Pain medicine to drug addict?

[MrBlueSky]

Hey guys I have a scenario I want to run by. So I work on a cardiovascular surgical floor. One of the things we do is heart valves. Every so often we get the endocarditis from drug use. Sometimes we get repeat offenders which is sad.

So anyways, thats the background. So I get my patient, 20 something year old female drug addict who had recent heart surgery. I got report in the morning and of course pain was a major issue. The night nurse was like I gave her vicodin and that seemed to help. So I come on and shes crying and visibly in pain. The vicodin is due, so I give that. Hour later she is still crying so I look on the mar and she has a small dose of morphine. So I give that. '

Next day nurse confronts me and says why would you give an IV drug user morphine? She goes on to say she was only giving the patient Tylenol. I tell her that the night shift nurse told me she was taking vicodin. She says he should not have even given her that.

Did I do wrong? The patient was clearly in pain and the medication was ordered by the surgeon. If the patient is in pain shouldn't we treat it?

[BostonFNP, APRN]

If you aren't writing the script then don't worry about it, give the meds as ordered and advocate for your patient if their pain is not controlled.

[Libby1987]

Who are these nurses? How pervasive is this and other ignorances in nursing?

[catsmeow1972, BSN, RN]

My thought is that even if such a patient is seeking, it's not my place to determine that, especially knowing the recent surgical history. Even if i know damn well the person is wanting more than they really need (which i have no way to actually ascertain) fine, so long as dosing it does not fall outside appropriate parameters (RR 7, BP 85/50, for example) I most likely would give it. Here and now is not the time to try any kind of rehab.

Rehab can be handled later. Reminds me of the young girl (under 18) that was in labor and her mother tried to prevent her getting an epidural saying that "that'll teach her to not run out and get pregnant again." uh, okay? Great parenting skills there.

I like what someone before said.."oh you diabetic with a history of noncompliance....no insulin for you. you don't deserve appropriate care." Play God, much?

[ComeTogether, LPN]

You didn't do wrong, you did right.

Just because someone has a history of drug abuse doesn't mean we get to deny them pain control. Unless the patient doesn't want the drugs, (some recovering addicts will tell you no way) there isn't any reason not to treat her pain.

The nurse who scolded you needs to be checked, who is she to determine this person doesn't get pain meds because she has an abuse history? Wrong on so many levels.

[DeeAngel]

There is no should involved, if it's ordered its to be given.

[historylovinglpn]

I remember a nurse lecturing me after my emergency c-section in which I was only given Tylenol. She went as far as calling me a drug seeker. Far from it. Well, you just opened me up, Tylenol isn't HELPING! My last hospital from my 1st birth gave me a morphine drip. I even had them take me off it when I realized I was hooked up to it because I said it wasn't working. (yeah I was that kind of patient. I still remember the nurses telling me it was not a good idea and I should use the drip as long as it was ordered) Does that sound like drug seeking behavior to you? WAnting to be off the morphine drip? Of course as soon as they unhooked me... I realized it really did work. My 2nd birth at a different hospital, I wasn't even given ibuprofen, just tylenol. I cried and the nurse told me to stop crying and take the damn tylenol..that "women all over the world give birth everyday and I was no snowflake. Tylenol or nothing." and she was muttering about my drug seeking behavior. I will never forget it. Made an already stressful birth even worse. I can only imagine how some nurses treat people with actual drug history. I found out later the doctor had ordered me Vicodin after my c-section.....which the nurse NEVER gave to me. I walked out with a prescription for it which I never filled. BEcause I went through the worst of my pain without it. SO I just took Motrin pretty much when I was home. Yup, typical drug seeking behavior. NOT.

