much liberty with, was revoked.
I don't think anyone here is arguing that there's no such thing as addiction, nor that some people who present (particularly to ED) are physically well people seeking opiates.
However the OP discussed a patient with a diagnosed, painful disease (pancreatitis)who had ongoing pain despite the prescribed medication. Even if she had a history of drug use (which she didn't, according to the case given), pancreatitis is extraordinarily painful. A history of narcotic use would make managing her pain more complex, but it wouldn't obviate her need for analgesia.
As other members have posted, asking for regular pain relief when it's due, and asking for stronger pain relief if the dose or drug given is inadequate, are not int hemselves indicators of dependency.
The concern expressed by many members about this particular case is the speed and conviction with which this (relatively inexperienced but highly confident) nurse judged and labelled a patient in pain as drug seeking.
Drug seeking behaviour is usually condemned by health care professionals - in my experience patients tend to receive less pain relief than regular patients, even in the presence of known pain, are treated brusquely and unsympathetically, and usually have to ask for analgesia rather than having it offered to them.
The nurse discussed in the original post brought real world consequences with her when she labelled her patient, who was already in distress and pain. She wasn't qualified to make a determination about drug dependency, had no grounds for making that determination any way, and without question crossed a line then imposing this determination on to the patient.
I'm Not sure HOW you think I lied to my patient, or what was illegal, I medicated him with as much as the physician ordered, it would have been ILLEGAL had I given him more than what was ordered, ANd since he had THREE fentanyl patches on I doubt that he was withdrawing
In your initial post, it sounded as though you requested Versed from the doctor as a chemical restraint (based on the context of the situation, patient yelling, disrupting the PACU, etc.), then failed to inform the patient what the Versed actually was and why it was being used. You told the patient that Versed was stronger, which in context would have come across to me as "Versed is a stronger opiate/pain reliever," which it is neither. I am actually surprised that the doctor would order Versed in the situation, especially considering that s/he refused to order Dilaudid, but I'm not a PACU nurse so maybe it's somewhat normal and I just don't know it.
I also use the vitals as a way to judge pain, as well as facial getures and posture, I BELIEVE that the chronic painers have REAL pain and i know from experience that it is HARD to get them relief, because of the amount of meds they are on, and while Pain is subjective, as a nurse it's also MY job to use some objectivity as well, For example many patients don't realize that lortab has tylenol in it, and they are taking WAY Too much, which can cause them liver damage, and they self medicate, I've had patients that have received ALOT of narcotics and then as you are wheeling them out they will pop 3 percocet or lortab, on top of what they've already received, and when you try to educate them, they are either unaware of the danger of too much tylenol, don't care, or NEED it, Addication is a terrible thing, and altho I believe that that the chronic painers have real pain, there is also a portion of that, that is addiction, anf alot of doc's don't try to help them they just keep on prescribing, so that they (doc's) don't have to deal with the phone calls, we had a patient who had a spinal cord stimulator put in to control the pain, and when they started weaning him off the narcs, his stimulator somehow got turned upside down, so that wasn't giving him relief, adn he needed more narcs, now if any of you have ever seen a stimulator put it, there is NO WAY that they can flip by them selves, without manipulation, so it's a fine line with the chronics, as a PACu nurse using the vitals is important part of the job, if a patient is sleeping HR 45, resp 16 and b/p 102/60, and then they wake up screaming , I'll medicate, however I also know that if you ask them how they rate their pain, it's always a 10, and then quickly fall asleep, can they have pain and still sleep SURE , but you will see a rise in their vitals,
Just so you all know, it is clear that nurses do judge patients regarding their pain. I always thought a patients pain was what they said it was not yours. Since everyone experiences pain in different ways... Hello?
Everyone relates to different experiences. It is not our job to judge, but help that patient obtain a goal of wellness and have a better quality of life. I recently had a surgical procedure on my posterior neck, which was definately horrible pain. I was actually praying to die as a result. I have also had pancreatitis and my opinion is that I would rather have pancreatitis again. After my psterior neck/spine fusion, I was in gut wrentching pain -so much I could not move. My nurse thought I was faking it and told everyone at the desk that I was demonstrating attention seeking behavior-and not one other nurse said a word! I was appauled, but could not move.That same nurse when I asked for a bedpan, told me to do it myself. I asked politely, not wanting to make her any madder than she was. I also need help as my right side is weak from SCI. I suffer from muscle spasm as well and have to take diazepam to control them. That bad nurse, flipped me over in the bed, into the rail, gave me an injection-not gently either in the rear and then flipped me onto the bedpan and left me there forever.That nurse pretty much accused my husband, my daughter of my being a drug addict. It was the most astounding experience of their and my life. Who did she think she was? She had not lived my life and in my opinion god does the judging. I reported her in a survey. Should I have done something else? I know addiction is bad, but I wish I did not have to take any meds. Guess you have to be me to appreciate what it is like on the other side of the coin. I hope she is reading this post! If you are, I was not imagining any of it. We both know who got the pain meds-not me! Remember "A patients pain is what they say it is-not what you think it is"! It is not your pain.
ANd since he had THREE fentanyl patches on I doubt that he was withdrawing
Mmartinson62
3 Posts
Pain is very subjective, so again I say it's hard to say how to really measure pain. I use vital signs in my practice as a way to gauge whether or not my patients are in great pain or not. I deal with addicts so I have to be very careful on how I care for them. Now I realize that most people out there are not addicts and they should not be judged as such, however, if there is a nurse who continually sees a "frequent flier", sometimes it's hard not to think that they are anything but.