Post-Holiday Special! 50% Off Admission for Addicts!

Nurses General Nursing

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This last week has been the absolute PITS at my workplace.......seems like they must be having a half-off admission sale for every practicing alcoholic and drug addict in the county. I've given more Lactulose and Ativan, cleaned up more vomit and diarrhea, used more restraints, and transferred more patients to the ICU in the past few days than I have in the past six months. As of last night, we had ten patients (out of 33 total) on my med/surg floor who are in various stages of withdrawal; our nine-bed ICU had four, and another one was on the way there as I was leaving for the night.

What's up with that??! We're all wondering if the holidays had some kind of mass depressive effect on the county's heroin and meth users, not to mention the ETOH'ers.........or maybe it was our unaccustomed snow and ice storms that kept everyone cooped inside for over a week and gave them a bizarre sort of cabin fever.

At any rate, most of us have never seen this many addicts at one time in our little hospital, and it seems no matter how many staff we have on the floor, it's not enough to deal with them. I can't even imagine working exclusively with this population; it's enough to make you spitting mad, and break your heart at the same time.

I've been caring for one 51-year-old heroin/ETOH addict who developed abscesses on both arms from skin-popping, bled out after her I & D, and is now on comfort care due to liver failure; I watched as the three daughters she walked out on some years ago came to her bedside yesterday to say good-bye and to tell her they forgave her for abandoning them. I felt awful for all of them, and yet angry with the patient for having put her children through hell and thrown away her own life with both hands, all because of the damned drugs. Then I thought, as I always do, of how there but for the grace of God go I......yes, my drug of choice was the legal kind, but no less devastating to body and soul.:o

At any rate, I think we all will be glad when our patient population returns to the usual: confused elderly, surgical patients, diabetics, and COPD'ers.

Have any of you who work in hospitals experienced a rise in the number of drug-addicted patients on your floors since the holidays? How are you coping with it, and is your administration staffing accordingly? We're fortunate in that ours has consistently OVERstaffed us when we have these high-acuity patients, but there are times you could put 20 people out there and it wouldn't be enough.......they are an enormous challenge, and they drain our energies faster than even the combative, confused, ambulatory dementia patients.

Specializes in LTC, assisted living, med-surg, psych.

Yup......Hep C is everywhere in the hospital right now. Seems to almost be universal among our IV drug users, but the tweakers are contracting it too, and this area has one of the worst meth problems on the entire West Coast. It's getting to the point now where probably half of our patients under age 40 have a history of Hep C, and that's not including the OB floor.

It does seem like there's a run on certain conditions at times.....last summer, it was GI bleeds in the elderly and vague complaints of "abdominal pain/nausea/vomiting" in middle-aged women. Lots of lap chole's, lots of endoscopies, few concrete diagnoses. Then this fall it was pneumonia.....the flu started early and hit hard; one local assisted-living facility sent 25 residents to us within a two-week period, and five of them died.

Now it's DKA and detox.........I'm still not at all sure the holidays don't have something to do with it, since they are a time of overindulgence AND a time when some people are very vulnerable to feelings of isolation and depression. I'll sure be glad when the winter doldrums are over!

I am not unsympathetic towards addicts or their problems. It's just frustrating to see the same people brought in over and over again when they don't WANT to get clean/sober, and to spend so much time and energy taking care of them when they don't want our help.

mjlrn97....you are exactly right. We have seen a huge increase in our pt's with ETOH, Hep C, cirrhosis in the last few years, not just over the holiday's and I think that's really burning me out. I am tired of taking care of people who have been slowly killing themselves for 20 years, then they come in and expect us to fix everything for them. The saddest is when the family can't seem to realize that their loved one is NOT going to get off the ventilator, he WILL need dialysis for the rest of his life, he PROBABLY won't live to leave the hospital, but they don't want to withdraw support "because they come from good gene's, he'll survive this".......as he is kept alive on machines....

then when they come in and they can't breathe because their abdomen is increadibly huge from ascities that their lungs can't expand (and this is after pulling 5000 ml's of fluid off) then they go into liver and renal failure in addition to their respiratory failure. So we do everything we can to help them and give them a second chance to live, and they say that they have no desire to stop drinking....IT IS VERY, VERY FRUSTRATING. These are also the one's who are unappreciative of what you have done.......

Just my little vent. When I step back and take a deep breath, I realize how sad and depresssing it is that so many people have no hope. For many, many people drugs and alcohol are a coping mechanism and a life style choice. I don't want to start another disease/decision debate....I'm sure it's different for different people.

I don't know what the answer is. All I know is that I need to do my best to be compassionate and keep them comfortable, educate the family and be a patient advocate. It is exhausting work, especially when the families just don't get it.....

Specializes in LTC, assisted living, med-surg, psych.

