ERKev

I have been working agency since June, but before that I was getting $1.50/hr at my full time job in ER when in charge. This was in Detroit at St John NE Comm Hosp, since then closed. Hope it helps! $.75 is NOT worth charge. Unless it entails no real duties or responsibilities. I would certainly not accept charge with no compensation at all for it. ERKev

As a new grad in the ED, I was doing an intitial assessment on a gentleman that had c/o a possible broken great toe at around 3am. His girlfriend, a little person (about 3'10") attentively and sympathetically listening. He had gotten up during the night to go to the bathroom and struck his toe on a nightstand, fracturing it. Later during his assessment when questioned re: pain, I asked him to rate his pain from 0, being "no pain", to 10 being "the worst pain you ever felt in your life". He looked at me with such a confused and lost look on his face, glancing back and forth between his girlfiend and I when he finally looked at the floor and said, "Gee, Sir... I ain't too good at math!" I stood there dumbfounded, holding back my giggles and had to excuse myself in order to recompose!:roll ERKev

Hey! I sport some rather intricate and colorful tattoos from my forearms to my shoulders! ...And I have ALL my teeth! ERKev

You may rest assured that I would NEVER label you that way. After many years of emergency nursing, I have a BIG problem with pain patients being undermedicated and poorly treated. I have had many a heated discussion with physicians and PAs reguarding undermedicating and unjustly labeling a pt as a seeker. I feel confident in having NEVER been the cause of anyone being labeled a seeker when they have had a legitimate complaint of pain. I think many ED nurses will tell you the same thing. After a while, you get to know the seekers. Some times I may get fooled by a seeker, but I have NEVER withheld or encouraged the withholding of pain meds to an ED patient that was even POSSIBLY a seeker. I prefer to err on the side of compassion... Many ED nurses will say the same. I would further like to apologize to those of you who have had a negative experience in the ED seeking treatment for pain. Pain IS a very subjective experience. I, myself, am a big baby when it comes to pain. Thank Goddess I do not have a chronic problem with it. ERKev

Thank you, MAGIK GIRL... As I said before in this thread, I am very impressed by all the posts here! I makes me proud of our profession! Even though some posts seem a little condescending, the writers obviously care deeply about those in their charge. We are truely a caring profession, thus the passion in our posts. I am truly proud of you all... ERKev

Also, Folks.... This thread's title says a lot: "pain in the ed" We're not talking about anyplace else in this thread. I think, perhaps to a degree, this is why this discussion may become heated at times. I, myself, come solely from an ED perspective. In reading these other posts again, it is quite obvious that most others do not. ED is particularly different from most other nursing contacts for pain control. It is usually in the form of acute pain control, not chronic, that pain is treated. And the ED/EMS is abused in a wide variety of ways - not just seekers. I have seen in the past year alone, people using the EMS to get from one side of town to the other - no real medical problems for which treatment is desired. Just a "free" way to get to another crack house across town. ERKev

Yes... This has gotten quite heated. And I think it's important for all to understand that our areas of practice differ, so our experiences differ. I, myself, work in a number or Detroit area EDs. We have a DEFINATE problem with SEEKERS!!! And I use the term NOT as an epithet, but as a very good descriptor. On some evenings as many as 30% of the people I see are there simply for pain drugs. At one particular ED I work at there are about 4 other EDs within the city that are all conected by the same computer system. We see the records of all of their visits! These people (not all, but many) make the rounds from ED to ED. In a perfect world, we could refer them to help and they might very well take us up on the help. But, most simply get peeved and split for the next ED. Now, you can look down on me and my usage of the term "seeker" and call me uncaring, but I am there, in the trenches, night after night with no breaks and no relief. Then, enter the seekers. They don't even stick with the same stories from one visit to the next, often only a few hours apart! They swear they haven't been treated before! They also (as previously mentioned by on of those nasty people using the term "seeker") threaten our lives and actually DO wait around and watch for you to leave. I have a close friend (ED nurse) that had a pistol held to her head in the parking lot by a SEEKER. I've cried more times than I can even recall over the people I've had under my care. And, further, I'll be the first one to push for proper pain control! But, there are seekers. They do cost us a great amount in time and resources. They do detract from the legitimate pain patients who get lumped into the same category. THEY ARE THERE.... ERKev

