Thessaly36

Well first I avoid this conflict by staying in my own bubble and do go with the "if it's ordered and they say they have pain the they get it" philosophy. A drug seeking patient on the hospital drugs and times in most cases isn't really getting a huge high off of what we're giving them because they are likely on drugs as well at home and I'm certain they aren't taking those as directed or they wouldn't be at ED a week after they filled their oxy Rx (at my hospital at least they don't Rx crazy amounts). Only when I see signs that a pt is starting to get in the clouds am I concerned and in that case I have never had an issue with the dr lowering the dose or increasing the time between doses. My second thought on these situations is that I (and also you trust me) will never ever ever ever get a person to stop abusing narcotics by any policy or means that might target seekers when dealing with healthcare environments. All kicking them out, or whatever other solutions I have heard offered in that vein to address the problem, will do is cause them to try more desperate means of obtaining the drugs be that pharmacy robbery or just plain old hitting the corner dealer for something way more dangerous than what we have. This is the perfect opportunity, however, to "crack the door" of change. I always have a small talk or make repeated but brief mention of their medical history showing a lot of pain Rx, or their hx of drug abuse, whatever fits their situation and then make sure to bring up a few things. That there is a such thing as physical addiction to these drugs so even if a person isn't "a junkie" they would still need help to stop using the drugs. I find that gives people an out because being a junkie that likes to get high is shameful in our society but if you have a physical addiction and you're not trying to get high it's just about your pain that's an acceptable thing to get treatment for so they feel safe telling their families ect they need help for that reason but not the other and of course I give them resources for pain Managment specialists and rehabs. Depending on the individual I may just leave the drug addict pamphlets after mentioning it to them or talking in depth. And finally there are some patients that I have been straight out with "hey I can tell you have a problem and while you are here I will continue to give you these medications as ordered but I would like you to think seriously about making a change." And I leave paper work and make sure they know if they ever want help they can always come back and ask for me and I will go out of my way to do what I can to get them into a program that will work for them. finally if I hav a patient that I think might become hostile if I approach them about their addiction I always frame it as a policy that the hospital has to speak with all patients that have been given pain killers about addiction and treatment and I try to give them as much info as I think I can. Bottom line it's safer for them to be trying to get high under your watchful eye than on the street, where I assure you 1000% they will go if they can get service at a hospital, and this gives you the opportunity to plant the seed of recovery with them.

In my area the only way to get a job at one of the few hospitals if you are a new grad is to physically go in and talk to the nurse managers and hand out your resume. The market is so small they don't care about experience they just want to like you and sadly the job postings online are for people to apply through HR once they have already been accepted by a manager. It is terrible and hellish but here you have to force yourself on the hospital until they get tired of seeing your face and give you a job just so you'll leave them alone.

Interesting, when I had my 2nd child I was Rx ibu and norco because they potentials each other. I often get an order for ibuprofen for my patients with their opioids because I know it's super effective when just the opioid alone isn't working to full effect.

Nurses like you always baffle me. How can one work in a field that requires so much use of common sense and so much scientific education and understand and yet clearly still not use science or common sense when approaching whatever the conspiracy of the day is? I have yet to meet a nurse that's a young earth creationist but this is along the same lines.

You would rather not get a flu shot because this person got H1N1 and almost died? You realize that makes absolutely no sense right?

Do you know why that's a ridiculous and irresponsible assertion or are you just being glib?

First I'd like to point out that we're getting much closer to a universal Flu vaccine which would seemingly skew some numbers in the studies you present. Scientists Take Huge Step Toward Universal Flu Vaccine Second while your argument is well reasoned and researched I would like to know if you are one of the people that has long drawn out fights about not wanting to get the vaccine and how unnecessary it is and goes on and on every year when mandatory vaccine time comes around or do you simply get it because it's required and share this information about the vaccines worthlessness as it is necessary, germane, and/or entertaining?

The more posts I read on this site the happier I am that I live and work in California. I very rarely have any issues with my atheism and when I do get an ultra religious patient I just avoid the question for their comfort not mine. I would never pray with a patient and I have told them I believe prayer is a private matter and if they need I will have the chaplain come in. I cannot imagine working in some closed minded area with a bunch of ignorant people threatening me because I don't believe in their sky fairy. My suggestion is move to a better state. Plus in California we have better pay and patient ratios.

Where I work we have a lab tech like that. Stories about how she used to be a nurse and always wants to give input on patients like she has a license. Guess she doesn't know that you can look up people's licenses with the BON here. Not to mention I can't imagine an RN going on the become a lab tech and not the other way around.

I don't know if anyone has brought this up but I have worked with a few "diploma" nurses from back in the day and although they have been nurses for upwards of 40 years they still lack a lot of the fundamental understanding of physiology and rationales that I use at work every day. They are great, don't get me wrong, but there is a reason there aren't any more "work to nurse" programs. In California you basically can't get LVN jobs anymore so I'd imagine it would be impossible to get a job when all you have is a diploma. I mi agree with everyone else if you think the classes are bs and you don't want to put the effort in now you absolutely should not be a nurse you will only be putting lives at risk.

Yet again I am thrilled I work in California. Our laws are very specific about nursing and they tend to veer toward the nurses side of the argument.

On a side note I'm not sure who we are really fooling because all of our Hospice services still have hospice in the name i.e. Hospice By the Bay.

I work in the Bay Area of California and all of the facilities I have dealings with are trying very hard to get away from the term "hospice". We now use Palliative Care or Confort Care and instead of a DNR we call it an AND (Allow Natural Death). Anecdotally I would say patients and families are more accepting of hospice care when it is masked in those terms but I would also add that I have had very few patients that I think would have had trouble with the term hospice in the first place I believe it is in most cases the families that find "hospice" difficult and think of it as "giving up" or "a death sentance" (both terms I've heard). I've even heard families say they were glad we have palliative care and not hospice care.

You comment also makes the point of not "precharting". I worked for a short time at a hospital that had a serious precharting problem once the new EMR rolled out because they hadn't prefected what the charting should consist of yet so many many dead pts had charts with all their hourly rounding filled in for several hours after they died. You never want to explain that to anyone.