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pain in the ed


i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick.

our er uses the pixis and computerized mar's. the doc orders a drug, you have to wait, wait, wait, and then go to the pixis, get a witness for a waste (if you don't need all of the pre measured dose), and then give the pain patient his dose. never mind the fact that on the way to the pixis you have 6 other things that suddenly need to be done and that pain patient has sent each of his 6 visitors individually at 5 minuet intervals to complain that the 2 hour er stay is rediculous and that he missed his dinner and wants you to fix him something to eat.

by the time you get to the patient, the award winning draumatic preformance is simply breath taking!

now i know that some pain is true. but if i have a kidney stone, an acute appendix, labor pains, or chest pain, the er nurse shouldn't have to come out to the smoking area, tell me to put out my cigarrette, put down my big mac and accompany her to a room where my vs are 120/80 - 70 - 16!

thanks for allowing a "newbw" to vent!


Here we go again...

Definately a thread that the Pain Management NP is going to stay out of.

On a side note to Nurse Complainer. Since you dislike pain so much, have you considered dermatology nursing?

-Dave, who reminds people that PAIN is what the PATIENT says it is...not the Nurse/PA/NP/DO/MD says.

Bravo, Dave NP!

To all you who gripe and kvetch about pts. who have pain...may you never find yourselves in the same unfortunate position, being cared for by people who are so short on empathy.

unknown99, BSN, RN

Specializes in Inpatient Acute Rehab.


Different people have different pain tolerance.

Did you not learn that in Fundamentals of Nursing in school?:rolleyes:

Hey, Magik Girl, I can relate. While the patient's perception is what we need to focus on, it's frustrating to be busy and have a social butterfly or fast-food junky demanding meds while not missing a step in their quest for more fries, etc... Ya get used to it...

To our other advanced practice folks and "old salts" - Lighten up! You guys descend like piranah! Why jump on her education??? Why jump on her compassion??? Geeze Louise!!! We're all in this together!!! Give her a chance! You can't teach compassion. And it takes a while for the true ED nurse to come through and bloom! :-)

gwenith, BSN, RN

Specializes in ICU.

As you all know I have jumped on this particular bandwagon before so here goes.

The problem with inadequate pain relief is not education - If the nurse does not know that pain is what a patient says it is then they will know 10 minutes after posting on this BB:chuckle

The problem lies in us recieving conflicting information from the patient - hearing a report of X amount of pain while seeing no evidence. Part of this is an unconscious expectation that people in pain should display xyz symptoms and partly because of persistant myths about pain and partly this is an area that IS poorly addressed in texts. i.e. what are the myths, what are peoples expectations of pain and behaviour that is fueling this conflict.

So, instead of us just coming out with the same old tired platitudes let us try to find out what that person believes and see if they are truly operating on myths.


It's one thing to ask because you don't know, quite another to come across with judgemental and sarcastic attitudes based on ignorance but offered as expertise.


slam! dunk! he scores!!!!!!!!!!!!!!!!!

again, perception is 9/10th' of reality......

ya'll should lighten up. i didn't realize that i was entering the twilight zone. i thought i left all of my uptight nursing instructors in college after i graduated 12 years ago!

sit back,relax, and enjoy the ride. life is too short!


Nope! They're hiding here with assumed names! :D

Originally posted by ERKev

Nope! They're hiding here with assumed names! :D

BRAVO! :chuckle

I just have to say it. Sorry but I have to say it.

I feel sorry for my patients who are in pain. Pain is subjective and I will administer the patients pain meds based on what they say it is.


In healthcare their is an allocation of resources. My TIME is a scarce resource. So when a person who has chronic pain issues and has PRN narcotics ordered starts DEMANDING that they need their pain medication NOW, and will cause such a ruckus if it is not delivered within minutes of their request it may become a problem. The problem may be that the little old lady down the hall has developed a heart arythmia or pulmonary congestion. She may not be screaming for help- in fact she may just lay there getting worse until you the nurse intervene.

That poor little old lady needs help now. She may not have the ability to call the NM and start screaming for help NOW. So then I have a decision to make. Sometimes my decision is not a popular one. Sometimes the person who can scream, can be demanding will do so at the expense of another, more fragile, more vulnerable patient. Hence- this nurse, or anothe nurse in the same position may feel frustrated. Resources should not be doled out based on the aggressiveness of a patients' demands.

There I have said it. I hope to not appear unsympathetic to our patients who are in pain. And although pain is the 5th vital sign, it may cause a life altering condition and not a life threatening condition. And I as a nurse will put a life threatening concern first. So some patients may have to be in pain a little longer than we both would like. We both end up frustrated, but sometimes that is just the way it is.

Resources should not be doled out based on the aggressiveness of a patients' demands.

