Munch

If the commute is your only concern I would take it. 50 miles isn't so bad. I commute daily from the suburbs to the city 45 minutes to an hour each way. Most of the time I take the train though do to traffic. But on days I take a PM shift I drive in and its not bad I actually find the drive enjoyable.

Enabling? You think not having a supervised injection site around is going to keep drug use down? They will just use in pubic restrooms or in the park or wherever. Having a place to do drugs is the last thing on an addicts mind. These places just have medical help standing by in case of an overdose. They are handing out Narcan now at Rikers Island to inmates upon discharge. Until better solutions come about the only thing we can do is make sure these addicts don't spread disease and stay alive long enough to make the decision to get clean.

I haven't read all of the responses yet apologies if I am redundant. I am all for harm reduction. As a nurse anything to help keep a person alive can't be a bad thing. The idea that safe injection sites or needle exchage programs encourage drug use and cause people who don't use to start using is preposterous. Actually most needle exchange and supervised injection sites also provide resources to addicts who are ready to get clean. In Manhattan at one needle exchange program they have a bathroom with an intercom in it and if someone goes in there they are required to check in every 2 minutes or so and if someone stops responding the door is unlocked and someone is standing by with narcan. They have saved 25 plus lives since implementing this. Its not a supervised injection site officially but same concept. Addicts lives are worth saving just as much as anyone else's. Until some better solution comes along people are going to do drugs. No getting around that.

Definitely NOT verbal abuse. Part of being a nurse is to EDUCATE our patients which is exactly what you did. You didn't say anything that wasn't true and while I wasn't there it doesnt seem like you said anything in an inappropriate manner. Telling people the possibly negative things that can happen if they aren't complaint might motivate them to be more vigilant with their treatment.

Jeez I'm so sorry no rest for the weary when it comes to nursing huh? I really had to adjust when I first started with my medical problems. I had a craniotomy that fixed the original problem but left me with scar tissue and nerve damage causing excruciating headaches and facial pain. I was also in a bad car accident(my mustang flipped) I thankfully only suffered a slipped disc in my neck. So pain is nothing new to me. A low dose of extended release morphine(mscontin)has been my friend on the job since it doesn't cause any impairment(my employer knows this and approved it and the chief of neurosurgery is in charge of my care). Also of course the obvious like IBU and sitting down as often as possible(to chart and do admission paperwork for example) helps a lot. Of course I like my job which you state you don't l..have you thought of another area of nursing where you don't need to be on your feet all the time?

Me too I would never want her as my nurse either. Thankfully the patient I was talking about will be going home tomorrow. A good friend of mine that floats on that unit often told me the patient is going home tomorrow on her oral regimen that they tweaked a little bit. It was oxycontin 40mgs q8hrs with OxyIR 15mgs q6hrs for BTP they bumped up her oxycontin up to 60mgs q8hrs and her oxycodone 15mgs q4hrs prn. So that should help her and hopefully prevent her from having to come to the hospital for crisis pain. As for this nurse my friend said a lot of the patients have been complaining about how she is being stingy with pain meds, not getting them in a timely manner if at all. The charge nurse is going to have a talk with her so hopefully the situation should resolve.

I had a couple of co-workers get stuck with needles one from a HIV positive patient and one from a Hep C patient. Luckily they both came back negative. Both of them left direct bedside care as they were freaked out like your co-worker. I think both of them actually became school nurses. As far as other things like a cold or the flu how can it be traced back to a patient for sure? When I've gotten a cold I was more likely to blame it on my train commute than any of my patients.

I'm the same way. It drives me nuts when I hear people singing or humming especially because more often than not its off key and out of tune!

Thank you for that information! We see such a huge population of sickle cell patients in my hospital as well. Actually when I came on that day I was covering I found it odd the patient wasn't on a PCA. When we get med-surg overflow on my floor(which actually we mostly have more med-surg patients than Neuro patients on my floor at any given time) we get a lot of sicklers and they always come up from the ED with a PCA order. If not and they require q1hr or q2hr narcotic doses then we get a PCA ordered right away. So I was just doing what was standard on my floor by getting her a PCA.

