Nurses Enabling Substance Abusers

ceccia · Dec 23, 2014

I will give patients whatever they want, as long as the physician has ordered it and their vitals check. because i do not have the energy to deal with whiners all day every day. you can explain to these people until the cows come home, why it's not ideal for the drug seeker to have all the narcs, or the 400-lb patient to have a pile of freaking donuts and a soda, or why the lazy ass who spent the past 30-40 years living the typical American lifestyle and now has a host of entirely-preventable "lifestyle diseases" should get out of bed before noon for therapy...it will just go in one ear and out the other. so why bother.

Gooselady, BSN, RN · Dec 23, 2014

I'm not saying I agree or disagree with the replys and yes I have followed Nurses who give MULTIPLE Narcs, it's like they don't care, and like I said I've done this for years, and anyone especially the Etoh abusers need Ativan, and the patients I'm referring to are already on scheduled Ativan, they are not being stopped cold turkey by no means, of course I don't want a patient to have a seizure.....and like I said most of the time we as nurses can tell when someone needs that extra dose of Ativan, I don't hesitate to give it....but it's the nurses that take no precaution and care about what they give patients that falls back on us that do...that is all I am saying.....oh and the fact that most of these patients are Voluntary and did come in for help, and yes we as nurses took an oath to help these people, we don't just hand out meds....I'm very surprised at the comments regarding it's not our job, or we shouldn't worry about it??? Last time I checked we took a oath to help people, drug detoxers come to us for help and that discipline otherwise they would just stay on the street getting high 24/7....

But you are NOT helping them by denying an unmotivated addict a PRN you don't think they 'need'. Your idea of what helps them is more punitive than understanding. "Helping" someone is always a lot more than we think, that's why nurses grow. You have a more personal issue (or have made it personal) with this than is justified at a clinical level.

I don't even think you should 'change' the way you are right now, but this is not the right place for you to be working, not when such resentment toward the patients and other staff is happening. It can't be a very satisfying job for you. I have plenty of nurse friends who hate dealing with addicts and have no intention of ever looking deeper into it. They are assigned the addict and their shift is miserable, angry, frustrated and listening to them complain got boring years ago. I'm not blaming them. It's just not their thing. One nurse was furious because day shift handed out PRNs on the hour every hour, and she refused to continue that for personal conviction reasons. I didn't want to deal with the addict either but I REALLY didn't want to listen to HER b*tch all shift either, so we switched patients. I barely noticed him. When the doc came by, I showed her the MAR. She made the PRNS q 2 hours starting in the am. I told him about it and charted his response.

It doesn't have to be such a drama. Nurses have enough trouble with teamwork as it is.

calivianya, BSN, RN · Dec 23, 2014

I don't think you can change people, ever, period. We aren't locking these people up in a hospital for the rest of their lives. They have to go out of the hospital and live the way they choose to eventually. If they are drug seeking in the hospital, they are probably drug seeking out of the hospital, too.

We work in different areas. Maybe if I worked in detox or rehab, which it sounds like you do OP, I would feel like you do. However, people don't come to me to detox, they come to me to have their medical problems fixed. Their addictions are not something I am in the slightest bit concerned about. Their sepsis, their pneumonia... those are things I worry about. Not getting the addicts their fix could harm my ability to fix their pneumonia because they could develop additional problems from their withdrawals, so I am not going to police their PRNs.

Besides... I respect people to make their own decisions. If a patient has an ordered PRN, they are not totally snowed, and they want it, I give it. No questions asked. I will even give multiple narcs/sedatives at the same time, if it is what the patient is capable of handling. My patients are on continuous SpO2/tele/respiration monitoring with BPs at least every hour. Our pain management protocols usually include PRN narcan, so I feel more free to medicate people the way they want to be medicated. I am still watching them very closely, and despite the huge amount of narcs I have given before, I have never needed to give a PRN narcan dose. The fact is that I believe patients are allowed to make their own life decisions. If they are not ready to come out of their addictions that's not my business. I believe people are allowed to kill themselves slowly in any way they choose, whether it's the boozer with the vodka, the pill poppers, the cigarette smokers, the heart patients who are unwilling to give up the fast food diet, the dialysis patients who are thirsty and decide to drink out of the sink because we won't give them any more fluids... it's their life, it's their business, and caring for them as PEOPLE requires me to respect their life decisions even if I disagree with what they are doing, even if those decisions are potentially harmful to them. Patients are real human beings too, and they deserve to have autonomy over their lives.

