BlueTang

I was hoping to find some advice on this website about legal aspects and pitfalls for nurses and dealing with pain managed patients, particularly those that to me appear to be addicted. I work for a busy family practice environment where some of the docs have tried to work with chronic pain patients, but some appear more to be addicted than relieved of pain. I get very concerned about dealing with these pts as their number one goal seems to be the next fix. These pts, particularly 2 I have dealt with, will stop at nothing to get their next fix...threatening to "freak out" either on the phone or in the office, and they are very manipulative. I do realize that to educate more is forever helpful, but at the same time, the nurse may feel the pain and abuse by the pt before the doctor realizes or takes the necessary steps to acknowledge the severity of the addiction vs the benefit of pain management. In addition, one of my doctors asked me to contact another doctors office to inform him that she was aware he prescribed percocet to her pt and to inform him that she was providing the pt with pain management as her PCM. Her purpose was out of concern for the pt as we received notice from the pts mom that she thought the pt was overdosing, however, just after I made this call, I realized this was at least a gray area concerning HIPPA requirements. In dealing with these pts, they are so argumentative, particularly without getting their RX for pain pills if the doc disagrees with the need for refill. I worry over issues of legalities as related to the pt overdosing and/or worst, the extensive documentation you feel is needed with dealing with these pts, the use and benefits of contracts with these patients. I know there are pain management websites but was hoping someone could point me toward training and/or websites that may be more related to providing assistance related to the above concerns vs just the patients feelings about pain.

Per Ehren Myers RNotes, Up to 3 mL; small muscles (deltoid) no more than 1 mL.

I'm not a military nurse, but do work in a military clinic as an RN. After reviewing some of the other responses I have to tell you, don't necessarily count on continuing to do things without accountability to the bottom dollar. Times are changing; and the surgeon general himself just confirmed the military will start to run more like a professional business...watching the bottom dollar, watching military and civilian referrals by primary care providers to care outside of network to avoid unnecessary costs, watching supply costs, etc. In addition, although I've worked at another military clinic and some of the military nurses did appear to avoid hard work if possible, at least the clinic I work in now, the military nurses do have initiative and work hard as in the civilian world. Finally, watch the big picture in the world on the budget and what the future holds where there's an opportunity to cut costs in how business in conducted, whether military or civilian; those funds are increasingly needed for higher priorities. I know I'm probably not helping to make a decision but do advise a bit more research on some of the advice given here.

Recommend you seek help from a specialized pain control center; training courses I've attended reveal many alternative, under-utilized. and effective strategies.

lack of adequate preceptorship, particularly for new nurses due to facilities overly concerned about the bottom dollar or their own ignorance of the importance of it. Personally, I feel it's more the 80/20 rule...20% of the problems are the blame of the individual, and 80% are a result of the system, for which the poor inidividual has no control.