Thanks, kc.........When I was in nursing school, I swore I'd never let myself get jaded or cynical, like so many people who have been in health care for years; unfortunately, there is such a thing as compassion fatigue, and I think that's what I'm experiencing with these patients. It doesn't mean doing less than my best for them, I just don't feel that it makes a difference......and that's what's disheartening.:o

Sounds like you and I are in the same rut. I never thought I'd be like this either, but I guess it just proves we are human....

So now the question is, how do we improve ourselves. What I mean is how do we take care of ourselves and nuture ourselves to help combat compassion fatigue?!

I personally love massages, just don't get them enough! Used to love getting my nails done until administration at the hospital made artificial nails "illegal" if you were directly involved in patient care. I think that would make a great thread.....the arguement for or against artificial nails in patient care.

You gals deserve a little pampering and tlc on your next day off. Please make every effort to get yourselves some.

I admire your honesty and committment to overcome the state of "compassion fatigue".

The patients are lucky to have you as nurses. Hope the work load gets better soon.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Originally posted by SmilingBluEyes

full moon = weirdos in the ER and OB units.

its proven.

.

Lately on our floor any moon has made the weirdos come on out.

Originally posted by Anniekins

Addiction is a DISEASE, NOT a DECISION. If they had the CHOICE, they would not be hurting their family by their using. They don't want to do this, but they cannot stop themselves. :o

This by no means excuses their behavior.

Getting sober, and remaining sober takes a STRONG EFFORT on a DAILY basis for the REST OF THEIR LIVES.

But by calling their compulsion to get high (or drunk, or eat) a disease, we are in fact taking away their accountability for their "DECISION"s. I agree with KMSRN...each person makes a decision to stick in the needle, inhale, snort, swallow, etc; this isn't a point that can be argued unless you don't believe in free will. We can give genetics only so much credit for our problems.

Of course this is an age old debate so this is my opinion in that debate.

Originally posted by KMSRN

.

Yes people do decide to become heroin addicts (or alcoholics or cocaine addicts). They make that decision when they DECIDE to get the money together, then DECIDE to go find a dealer, then DECIDE to buy the heroin, then DECIDE to get a syringe and needles, then DECIDE to mix the heroin, then DECIDE to find a vein, and DECIDE to inject it into that vein. Then they DECIDE to do it all over again the next day. That's how they DECIDE to become addicts - one little decision at a time

Oh I totally disagreee. Heroin steals your soul and does so quick and insidiously.

And its horrible to watch from the sidelines.

The individuals with the poor judgement you describe are choosing nothing! They believe"everything happens for a reason"

because they dont believe they have any control or power. they let things happen to them.

Same dynamics different drugs.

So one day they just let heroin or what ever inject itself into thier body. Get real. Addiction is genuine but that first time was clearly a decision. One is NEVER addicted without first taking in the substance. Unless it was literally done to them involuntairly, it was clearly a decision at least the first time.

It may or may not be a well informed decision but a decision still.

Even those who are not well informed have the commonsense and self respect not to do it the first time. Starting is a decision and there is no real excuse for that.

Specializes in cardiac ICU.

So now the question is, how do we improve ourselves. What I mean is how do we take care of ourselves and nuture ourselves to help combat compassion fatigue?!

I personally love massages, just don't get them enough! Used to love getting my nails done until administration at the hospital made artificial nails "illegal" if you were directly involved in patient care. I think that would make a great thread.....the arguement for or against artificial nails in patient care. [/b]

A pedicure is always nice, especially if they throw in a massage of feet, ankles, lower legs. The place I usually go to has heated leather massaging chairs...:) nice

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I don't agree that addiction is a disease, but i don't agree that it's a decision either.

One of our frequent flyers came back last night. Covered in lice (again, despite being sent home with boxes of treatment, the HH nurse reported they all sat on the floor at her home unopened.), no bath in days, (or since the last day she was on our floor, about 2 weeks ago), and demanding her meds.

The woman has been taking various narcs for years, and the last two doctors she's had will not prescribe anything stronger than a regular Tylenol.

Last night she whined (this is the only way to described how she said this) "I need my Percocets, that's the only thing that gets rid of the pain". Ok. Well if i go in there after she's rang her bell for the 16th (no joke) time in the hour, she rates her pain at a 10 (as always) and says it's her legs. The NURSE goes in there not even a minute later and asks "Where is your pain", the woman says her back. When the nurse asks about the legs, the pt. says "no they don't hurt". The nurse: "Well you just told the CA Extern it was located in your legs". And then the pt. stammers out some excuse. I forgot to add that after we leave the room, her wimpering stops and she's calming eating her 4th cup of pudding, sitting ont eh side of the bed, after QUICKLY swinging up to a sitting position.

But it gets old. She refuses rehab, or psych consults, but i guarentee we'll have her for a good 2 weeks. She's admitted for a possible detox, but if she refuses to receive help, she's ultimately wasting a bed.

Similar units throughout the Burg are bursting at the seams. My unit is constantly short due to the fact that our staff is being pulled to psych.

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