wanda06211

I have done a few searches on drug seeking behaviors. Mostly what I was looking for was maybe like a class that is offered for health care professionals on how to deal with the situation. I could not find anything offered (if anyone knows of anything, please let me know), but what I did learn was very interesting to me. Drug seekers are categorized into basically 3 groups. #1 are the patients that sell the prescriptions in order to obtain their actual drug of choice (I've not personally had any dealing with this group that I know of yet). #2 Is the group that likes the effects of the prescription meds (these are their drugs of choice). and #3 are the patients who actually are in chronic pain and try to "stock up" because they are afraid of running out. What I tend to see are groups 2 & 3. I must admit that I am (for the most part) a little more tolerant of group 3. I understand that no one wants to be in pain, and it can be scary to think that the drugs could run out. Group 2, however, is another story all-together. I understand that people build up a tolerance for pain meds and I try not to be leery of every patient who says they're in pain. Personally, i don't care what a person has done before they are my patient, they are my patients and I care for them to the best of my ability. One of my first patients in nursing school had a history of drug abuse and had been in a major MVA. Was he addicted to drugs? Without a doubt. Was he in pain? Without a doubt. There were nurses on the floor that were discussing it in report and basically admitted to "putting him off" when he called for pain meds. I was appalled to say the least. I mean, here is this poor guy with multiple fractures, lacerations and bruises having to wait on his pain meds. But then there are the ones like I had last week that reported constant pain 10/10 and nothing helped---which was just hard for me to believe when I had to physically SHAKE her awake (every time) to give her scheduled meds. Yes, I gave her pain meds when she called, but I did chart the situation exactly as it happened and discussed it with her doctor. I know when it comes to pain, I can niether prove nor disprove what someone tells me. If they have pain meds available and call me for them, unless they fall asleep before I get there, I give the meds (but I refuse to wake someone up to give them pain meds). Anyway,Sorry so long and rambling. I guess I just still needed to vent a little. Wanda

OK guys, I am sure this is a touchy subject, but I really need some input before I loose my mind. We have 3-5 frequent flyers that are most certainly drug seekers. Believe me, I am not quick to jump to this assumption, bc I understand pain is a subjective thing and I want to help anyone who is in pain. But the ones who are complaining of pain 10/10 all the while entertaining visitors, laughing it up on the phone or walking outside to smoke every 30-45 minutes make me want to climb the walls. My personal favorites are the ones who know their drug schedule to the second and call like clockwork because the pain is so unbearable they can't take it anymore and by the time you get to their room with the ordered meds, they are sound asleep (the whole "head back, drooling and snoring sleep"). Or the ones who are fortunate enough to have someone stay with them all night and wake them up on time and remind them they are in pain. I actually went for an interview today for a PRN job at another larger hospital in my area bc I want to work a little at another hospital to see if it is as bad there as it is in our little hospital. Well, as I am walking across the parking lot of this larger hospital, I see one of our drug seekers sitting in the smoking area with her IV pump in tow. I guess that answers one of my questions, huh? Seriously guys I feel like nothing more than a drug dealer at times. If the patient has fallen asleep in the 5-10 minutes it took me to get the meds, I politely put them back up, chart what happened and wait for them to call again---which is usually when the CNA goes back in to get vitals the next time. How do you deal with this, and if there is nothing we can do, how do we cope? i so do not feel good about myself when I feel like I am doing nothing more than supporting someone's drug habit. Wanda

I am glad every thing worked out well for both you and the patient. It's not something any of us wants to happen, but these things do happen. My first med "error" was not so much a med error as it was a laspe in good judgement. Looking back on it, and knowing no one was hurt by it, i can almost laugh at it now.I REALLY do take meds seriously and the error itself wasn't funny at all, but the situation under which it happened was a little comical... you see, I was taking care of this little lady while I was a student. You know how those little old ladies love their laxatives and stool softeners. Well, this lady had an order for miralax on her MAR. While discussing the meds with my instructor before giving them we decided that since I had just spent 20 minutes cleaning this lady and her ENTIRE bed after she had just had a rather large semi formed BM maybe we should hold the laxative this morning. Well, what did I do? I marched right in there and gave her all her scheduled meds. ALL of them---including the miralax. I felt so horrible. I went straight to my instructor and told him what I had done. He was great about it and went into the room with me to tell her about it. She was good about it too. She told me had I not given it to her she would have asked any way. No harm no foul, I guess, but I will hold a dose of laxative in a hot second now. It is something that will always stay with me. As far as other med errors go, at my hospital it is policy that all injectables be verified by another nurse. It really doesn't take that long to do and I personally have seen quite a few med errors avoided because of this system. Wanda

I've worked both nights and days at my hospital as well. On days, there is a more steady flow of patients (discharges and admissions), but there is a ward secretary and a doctor around every corner it seems. At night, (depending on which doc is in the ER) our admissions vary from day to day. One day last week, we had 4 admissions in 45 minutes (with 2 nurses on the floor). At our hospital, day shift faxes their orders down to pharmacy and pharmacy enters the meds in the computer and sends them up. On nights, nurses have to enter the meds and go find/mix them as well. On nights, we are responsible for MAR checks, 24 hour chart checks, QC checks on the glucose monitors, re-stocking all med carts, updating the worksheet, and prep any patients who are going for any surgery or procedures the next day. I'll be the first to admit that when it is slow, it is REALLY slow, but when it is busy, it is completely overwhelming---however, this is not the problem as I see it. My problem lies in the fact that it seems that doctors think that when there is a problem, it can wait until morning comes to deal with it. I can handle all the other stuff as well as 8-9 patients no problem as long as I don't have a patient "falling out" on me every couple of hours or one that is so unruly that I cannot leave his beside long enough to take proper care of the others. My problem is also in the fact that when we have these "hairy" nights, day shift comes all unglued if they have to check the glucose monitors or do a few of their own MAR checks. I understand that nursing isn't easy on any shift, but night can be as rough as days, and what I really would like to be able to do is to cut out all the competition and pettiness between our shifts and figure out how to get the doctors to take problems (and nurses) as serious at night as they do during the day. From what I can gather, though, ending world hunger would be a much easier feat! LOL! ;-)