Have you ever done something that you know wasn't good for you? Have you ever driven above the speed limit? Dated someone you know you shouldn't? Eaten a food you know is bad for you? And... would you be okay with someone else judging you for it and telling you you weren't allowed to do these things? Just something to think about. I don't think people should lose their ability to make decisions for themselves just because some of the decisions they make are bad.

heron, ASN, RN · Dec 23, 2014

Besides, isn't assuming responsibility for controlling another's addiction flirting with codependency? Not too healthy for the nurse or the addict, seems to me.

jadelpn, LPN, EMT-B · Dec 23, 2014

I'm not saying I agree or disagree with the replys and yes I have followed Nurses who give MULTIPLE Narcs, it's like they don't care, and like I said I've done this for years, and anyone especially the Etoh abusers need Ativan, and the patients I'm referring to are already on scheduled Ativan, they are not being stopped cold turkey by no means, of course I don't want a patient to have a seizure.....and like I said most of the time we as nurses can tell when someone needs that extra dose of Ativan, I don't hesitate to give it....but it's the nurses that take no precaution and care about what they give patients that falls back on us that do...that is all I am saying.....oh and the fact that most of these patients are Voluntary and did come in for help, and yes we as nurses took an oath to help these people, we don't just hand out meds....I'm very surprised at the comments regarding it's not our job, or we shouldn't worry about it??? Last time I checked we took a oath to help people, drug detoxers come to us for help and that discipline otherwise they would just stay on the street getting high 24/7....

and perhaps tomorrow they WILL be on the street getting high 24/7. Not for us to judge. People who are addicted come voluntarily for any number of reasons. And detoxing is really difficult to do. And can be a dangerous thing to do without monitoring accordingly.

I get it. You are not overly into taking care of people who are addicts. And not everyone is. But what you do need to do is trust that the care nurse has assessed accordingly, documented completely, and followed an order.

Be careful, as the last thing I am sure that you want is for a patient to be under-medicated with the thought process of "my charge nurse gets so angry when I medicate an addict with a PRN, that I will not." Well, then something happens, and the documentation reflects this. Or your care nurses complain that they are receiving negative feedback from you when medicating with PRNs for addicts. Remember, there are nurses for whom this is the type of nursing that they thrive on and enjoy doing.

If this is the line of thinking, perhaps on your shift you should have your nurses have YOU do a secondary assessment, medicate or not, then it will be entirely on you should something untoward occur. Then you can explain to your higher ups when evidence based practice has been tossed aside for discipline and "helping" by not medicating accordingly.

Because you do not do assessments yourself, how can you say for certain that a patient in active withdrawal doesn't need a prn?

As a complete aside, addicts who voluntarily, themselves, want to get clean have a greater success if they are medicated accordingly. When they are not medicated, why are they staying to actively withdraw? You need to separate your distaste for addicts from your clinical judgment.

ak2190 · Dec 25, 2014

Does the thought of giving prn diabetes/antihypertensive medication to an obese patient repulse you? Do you refuse to feed their addiction to food (pardon my generalization) by witholding prn clonidine or insulin? No? Why not?

Addiction is just as much a disease as those conditions, and needs to be treated based on protocol. You aren't going to cure anyone by refusing them medication as prescribed for short-term pain/anxiety/relief. They need to get to the point in their lives where they can get themselves together enough to change their lives. And many will never get there. You treat their disease, regardless of that. We aren't morality police, we are there to reduce suffering and provide clinical care within our scope of practice.