I totally agree with what you are saying. I am a big believer in harm reduction and while I DO NOT think we should be giving every addict that walks through their doors a fix but we aren't going to cure addiction in an acute care setting. Also my hospital serves a lot of underserved people with addictions so I see the outcome the war on drugs has created(a different discussion all together). Not to mention with this patient..addiction or not she has a painful condition that requires narcotics regardless. Withholding pain meds from her is not productive. Even if she admitted she was an addict and got her into detox its counterproductive she is going to need narcotics sooner or later.

I was reading an old thread about a patient that was an addict and was prescribed something like a Vicodin for a really painful condition and the Vicodin wasn't working. One of the nurses on this thread replied that maybe they should think about the consequences of their drug abuse before they go using. As to say well you're an addict too bad. I was talking to my friend about the co-worker I was covering for and she said she is always the first to comment about a potential drug seeker and never gives anyone the benefit of the doubt. Its really scary to think she has been a nurse for all these years. I reported the incident to my manager. I sure hope something is done. Pain should be treated as real until proven otherwise..bottom line.

I was reading an old thread about a patient that was an addict and was prescribed something like a Vicodin for a really painful condition and the Vicodin wasn't working. One of the nurses on this thread replied that maybe they should think about the consequences of their drug abuse before they go using. As to say well you're an addict too bad. I was talking to my friend about the co-worker I was covering for and she said she is always the first to comment about a potential drug seeker and never gives anyone the benefit of the doubt. Its really scary to think she has been a nurse for all these years. I reported the incident to my manager. I sure hope something is done. Pain should be treated as real until proven otherwise..bottom line.

That's the thing though the patient didn't really show signs of being a drug seeker. She had maybe one or two admissions to the hospital since 2016 and maybe 4 or 5 visits to the ED since 2016. She isn't on the radar at all before 2016 actually. After the ED visits she was okay for discharge. She also doesn't seem to have a HUGE tolerance to narcotics at all. The 50mcgs of fentanyl made her feel a bit better and 50 mcgs of fentanyl is equal to about 5-6 of morphine. These are doses used actually on naive patients. I think this nurse was just being very judgmental and is jaded. Being the inner-city hospital we are we DO get A LOT of addicts and drug seeking patients, A lot of patients trying to scam the system to get a warm bed to stay, people using the ED as their own private drug store(people come in for pregnancy tests and for RX of Motrin so they don't have to pay for it) The thing to remember is not to paint every patient with the same brush.

Yes the whole diverting theory is all speculation and is nothing more than a theory. I would never report her unless I had hard evidence she was diverting medications. She has been working at the hospital for quite a while and my guess is if she is diverting it will show itself soon enough. I'm just glad the patient is doing better. Within the next day or two they are going to start to PO narcotics and discharge her home once they get a PO regimen that works established.

Yeah I am definitely in agreement. She really did overreact. The thing is I don't have any hard evidence and making an accusation like that with little to no proof can really have damaging consequences to her career if for some reason she isn't diverting I don't know her I don't work with her normally so I don't know her well enough I was just doing her a favor by covering for her that day. I did get to talk to my manager about what happened and I did check on the patient before my shift started and she still did have the PCA and my friend who works on that floor said that the patient was doing good and is going to be discharged soon.

The nurse can call the doctor and try to get the order for the PCA discontinued. I dont think he would do that because after I started the PCA I was on the phone with him a few times giving him her status and I told him that the only side effect she was having was pain relief! It really was night and day with this patient she was flat on her back clenching the rails on the bed with the lights off and she didn't touch her breakfast tray before the fentanyl IVP and PCA. I checked on her frequently and after the PCA she was out of bed in the chair watching TV pretty much the rest of the time I was there and she even ate a little bit of soup for lunch. I told the resident all of this and he and the attending were happy with this and they were going to make a note in her records if she is admitted next time that fentanyl is what should be tried first. So with such good results the doctor should not d/c the PCA until she is able to get relief from PO meds. It was my day off but I'm going in to work in a few hours actually(darn insomnia) and I'm going to check on the patient assuming she is still there and I'm getting with my manager as well as the resident to explain what happened. I don't want anyone in the future to suffer needlessly either.

