Thunderwolf

No person has the right to abuse another. Not even a patient.

Truly sad.

Don't feel bad RNinIN, I'll probably be flamed also. Regarding inpatient hospital nursing, for the most part, this has improved or greatly improved, at least from my experience. Talk about bullying, it was "power for the course" and almost routine on inpatient floors 20-30 years ago. As a nurse, it was called, developing your "tough skin", which was on the job training. Bullying came from ALL directions...other nurses, nurse managers, and especially (OMG) the physicians. If you survived and developed that protective emotional skin, you were half way home to be considered being a "seasoned" nurse. Nurses, especially new nurses, crying at the nurses station or in the hallways was not uncommon. I would imagine now that that kind of bullying or some measure of it would probably be more common in smaller community hospitals and at ECF/SNFs than at large inpatient hospitals. From my experience, bullying is a climate that is either permitted or NOT permitted by hospital administration. Bullying starts and ends there. And with the proverbial "**** runs downhill," so does bullying...from admin on high to the physicians, from the physicians to the nurses and patients, from nurses to other nurses and also to patients. Do you see who ultimately looses in this whole process chain?....it is the patient, because they get it from all directions as well. Bullying is detrimental to patient health and well being. So, a bullying climate in any hospital or at any outside facility is a measure (in my opinion) of management or administration. So, not meaning to minimalize bullying found today....but, you should have seen it 20-30 years ago. It was bad. Real bad. Not as much any more, but if it is bad for you today, this may be more facility specific. If so...look at administration in being somewhat responsible for it. Administration directs and structures the climate. Then ask yourself, is it really worth it to stay there and not look elsewhere if that is an option? More medical institutions are "modernizing" themselves away from it.

After reading many posts on this thread, this seems relevant to the discussion. Medical goal of eliminating pain can lead to over-prescribing pills, accidental dependence | The Columbus Dispatch "Americans have been told that we can and should be pain-free," said Constance Scharff, director of addiction research at the Cliffside Malibu Treatment Center in Los Angeles. "And doctors have been told that there are medications that will make that happen. That's the root of the whole drug epidemic." And in part with this, if we have ongoing chronic pain issues ourselves as nurses, does this lend ourselves as nurses to medicate/overmedicate a patient more often because we refer back to what made us feel better? In a small nutshell, co-dependency. That needs brought up. Can't neglect that issue altogether. And lastly, there are medical conditions like sickle cell, acute post op, cancer, et cetera that do benefit from ATC (Around The Clock) medications. That is a separate issue altogether. Not talking about that....just for the record.

Found an excellent news report on the epidemic of Heroin in West Virginia. But, I am sure, it pandemic across our nation. EMT Wears A Body Cam To Show What Heroin Does To People | 97.5 WAMZ

The BSN will become, and already is in many cities, THE entry point into acute care/hospital nursing. Many, if not most, hospitals in my city will only hire BSN nurses. Also, many of our own non-BSN nurses are going back to school for their BSN. The writing is on the wall. Get your BSN sooner, than later, if all possible.

Totally agree with twozer0 on most of his rationale. To put it in even more simpler terms, would you wake up a patient to give him/her a sleeping pill? No. The same logic applies here with pain medication. Wakefulness and pain are both conscious experiences, for the most part. If unconscious/asleep, what are you truly medicating? Now in saying that, does that mean pain is not present? It depends. We all experience some discomfort when we sleep to one degree or another. One example of this is when we change positions off and on during our time of sleep. Lying too long in one position often becomes uncomfortable, so we turn and reposition ourselves while sleeping. We tend to do this unconsciously. Does that mean we need to medicate it? No. Does that mean pain will not wake us up? No. If a level of threshold discomfort is achieved due to injury/surgery/disease, we may awaken and then may/will become conscious to our level of comfort/discomfort. At that time, yes, it may become appropriate to medicate for pain then. Will I automatically wake up a patient to medicate them with a prn pain medication if he/she earlier requests that I do? No, 99% of the time. I will medicate for pain only if the patient awakens on his/her own and then becomes aware of pain and requests it. So, what may contribute to discomfort while one sleeps other than injury/surgery/disease? What are some non-verbals that may indicate discomfort/pain in a sleeping patient? How about a full bladder? And...do you medicate that? No. You toilet. Is the room too cold or too hot? Do you medicate that? No. You adjust the room temperature. There are many things that can contribute to unrestful sleep. That is where sleep hygiene comes into play. Good job, twozer0, in your explanations on this thread. You are most correct regarding a patient who is unconsciously sedated. It does, however, become a tad different with a patient who sleeps that is non-sedated chemically. This is where nursing becomes more an art mixed with science than vice versa.