I can completely relate, teeituptom! Though my hair's not turning gray, it IS falling out! This is a great forum, though. No where else can we compare notes and frustrations. And, while we seem to differ quite a bit in our potential solutions, it is obvious to me that you are all some fine, compassionate and caring nurses. May you all have great blessings and a gentle wind at your back... ERKev

When I was a new grad in the ED, we used to keep a card file of our frequent fliers and share them with some of the other local EDs. Can't do that any longer though. It was nice! Just look up the name when you suspected drug seeking. Also good for other probs, like Van Munchousen By Proxy Alas, the "Powers That Be" have put the kobash on that. It was a NICE referrence tool and did NOT result in people being dealt with impropperly, but allowed us to deal with them with KNOWLEDGE... ERKev

I agree with you, hogan4736... Many times at triage, I have been able to deter them, either by warning them of the rediculously long wait of "up to 6 or 8 hours" (when in reality it would be maybe 30 mins), or warning that the Doc on duty "rarely gives narcs but uses Toradol", etc... On another note: Anyone have the unusual type of Doc that gives more effective pain med doses to the fakers than to the legit pts? IOW when the pt has legit pain complaints, they tend to be more "frugal" with the doses? ERKev

As I've said before, I work agency, but strictly ER. Lately I've been working in a Detroit teaching Hospital (which shall remain nameless). They are the absolute slowest I have EVER worked with! They will order NOTHING until examined by themselves and then hope that pain meds are not needed! Unless it's sickle cell crisis, everyone gets MS 2 mg SC/IV.... no matter whether they're 200# or 110#.... But, I'm outta here VERY soon..... Thank Goddess!!!

:roll I totally agree with you about standing up to management! However, there IS a lot of cronyism and clickey behaviour in nursing. Often to the point where the work environment is nearly intollerable. I'm on my 3rd career (been in nursing for 15 yrs) and have NEVER seen this problem to the degree it is in nursing. Yeah... Darwin wasn't all wrong, either!!!:chuckle ERKev

VickyRN, this is a topic I'm SURE will open a can of worms! I agree TOTALLY. I have seen this (and been victim to it) many times, in fact I brought out an issue on one of the discussion boards here expecting (hoping for) some consideration, advice and compassion and instead got trashed. Happens a lot. I don't understand why and I cannot blame it on stress. I, personally, try to take any new grads or new people under my wing, so to speak. I'm glad for the help and glad to have fresh viewpoints and new people around. Keeps things from getting stagnant!:) ERKev

Gwenith! We need nurses like you in Detroit! My posts, while I have "taken to task", somewhat, the advanced practice folks, it is solely because they seem to forget that others have valid experience which is appropriate to draw upon. Certainly we are, most of us, in this to make a difference in whatever way we can. Don't throw your (not you, Gwenith) credentials in my face and attempt to denigrate my experience and compassion. Yes, we need not to be TOO judgemental with our patients. And, true, with chronic pain, we may mistake some tolerance of the pain as a lack, thereof. But, I feel, as you, that we all truly care about pain control. But, there are the junkies that come in and need an EJ or central line placed 'cuz they've used up everything else. And they slip out for a smoke after getting doesed or complain that our turkey sandwiches are too dry, or "why can't I get a meal, rather than a snack?", etc... The abusers.... No, don't be too judgemental, but open the eyes and see what is there, yes? PS: Just took my wife to the local ED tonight for bad tooth pain... Very slow to deal with her, but they ultimately DID give her the appropriate relief.:) ERKev

You noticed!?!?! Funny that the more one is educated (book wise or experentially), the less tolerant one becomes of other's opinions. I'm an agency nurse and the facility I've been working in lately makes extensive use of NPs. I've run into attitudes by far worse than many new residents. Very disappointing... ERKev

I could not agree more. I always love to read opinions of others here. Only recently have I decided to post and respond. Please, no one assume that I am "against" anyone due to my posts. I feel it's important to understand that all of us have a valid perspective and certain views developed by our experiences - none are more valid or important than others. ...of course, sometimes we ALL need to come down a notch or two... :chuckle Just a thought from ERKev............