What is it with some nurses(and docs) that think that just because someone abuses drugs and or alcohol that 1) they can't possibly be having real pain and 2)if they really are having pain they are addicts so no addicting meds for them like they should be punished for being addicted to something. As far as sickle cell goes it really isn't relevant if they are addicts. They have a life long excruciating painful disease. Its almost like being worried about getting a patient in hospice addicted to narcs. With sickle cell the disease is never going away their is no cure. Some if not most will need narcotics for the rest of their lives. Being addicted isn't really relevent. Thats another issue that comes up is the huge amounts of narcotics these SSC patients are indeed tolerant to. If they don't get the right dosages of these meds for these patients then you also have to deal with opiate withdrawal on top of the excruciating disease process sickle cell. Gosh can you imagine being in withdrawal during a crisis? I luckily can't even imagine but its something I wouldn't wish on anyone.

Thanks for the article I am definitely going to check it out. Being an inner-city hospital with a huge amount of SCC patients I get young people on my floor all the time with the disease. Luckily the doctors have experience with these patients so they usually get the doses of meds they need. If not a phone call is all that is needed and the docs adjust the meds. They usually throw in a long acting opiate and some kind of benzo and benadryl to help them relax and sleep. Sometimes anxiety can make pain worse and a dose of ativan or valium can really be a great adjuvant to the opiates.

You know that really is a very good point. A case of let me point my finger at this patient before the fingers are pointed at me. I was also wondering why she didn't try to get the order changed. Q2hr dosing is a lot and takes up a lot of time. We get regular med-surg overflow patients all the time and anyone with dosing that frequently gets a PCA for the most part especially sicklers as we know they have huge amounts of constant pain. It really makes me think too because when I have her that one time fentanyl dose of 50mcg she said she was feeling a bit better where as the morphine 6mgs didn't touch her. 50mcgs of fentanyl is roughly equivalent to 6 of morphine. Makes me think she was skimming some of that morphine for herself that's why the patient reported zero relief. She obviously wasn't being difficult otherwise she would have said the fentanyl did nothing as well. Of course this is all speculation but it sure makes me wonder now.

It makes me sick to think of how many patients who were genuinely in pain were dismissed by this nurse and others like her who are quick to judgment. I know the whole drug seeker and pain medicine topic has been discussed before but its like my co-worker was taking my patient potentially being a drug seeker personally(I don't think she was a seeker though). She said she had patients with real complaints and problems needing her attention. Well I did her a favor then by getting this patient a PCA. Now she doesn't have to administer that morphine q2hrs like she was before.

Thank you. This patient didn't seem irresponsible or even tolerant to a huge amount of narcotics anyway which says to me that she was responsible and trying to take care of herself. Her home meds were nothing crazy she was taking oxycontin 40 TID at home with oxycodone 15mgs for BTP q6hrs PRN. That isn't anything ridiculously high. Ive had patients both with sickle cell and other chronic pain patients on A LOT more meds. Ive had chronic back pain patients on 100mcg fentanyl patches with huge amounts of PO short acting narcotics for BTP. This girl just needed to break the cycle. NYC can be very cold in the winter and we all know cold can bring on a crisis for these poor patients.

Exactly my thoughts. She wasn't in the hospital on the clock working. Her patients were now MY responsibility. I was on the clock on the floor using my license to care for them.

Thank you guys. I will definitely NOT be covering for this nurse again(though maybe its better for the patients if this nurse isn't around much). I will definitely be saying something to the manager about this. I work in an inner-city hospital with a HUGE sickle cell population. It really bothers me to think how many patients have suffered needlessly in the past because of this nurses judgments. She's been with the hospital for years so sickle cell patients and chronic pain patients aren't anything that is new for her. She was so mad though she was practically foaming at the mouth. She didn't like that I "went over her head" and got the patients orders changed. Since when am I her subordinate anyway? As far as the drug seeking patient goes she thought I should have checked the patients history which I actually did after..and this patient didn't have what I would call an excessive history. Actually she had a handful of ED visits but left after receiving a couple of IV doses of pain meds. See how it works in our ED with SCC patients after 3 doses of IV narcotics if you aren't feeling better after the 3rd dose you are admitted. If you are feeling better after the 3rd dose you can go home if she was really a talented seeker no way would she say she was feeling better..she would say she wasn't feeling better to get that admission for pain control. I don't know who made her lord and master of pain management but I will definitely be speaking to the nurse manager and the doctor that usually covers that floor just to keep the bases covered. Even if this patient was a drug seeker I would rather treat 10 fakers than miss 1 patient that might be genuinely suffering.