There I have said it. I hope to not appear unsympathetic to our patients who are in pain. And although pain is the 5th vital sign, it may cause a life altering condition and not a life threatening condition. And I as a nurse will put a life threatening concern first. So some patients may have to be in pain a little longer than we both would like. We both end up frustrated, but sometimes that is just the way it is. [/b]


i agree with you 100%!;)

unless that aggressive demanding pain pt has life threatening .....

pain may be the 5th vital sign but where does it fit in our abc's?

what about good old triage. or if you want to use the more "fab" term, prioritizing? don't let the sensationalism of the arguement let us forget er 101... constant re-assessment and prioritizing. every second you have to do that in the er. i agree with the above thread, the screamer will have to wait until the life threats are over! when is the last time that someone has actually died from his kidney stone pain? but i can remember lot's of pt's with arrthymias that died.

guys, i am not heartless. i realize that pain hurts, but the moral of this is, put it into perspective. :kiss:) :) :rolleyes: :rolleyes:

i thought this was a site for nurses to vent... instead we are getting sniper'd in the back by our own!!!

i have not read one thread here that assumes patients don't have pain --- do those of you lecturing us about perception ACTUALLY work in an ED?!?!?!

on a personal level - i can tell you that i see approx 20 patients a few times every wk....either w/ an etoh of 300 and out of their narc's - or just out of narc's - these patients have been placed in a PAIN PROGRAM by US - when i mean us i mean us caring/compassionate ed nurses who want them to get the best pain med and f/u possible - and guess what happens when we call their pain management doc - he tells us - don't give them anything - they were given new rx two days ago !!

before we start to judge i think you should contemplate where nurses are coming from w/ their views and perhaps allow for the possibility that they are not speaking of every patient but maybe only a few.......

Couple of things to think about:

1. Although pain is not "life threatening" in itself it can be indicative that something life threatening is going on..hence the 5th VITAL SIGN.

True Story: We had a guy some in to the ER that was a "frequent flyer" complaining of abdominal pain. Of course we all rolled our eyes, saying, "whats new". We gave him Donnatol and Lido..of course the pain was still 10/10 again rolling of the eyes..we knew he wanted the "good stuff". The staff taking care of him put him on the low priority list due to his past history and our predjudice against him..Finally after sitting in a room for several hours the MD scanned his belly just in case. He was perforated and had to go and have an emergency appy. The surgeon screamed at us when she came in over the amount of time we had basically let him stew. He ended up in the ICU for over a week with a systemic infection and brought a suit against the hospital maintaining that IF the ER staff would have taken him seriously then he would not have become septic. Would he hve? It is unknown BUT try to defend your actions in depostition on that one..."Um well he is usually full of crap so I figured this time was no different...A plantiff atty would tear you a new one for that. Now I know I am going to hear variations of the little boy that cried wolf here but a BIG part of nursing and critical thinking is based on remaining OBJECTIVE to the patient at hand. That is part of our responsibility as healthcare providers. By not doing so, the staff in our ER put a patient at high risk..not something any of us were proud of.

2. As far as the patients that come in over and over for narcs and the fact that we as nurses think it is bull..the MD is ordering these. If the supply dried up they would no longer come. Maybe rather than complain and complain about the patients go speak to your MD group or refuse to give them. I have seen more than one nurse say, "NO". I told an MD "No" once since the pt was so completely gorked and her resp were so slow in my judgement it would not have been safe to give her anymore. After I told the MD her vitals etc he agreed.

I no longer work ER and am glad when I read these types of theads. I used to be the same very judgemental and the pt basically had to "prove" to me that he/she was really deserving of that pain medication. It is sad really. Bottom line is the seekers are not going to go away so I agree with the NM "give em what they want and get em out"..wasting emotion and time on being "mad" at the pt only serves to take away from the nurse.


as far as pain indicating a life-threatening emergency - that would be detected on a physical exam which a nurse should do on every patient

but when your patient rates their pain a 10/10 - you have to pull them off their cell phone while their laughing w/ their friends to assess them, they ask for food and drink, they want to go smoke, and on physical exam they have no tenderness/rebound/guarding........

Firstly, I do work in ER. I cover patients for my practice and spend a good portion of my time there. A few times a month, the MD I work with and myself are the sole providers in ER doing complete coverage. So I DO have plenty of ER expeirence.

Secondly, I do not understand the presumption that just because a person is able to function in an outward apperance (meaning laughing, talking on the phone) they are not in pain. Chronic pain suffers have learned to cope with their pain and many times they appear this way, even though they are in extreme pain. Yank their family out of them room and talk to them one on one. Their change in presentation can be amazing. Jane Doe who was laughing, chatting and eating can suddenly BE your typical person in pain. Not because of a "show" but because they are coping for their family. Many pain patients have isolated their families by their constant complaints of pain, and this is one of their mechanisms.

Finally, and ONCE AGAIN until you are in their body do not persume you can tell someone what's going on. That's part of the reason we call it the PRACTICE of medicine. If you weren't just practicing, then you WOULD be able to tell me what's going on.

Dave, who will gladly order medication based on what the PATIENT says their pain is.

thank you sister mary margaret.;)

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