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Recently, it has come to my attention that MDs have been targeted for over prescribing narcotics for pain control. My mother has become one of the victims of these new laws that have made it difficult for primary care physicians to assist patients with managing their pain. First of all, I would like to say that this is a quality of life issue and for those that do abuse drugs under a physician's care, their plight is not what I am writing about. This is not the case with my mother. Her pain medications have been well controlled. My mother has back pain and tremors that have caused her much distress since her mid-50s and before 2 years ago, she had never been on narcotics. Getting her to go to the doctor was a strain and now it has become a necessity. Her pain is constant with intermittent acute episodes. It is also difficult to deal with because she has progressively become more forgetful and confused with personality changes over the last 5 years. She fell and broke her hip 1.5 years ago and her shaking makes her a much higher fall risk and her pain makes her a suicide risk. My sister and I are trying to keep her at home, but the anxiety and pain keep her awake. For fear of loosing her pain management regime, she had elected not to change physicians. This was a mistake. This primary care doctor has a wonderful nurse practitioner that understood her condition. Her doctor was asked for a neurology consult and pain management consult and instead was condescending and rude. She has been on Norco 7.5 and Ativan 1 mg BID for 1 year and intermittent use before this for approximately 1 year. Her medications where well controlled and changing them had been discussed repeatedly with no results. Upon her final visit to her doctor's office, my mother had been complaining about a strange intermittent sharp pain in her peri area. My sister had requested the nurse practitioner for the pelvic exam and the doctor insisted on doing it himself. He abruptly cut my mother off about her pain complaints and stopped all pain medications and prescribed her Prozac. At other visits, I requested attention be given to her signs and symptoms of dementia that have made her anxiety and pain control worse. At her last visit he accused my mother of being a drug addict and refused to listen to her or my sister. I can go on and on, but I know that had she changed her MD sooner, this may not have happened. She did change physicians and her new physician was as rude as her previous one. This time I was present. It was obvious this doctor had in some way communicated with her previous physician. Her new doctor was up front about not prescribing narcotics. I told her that I understood her position, but could she at least prescribe enough to get her through till her pain management appointment. My mother interrupted me by having a fit in her office, but not directed at the doctor. It was due to lack of sleep and her mentality. It is obvious that my mom has progressive dementia and that her actions were directly from her frustrations. The dementia symptoms started years before the narcotics were in place and her demeanor was always calm and kind before. We, as medical providers, can debate the side affects of anxiolytics, especially on the elderly and why, but the big picture is informed consent and quality of life. I have been a nurse for 20 years and I was trained repeated that we are NOT rehabilitation nurses and that pain is subjective. Any nurse with experience, knows what I am talking about.

ER nurses tend to get desensitized. The hospital should rotate them. I floated to ER from med/surg. Not sure how your ER is run, but this ER worked as a team. The stress level was not the same as the floor. The patients were seen as rooms and hallways emptied. I once heard an ER nurse say to me about a patient yelling in pain, "Just ignore it." If you have ever been in pain, real pain! You would not say that, I thought. I have and I was ignored and almost died in the ER. There are a lot of disfunctional people in ER, because it is the place people go when they don't have health insurance or live in the street or need a fix. Understand this and it will make being an ER nurse easier. People tend to mirror their judgement of others. Remember that the next time you work. Try to wear these people's shoes for a while. It is not a personal attack on you. In my years of nursing, I have had very few truely mean or intolerable patients/families. But when I have, they are definitely hard to take. I do understand this. But most of the time, it is just people with dis-ease.

Venting is good. I totally get it. I hope you can find something that fits for you better. There are jobs with more human contact and support. Try a nursing home.

All medical staff should have life time health care. We are exposed to everything. I think staffing companies have there place, but we are at risk as a profession. I hate to use union busting as an example, but it is the same. We have no protection.

Nursing is such a broad field. There are so many types of nurses with varying degrees of expertise. Not all nursing positions hold the same stress levels. Once you have been a nurse for a while and if you ever get the experience of being a floor nurse, then you will understand. Until then, it is best to listen and learn.

Patient routine is a given in report, but remember anything that helps the next nurse coming on shift to know what to expect is important too. Because if it is not an expected situation, it should set off her alarms to look for a change. Remember the goals and what has been done and not done. We get to mechanical and things get passed on till discharge comes. Then the discharging nurse is stuck doing things that should have been done through out the patients stay in the hospital. Teaching is one of those things. Remember to get an order for home health if it applies too. I never send a patient home without it, if it is deamed necessary. In nursing school, I was not taught about the value of the home health agency and the flow of care. Ask lots of questions. Discharge planners and case managers are valueable resources for continuity of care.

Remember as a new nurse being so confused, writing down the report, and being uncertain as to what was the most important. For me, it took experience and learning to process the significance of everything. Understanding the disease process, risk factors, patient history, and so on. I wrote everything down. Every day I learn something new. I hope you have experienced nurses working with you that are teachers too. It is a given that when you are a new nurse, report goes somewhat slower. Narc count, you bet ya. Just worked in a PACU unit with some problems. One nurse was fired while I was there. It was a contract job. I was toooo trusting too. Never assume anything. There are checks and balances for a reason. You never know who may have a secret problem and some people are good at hiding it or at least for a while.

BSN is the path I would go if I could do it again. ASN is not what it use to be and the hospitals want the BSN behind your name.

You are not alone. I remember the torture of being a new grad in a sea of stressed out staff. The demands placed on the floor nurse are astronomical. I remember when I had just come off orientation, I was working night shift. I had three admissions back to back with a total of 9 patients and no med nurse. It was a night mare. I wanted to quit too. It takes courage to walk. I hand it to you! It does not have to be this way. I have since worked in other deptments of the hospital and believe me, it is nothing like the med/surg floor. ER, PACU, and ICU nurses I have worked with understand the value of colaboration and teamwork. Noone can know it all or see it all. It always amazes me when I see the most experienced and knowledgeable nurse ask a question that I would ask. It just confirms that we are all just human. I hope your next position is less compromising. Just remember that there is always that learning curb in any new job no matter where you go.

Good reply!