Bear with me for this is going to be a little long. I was covering part of a shift for a co-worker on my scheduled day off. The shift was 7am-730pm and I was working 9 to 3:30 for her on the regular med-surg floor(I work Neuro med-surg normally). I came in and my co-worker gave me report on her patients and then she left. She told me she did everyone's vitals and morning meds so everyone was set that the only thing she asked me to do was to give her sickle cell patient her PRN morphine. So I went in and accessed the patient and the poor girl was clenching the side of the rails squeezing her eyes shut she was obviously hurting. She was admitted for pain control and dehydration. She had orders for morphine 6mgs IV q2hr. Oxycontin 40mgs q8hrs, ativan 2mgs IV q6hr she also had prns for benadryl and zofran forgot the dosages though..probably 25mgs and 4mgs respectively. So I went in and gave her the morphine and she said it hasnt been working and the other nurse was supposed to get an order for something else. The other nurse made no mention of this to me so I called her doctor. I spoke to the resident and he was open to my suggestions so I suggested this patient would be a good candidate for a PCA since she was requiring PRNs Q2 and wasn't getting much relief from that I thought a PCA would be good for this patient. Not to mention most sicklers I get on my floor are on a PCA and do well. So I got an order for a fentanyl PCA and the doctor also ordered toradol 30 IV q6 and a one time dose of IVP fentanyl 50mcgs to break the pain she was in since the morphine didnt help and to hold her while I was setting up the PCA. So I gave her the fentanyl and toradol and just after that she said she was feeling a bit better. I gave her the PCA and about an hour and 15 minutes after I set it up for her she was up and sitting in a chair watching TV and drinking cranberry juice where before she was clenching the rails looking(and feeling I am sure) like death warmed over. She was smiling and thanked me and reported her pain down to 3 when it was a 9 before. Now this is where the trouble started. My co-worker came back shortly after 3:00 to finish the rest of her shift. I gave her report and of course told her about her sickle cell patient how the morphine wasn't working and how I got her a PCA. My co-worker went ballistic on me. She told me this patient was a known drug seeker and scammer how she comes in the hospital all the time for narcotics and 3 hots and a cot and she was going to do everything in her power to get the PCA d/c because she wasn't going to cater to this addict when she had other patients with real problems to deal with. She was also mad that I didn't call her and consult with her about getting HER patients meds changed. I was just covering I should have just followed the med orders and she would be the one calling for order changes not me. Am I losing it or am I really in the wrong here? This patient was obviously in genuine pain and with a sickle cell diagnosis I would rather treat faked pain then not treat potentially real pain. Also she didn't say one word about this patient being a seeker. She actually asked me to give her patient the morphine. I dont think anything is wrong with calling and getting a patients order changed that was visibly in distress. Its not like I was covering a lunch break. According to this nurse I should have made this poor patient wait 5 plus hours in excruciating pain for her to get back. I also didnt see any drug seeking red flags. She wasn't asking for any of the double D medications(demerol or dilaudid) she wasn't reporting 10 out of 10 pain while laughing on her phone and scarfing down trays of food and her HR was 110..she was in pain. What would you have done? Would you have waited for your co-worker to get back or would you have called for a different order?

Its the oldest interrogation trick in the book. Police do this all the time when trying to get info out of a suspect. They always say it will go better for the person if they cooperate. Its not true! The board is not your friend. Now that they have a confession they have information against you that they wouldn't have had if you kept your mouth shut. Heaven forbid they pursue criminal charges your words can be used against you. Definitely seek counsel to try and mitigate as much damage as possible!