[iluvivt, BSN, RN]

Trust me I have been a nurse for 35 years and I know that higher doses of narcotics are required to control the pain of those legally using narcotics and those using them illegally and other street ones.I even know from person experience.Years ago while waiting for surgery I was taking Vicodin for 9 months and I had the absolute worst postoperative pain because they could not get my epidural in...they tried for 2 hours....then they did not use dilaudid pcas and the morphine pca did not even touch the pain.To this day I consider what happened to me pure torture.I was able to get some pain relief for the 1.5 hrs the dilaudud IM worked for .Without fail it wore off at 1.5 hrs and while I waited the rest of the 1.5 hrs until the next shot I was in such agony all I could do was roll in bed...hum...and watch the clock minute by minute praying the time went by fast.So yes the nurse did great and I wish I had one like that because as you can see I would be terrified to have surgery again.

[WKShadowNP, DNP, APRN]

historylovinglpn said:

I remember a nurse lecturing me after my emergency c-section in which I was only given Tylenol. She went as far as calling me a drug seeker. Far from it. Well, you just opened me up, Tylenol isn't HELPING! My last hospital from my 1st birth gave me a morphine drip. I even had them take me off it when I realized I was hooked up to it because I said it wasn't working. (yeah I was that kind of patient. I still remember the nurses telling me it was not a good idea and I should use the drip as long as it was ordered) Does that sound like drug seeking behavior to you? WAnting to be off the morphine drip? Of course as soon as they unhooked me... I realized it really did work. My 2nd birth at a different hospital, I wasn't even given ibuprofen, just tylenol. I cried and the nurse told me to stop crying and take the damn tylenol..that "women all over the world give birth everyday and I was no snowflake. Tylenol or nothing." and she was muttering about my drug seeking behavior. I will never forget it. Made an already stressful birth even worse. I can only imagine how some nurses treat people with actual drug history. I found out later the doctor had ordered me Vicodin after my c-section.....which the nurse NEVER gave to me. I walked out with a prescription for it which I never filled. BEcause I went through the worst of my pain without it. SO I just took Motrin pretty much when I was home. Yup, typical drug seeking behavior. NOT.

After my first delivery (and an episiotomy to boot) I asked for motrin but was told no by the LPN because I had already had something else (vicodin maybe?) But I told her I was still hurting. I am mad that she didn't respect my need for comfort (so I could bond with my new baby, damnit) and I wish I'd spoken up. The next day the doctor listened to me and ordered the motrin only and I was much much more comfortable.

And oh my god only tylenol after a surgical delivery? Hell to the no!

[SororAKS, ADN, RN]

NurseGirl525 said:

That was so unethical. It angers me when people don't treat pain adequately. I see a lot of drug abusers. Because of their use of drugs and alcohol, they do dumb things and end up on my unit. Car accidents, falls, shootings, all kinds of crazy stuff. They are in pain just like anybody else. Especially when they break their necks and other internal injuries.

Plus, they end up detoxing which can make everything worse, especially when you are just trying to maintain an airway on them. I will often try to keep them from going in detox or DTs if they are an alcoholic.

I will immediately make sure CIWA is put in if I find out they are a drinker. They may not see themselves as an alcoholic, but going from drinking a 12 pack of beer a day to nothing can affect the body. I had somebody who's blood pressure would spike everyday at shift change. It would take 2hpurz to get him under control. I finally found out his alcohol history, had CIWA put in for a mg of Ativan, and that did wonders for this man. He had many other symptoms I won't go into, but he was starting to detox.

It is our responsibility to protect our patients. Not judge and force our values on them. I had a young person who ended up paralyzed from her outside behaviors. They were with us for two months. I hoped in my heart by the end of the stay, maybe they woke up and realized they wanted to change their life, but I can't judge and I don't comment, I can educate, but not judge.

Don't get me wrong, I won't be manipulated as many do, but I also will always treat their pain. It's our job.

This. Seems quite straightforward.

[startingover2016]

Hi everyone you are all special because it takes a lot to do what we do bu here we go guys.

Keep an Open mind my comment is only suggested.

Hi everyone I see both healthy nurses and those like me seem to be a bit filled with emotions. Some frustrated, others feel really what is it that a nurse can do for a patient in pain with a history of addiction. Here it Goes

1.First no matter your views maintain your emotional connection away so you can care professionally for a person.