Thanks, athomas:D Nurses need to pull together....

Thanks, Magik Girl!

This is to athomas91 and avigail I completely respect what you've had to say here. I am very disappointed when advanced practice nurses and similarly experienced nurses trash the views of other nurses. We each have a unique experience that should be considered and respected. Though we all appear to be coming from a patient advocate type of perspective, we indeed do have a lot of variance in them. This is good! YES! We DO need to be nonjudgemental in our assessments of patients, including pain. But, this needs to be tempered with our EXPERIENCE. I am personally aware of a "sickler" whose a regular in our ED that has a script for (are you ready???) 3200mg of oxycontin q 8 hours!!! I am serious! She then expects this from us in ED for exacerbations. We were all stunned when the doc looked up records on said pt during a recent visit and found this rx! I fail to see how a human being could tolerate that much. This aside, the patient DID get enough IV pain meds to releave her symptoms, though no where NEAR what she was asking for. We all assume, this is a second income for her - keeping the local junkies fixed... Of course, Medicaid (WE) pays for this. A person's perceptions and personal habits (drug use) do indeed have a drastic affect on their pain perception and how much it takes to get relief. I have no problems with ensuring a pt gets relief. In fact, my biggest problem is getting a reasonable order from a doc for pain control. How many times have you had a huge person with obviously severe pain get a rediculous med order, such as MS 2 mg IVP? There's a happy medium here, some where. Trashing other nurses opins do not help. athomas91 and avigail, read this as I am in agreement with you. And, to my learned colleagues that laud themselves over our "ignorant" views: get a life! You should learn to respect your colleagues as much as you respect your drug abusers. 'nuff said! ------------------------------------------------------------ "Discretion in speech is more than eloquence." Sir Francis Bacon

Nope! They're hiding here with assumed names!

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! :-)

How dare you continue your ignorant tirade! Obviously you're in a dream world made up of touchy-feely nursing text with no clear grip on reality. Compassion in text, but not in reality. The inablilty to understand the big picture is quite obvious! I should have seen from your first post that you are in La-La Land and so I've wasted my keystrokes on this thread. To turn your back on your peers seems quite easy for you. And comparisons to executions and murder so far off track as to be almost laughable, were it not for the sheer dark devisiveness you ooze. XtREmeRN - yes, you are....

Actually, that ISN'T extreme. I work in a number of Metro Detroit ERs and it is very common. What do I think? I think they should be prosecuted... Bogging down the emergency medical system for non medical reasons should be dealt with firmly, but alas, it is politically INcorrect to deal with these abusers...

"ashamed"??? Nursing NEEDS to show strength in dealing with corporate America! I've been in a few union facilities that had some serious issues to deal with and more often thn not, nurses cave just so they won't be out of work or put others out of work. Corporations count on this. Also, nursing schools tend to foster anti-union attitudes in students, telling them that truly caring nurses would not unionize or strike. Bunk! When we, as a profession, can stand together and show a unified front that will improve patient care and improve the status (and yes - PAY!), we will not have a shortage and will not be looked upon as handmaidens to physicians. I'm curious as to how many nurses actually feel they are compensated appropriately? I know I work in a higher paying area of the country, but I feel our pay has a long way to go! If you're ashamed of nurses seeing a strike vote as a victory, perhaps you should rethink your choice of career...

I'm an agency nurse. I work a lot of different places and the general way of handling this situation is to inform your supervisor and tell them of your concerns. They should accomodate the situation by a different nurse taking the patient. If the problem is with ANY nurse, then if the patient is "stable", they can leave. You do NOT have to work under duress! There's enough stress in this field wiothout having to work in hostile conditions. Regardless, the problem should be given to supervision (charge nurse, house supervisor, etc).