Non-union hospitals in my experience tend to globally run under the dictum of "Don't like it, then leave." Union hospitals tend to globally run under the dictum of "Don't like it, then change it." For most of my 30 years of nursing, it has been in non-union hospitals. I now work in a union hospital. I am going on my 9th year. You couldn't have me return to a non-union hospital again. Believe me, unions DO...STILL...have their place.

This physician reminds me of OLD School medicine. Hostile Work Environment is often, in my mind, from my 30 years of nursing, a code phrase of bullying physicians in the work place. In my first 15 years of nursing, it was more common than not to witness physicians being totally disrespectful and unprofessional towards nurses. Sexist, rude, profane, aggressive, immature, you name it, you saw it. Physicians cursing ten times worse than sailors in front of or at patients and nurses. Physicians picking up charts and throwing them at nurses and clerks. Physicians having very loud temper tantrums in the hallways. Yes...this was common...back then. Administration did nothing and tended to look the other way. Whistle blowers were often retaliated against by Admin. Later on...thanks, I'm sure, to lawsuits and patient satisfaction scores impacting the administrative dollar, administration began to step in and intervene. Nowadays, that same physician would get hospital security called upon him/her in many hospital facilities. In fact, for myself, if a physician did become hostile and I felt unsafe, I would not hesitate to call security...even if just to begin a paper trail on that physician. If he/she becomes hostile towards you, it may very well occur again with another staff member. In the past, many nurses had to put up with a lot of poor physician behavior...because THAT was the norm and you were expected to suck it up or leave according to most Admin back then. Nowadays, such behavior is totally unacceptable by anyone, including a physician. In saying all of this, I truly believe from being a nurse for so long and by working in different hospital settings, much of physician behavior in the hospital is directly related to what the work philosophy is in Admin. It all starts and ends in Admin on high. If they permit it or turn the blind eye to it, then poor physician behavior would certainly return. If a physician threatens you harm, that is assault. If he/she actually lays hands on you, that is battery. In either case, security needs called and the paper work needs to begin....before even contacting your manager. Next, you begin looking at your options.

Good job. "Safety First" often becomes our top principle that directs everything that we do. Is the patient safe? In regard to self injurious behavior, the need for setting limits on behavior directly/indirectly and for implementing interventions to reduce such risks are certainly within our realm. Oftentimes, this may be simply being that we step in as a patient liaison that pulls in other resources for that patient. In this case, parents, psych, social worker, the E.D. Never take something like this upon yourself alone as a nurse. When it comes to unsafe behavior, we need to take this seriously, assessed and intervened. Regardless of the reason why a person cuts, it is not your issue. Your issue is to answer that question...Is the patient safe? If the answer is no, then assess and intervene upon the immediate risk at hand and then liaison out for the patient as their advocate. Good job. Good job.

An individual with strong clinical skills who can be equally competent as an independent clinician as well as a team player.

Excellent advice.

I find it interesting that the prescription overdose trend also tends to show some parallels to JCAHO's goal in improving a patients alleviation of pain. I would really like to see some studies that may demonstrate or not a correlation between the two...JCAHO and rising prescription drug overdoses. I wouldn't be surprised that a correlation exists, proving some iatrogenesis.