2. Yes I'm an RN BEn mother etc and

Recovering Addict from opioids. Diverted not but were I stand doesnt matter.

3. This is my suggestion. All individuals that are in in recovery or not have the responsibility to prior to having a procedure have a plan in place for pain. They are to speak to their doctors and surgeons whoever to plan it immediately.

4. My recovery is my responsibility not anyone caring so greatly for me.

5. As nurses we get to a point were we want to save all humans or at least try.

6. No one can change the mind or life of anybody unless they want.

7. I know is tough my addiction was a surprise to me trust me. I never thought I would be enlightening others on an illness I prayed never happened to me but here I am.

8. As Nurses if you think of what the role stands for it is not enforcers, cops, security, doctors etc who are we.

9. Nurses that even when we are treated horribly we return to the pt room and provide care no matter how frustrated or angry we feel

10. This is your answer guys and I mean all because I remember before my addiction how angry I fealt towards the addict who puts the alarm on, etc

11. With the compassion in your heart that made be a nurse never ever deny nor delay a patients pain meds no matter what you feel. You are the RN. The day the decide to change they must choose.

Nursing and what we do is sacred. We are not judges nor juries. If you follow spirituality all you can do is pray that somehow they will find the need, strength to get help.

To all the hardworking, kind, tough and new or experienced nurses please don't forget one word. Compassion. Getting clean is really painful and so tough but hopefully the people in and out with an addiction decide enough is enough.

but guys and gals understand this one area you cannot control is best to stay calm, maintain your sanity. Do not allow a persons addiction muddy or make your spirit sad. Believe me I once thought I could help a patient who was detoxing from alcohol, he was young. I didn't know I was beginning my own personal addiction but I wanted him to make it. He signed out. Today I get it

one more thing please lets begin a world in our hospitals and places we work free of stigmatizing or making it taboo.

Mental Illness and addiction are diseases. Whether you believe me or not pretend you do. The only way to help our patients and coworkers is to stop calling the individuals with bipolar crazy. And the addict A drug addict. They feel like crap already our opinions do nothing but make the environment toxic and those co-workers that need help hold back in fear of judgement. Change goes slow but lets at least try.

wounds heal from inside out. We can help if we learn to just stop being so opinionated. This goes for the doctors too.

May all that read this live and continue to grow. If you are like me a RN BSN and addict who doesn't know what to do. NA and AA are free and they are waiting to give you a hug.

[wolf9653]

So this other nurse would have the patient in surgical pain AND be going through narcotic withdrawal at the same time??

[Here.I.Stand, BSN, RN]

historylovinglpn said:

I remember a nurse lecturing me after my emergency c-section in which I was only given Tylenol. She went as far as calling me a drug seeker.

I'm so sorry that happened to you! I was sent home with percocet or oxy after lady partsl deliveries #2-#5 because the post-partum contractions were so strong (they rivaled labor; CNM after baby #2 said my uterus was involuting faster than usual, so that would explain the level of pain)...I can't imagine going through abdominal surgery without it. That RN, like OP's colleague, has no business caring for patients without thorough remediation and an agreement to not withhold ordered meds. And I'm not one to take "they have no business caring for patients" lightly.

Really it's a series of intentional med errors, possibly even practicing medicine, if a med is ordered "for severe/moderate pain" and she chooses not to give it. And if there were a true nursing judgment issue (e.g. you're oversedated or BP in toilet), her responsibility is to discuss that with you and your provider so an alternate plan can be established. What is an unacceptable option is simply deciding to let you suffer. I also don't take reporting colleagues lightly, but in this case I would be reporting her -- to her nurse manager, and probably to the BON as well because this is completely unacceptable nursing practice. (Not sure if the BON would actually do anything, but they for sure would not if they don't know about it.)

I'm so angry for you, and for WKShadowRN. Those behaviors are unconsionable.