Patients with drug issues vs. the doctor playing dumb about it!

[nursey07]

I recently had a patient who "fired" me (haha) because I refused to push his dilaudid when he had fluids running. Aside from the fact that he was getting it every hour on top of Fentanyl patch, Phenergan, Zofran, Ativan, Valium......you get the jist. The doctor absolutely refused to use a PCA pump and would not discuss addiction issues with said patient and or staff. He just decided to go with what the patient wanted! I calmy suggested to the patient that he ask the doctor himself for the PCA pump if he felt the doses we were giving him were not taking away the pain sufficiently because the pca can give him MORE! I also said at one point that I hoped the Fentanyl patch would help his pain more so he didn't have to use the Dilaudid as much! He took this as a direct attack from me and went to my charge nurse saying I made him feel like I was judging him for asking for pain meds. In my experience, I know this is his own guilt of knowing what he is doing and was happy when he decided I wasn't the nurse for him!

What ****** me off is this makes me look bad to charge, management and administration where I felt I was advocating for the patient!

The doctor won't listen and when a solution (pca pump) was suggested he would get mad about it! Number one: who has the time to make sure one out of 8 patients is properly doped every hour? On top of more frequent trips for his other PRNS?

Number two: If the doctor wants to put him on an hourly dosing, COME UP AND DO IT YOURSELF!!!!!!!!!!

This doctor is such a wuss to come up and look at the guy and say, "You're an addict and we're lowering your doses?" I'm also sick of the other nurses who "just go with it". How does this help the guy and why are we powerless over this?

Ughhhhhhh sorry for the rant, but it just ****** me off!!!!!!!!

[Virgo_RN, BSN, RN]

I wouldn't order a PCA for this patient either. If the goal is to work toward discharge home, he cannot go home on a PCA. He needs to be transitioned off the IVP meds and onto an effective oral medication.

[Iam46yearsold]

Have they tried those fentanyl lollipops, I think those are cute and highly effective, from what I have been told.

[Roy Fokker, BSN, RN]

At the same time that Joint Commission is pushing the "Pain is what the patient says it is."

Because the idiots at JCAHO (I refuse to call them "The Joint Comission") secure in their supreme wisdom don't think that human beings can lie and sometimes exhibit manipulative behavior.

Drug seekers don't exist in JCAHOs world and nobody cries wolf. Patients are always tell us the truth, the whole truth and nothing but the truth and don't consume liquor/tobacco/street drugs when not in the hospital.

That's JCAHOs perception of reality.

Sorry for the rant. Can you tell I had a very productive day at work?

cheers,