Think of heroin withdrawal symptoms like the worst flu symptoms...muscle/abd cramping, joint aches, anxiety, some dehydration as a result of nausea/vomiting, diaphoresis, lacrimation, rhinorhea, diarrhea...very unpleasant, but not at all fatal. They feel like dying, but it is nothing like alcohol or benzo withdrawal, which can be fatal. Pretty much, heroin/opiate withdrawal only requires supportive care till it runs its course. Some meds can be helpful. Bentyl for abd cramping, Neurontin at a fairly moderate to high dosing schedule for anxiety and aches (only if kidney functioning is adequate though...check the BUN/Creatinine levels), Motrin for joint aches, Trazodone or Seroquel as a sleeper, Benadryl or Vistaril for itch/pruritis, Haldol or another antipsychotic for psychotic symptoms, Zofran or Tigan for nausea....please notice, no PRN meds with an addictive quality (ie Benzos)...this is very very important with this population. If they shoot up, be mindful that Hep C may be present, which can jack up those liver enzymes. Also, if shooting up, most fatalities from IV heroin occur from endocarditis from using dirty needles. If there is this concern, an echocardiogram may be warranted to rule it out. These folks are also well known to be very theatrical in their presentation of symptoms. Be mindful of this. Manipulation and lying are their names of the game. It comes with the turf in this drug category of dependence, much worse than in alcohol. Observing them/behaviors/reported symptoms when they are not aware of being observed by you is best, if possible (ie TV monitor). You will often observe huge inconsistencies in what they report and in what you observe. Also, have strict guidelines that your patients are only medicated by their assigned nurse...do not permit staff splitting or going behind your back to another nurse for medication of symptoms. The games, the games...watch for it. Now is not the time to be working on depression issues with you...while going thru active withdrawal. That is for the CD/MH Counselor. That is for outpatient or followup after detox. Many have used heroin/opiates as a means to numb out...physically, spiritually, and emotionally. Numb is what most heroin addicts call "feeling normal"...and they actively seek it by any means. Normal to them is numb. When they actually are off the drug after detox, they will begin experiencing feelings once again...that is good, very good...but they may not want to...much easier in their minds to be numb and soulless. Outpatient counseling after detox will then be helpful as they begin experiencing feelings previously denied or numbed. As a detox nurse, it is your role to help them from the physical aspect...the physical withdrawal. Counseling comes after you or in conjunction with you if your facility has CD counselors on site. But, you are not the one to be really delving into their issues or business. If you do, it tends to reflect more about yourself than the patient in front of you. As a nurse, it is best to be objective in your approach, assessment, and intervention. If you have issues with codependency yourself, this makes this all the more important. If not, you may allow yourself to become totally ineffective as a nurse. Side and last note, nurses are to be very mindful of their professional boundaries with this population....that means...no giving out your personal info like your cell or home phone number, your address, giving money, going out together after detox on a personal level, and god forbid, dating your ex patient. If you cross these boundaries, it says much more about yourself than the patient....you have issues. Your patients are not your friends, your buddies, or to be your potential future mate. If a nurse treads these sort of waters, that nurse needs counseling. As you can tell, I am very passionate about this topic. I saw alot when I worked in detox...excellent experiences. I learned greatly from the literature, from this population while in the field, and from the nurses themselves. Some of the nurses were excellent role models, very learned and experienced. Some, well, going back to the boundary topic, really needed some professional help. Hope this answered many of your questions (asked and unasked). Peace to yah. Good luck in your clinicals.

addiction in america has a new face: prescription drugs. last year, prescription drugs replaced heroin and cocaine as the leading cause of deadly overdoses. and celebrities are showing us that mixing prescription pills -- the pills you may have in your home right now -- could be just as deadly as shooting up heroin or snorting cocaine. according to [color=#004276]statistics from the office of national drug control policy, there are some 20,000 drug-related deaths a year in the united states. even more shocking than the deaths of all of our mothers, fathers, brothers, sisters and children is that drugs prescribed by a doctor -- not bought off the streets -- were the leading cause of fatal overdoses. http://www.cnn.com/2009/health/09/14/velez.mitchell.pill.addiction/index.html