Let me start by saying that I L-O-V-E my job and I absolutely love working nights, but there are some things between night and day shifts that just irk me. At my hospital, day shift nurses (med/surg floor) get a max load of 4 patients, on nights our max load is nine. I understand that this is not a big deal and I am ok with that. Day shift is always complaining about how many discharges/admissions they have and how much harder it is on days. On average, we get almost as many admissions as they do on days, but we do not have a ward secretary to help us with the paperwork AND we have twice the number of patients they have. We are responsible for 24 hour chart checks AND MAR checks as well. I am consistently being left new orders for 3-4 patients at the begining of my shift (some of them have been taken up to 45 minutes before day shift ends). A lot of this I can just overlook as being "just how it goes" but the kicker for me was last night when I was talking to a nurse that usually works days and we were talking about two of our more "memorable" patients from a few weeks ago. One of the patients was a 101 y/o who was a breath away from coding on me all night (yes, she was a full code). I had three major episodes with her each lasting close to an hour. I struggled with this all night long on top of caring for all of my other patients (including one who had an episode of respiratory distress). I was on the phone with her docor no less than 4 times that night. Well, as soon as 0700 came, she was on her way to the unit (before I even got off the floor). This much I knew and I was a little upset about it bc she seriously needed to be in the unit from the get-go. The other patient was a male with a hemoglobin of like 5. You may remember this from one of my earlier posts---he had just enough brain damage to be ornary and combative. He ripped out 2 IVs and smoked in the bathroom 3 times (all while getting blood). I had called the doctor a couple of times on him bc I could not get him calmed down and the only order he gave was for 1 (that's right, ONE) mg of ativan. I left work that morning quite frazzled to say the least. Well, as it turns out, day shift got an order for Haldol less than two hours in to their shift bc they just could not handle this guy. Don't get me wrong, I am not a big fan of restraints be it chemical or physical, but we really needed something for this guy. I just don't understand why day shift was able to get and order when I could not. Every one seems to think that all the patients just sleep at night so there should be no problem. In all reality, what I have found to be true is that they just get wilder as the sun goes down. Every patient on the floor is calling for pain meds as soon as the night shift nurses get to the floor. All their visitors have gone home and there is no one or nothing to distract them from their pain or boredom. Throw in all the one million other things we have to do and it makes for a very "interesting" (please note the sarcasm there) night. Does everyone else on night shift have this problem as well? If so, please give me some tips on how to get the doctors to take note when we are having a problem with a patient. I have had doctors tell me over and over that they will "deal with it in the morning." Yeah, they'll deal with it in the morning---meanwhile I am up to my elbows in it right now!

I'm not sure what kind of system you have to work with or what you're looking for, but we have our meds in drawers under our COWs which are pretty easily transported from room to room. The one thing I do to save myself some time is that I go through each patient's meds and get all of the 2100 meds in a baggy so that when I walk into their room, I have already been through all of them (and looked up the ones I was not already familiar with--bc you know that's the ones they'll ask about! ;-) then all I have to do is scan them and give them. I like to do it this way bc I am actually looking through their meds twice and it really does seem to save me some time. As far as the tray you're looking for, how about like a mini-muffin pan or something? (Just a thought)

you seem to really have it together, and I commend you for that That's the thing, I SO did not have it all together, and I was about ready to pull my hair out. At one point I even asked my charge nurse if we could call the doctor and get an order for xanax---for me! LOL! But I just kept thinking that I was doing the best I could and that was all I had to offer. I was so glad to see 0700 come that morning so I could get out of there. I was to be off the next night (fri), but I came home that morning and got some rest and actually went back in for a couple of hours (off the clock) to "baby sit" this guy and help my co-workers out. (I just could not imagine knowingly leaving someone else in the shape I was in the night before.) I figured a couple of hours would give them time to get other assessments done and catch up on some charting. (I'm sure it sounds like I am a really generous person for that, but the nurses I was helping would have done the exact same thing for me. I would not have done it for just anyone. ;-)

Thurs night was a crazy night for me. I only had 6 patients and most of them were good except I had one with a hemoglobin of 4.0 (that is not a typo). The 4.0 hemoglobin guy was getting blood all night and had a previous MVA that left him with just enough brain damage to be ornary, combative, and just mean in general, but he was still "with it" enough that we couldn't really restrain him. Hemoglobin guy was scheduled for an EGD and colonoscopy in the am so he was NPO (and not one bit happy about it; nor was he happy about the blood). He proceeded to tell me that he felt we were using him as an experiment and that he would not be back to this hospital every time I went into his room. He wanted to go outside so he could smoke, but with blood hanging and his low hemoglobin, this was not an option. No worries, he just drug his IV pole to the bathroom and smoked there (3 times!). We had to stop in between each of 4 units to take him out in a w/c just to keep him from smoking in the bathroom. At 0600, I was standing at the med cart when I smelled smoke yet again. By this point I had had enough. I walked to his room, turned the corner and saw his IV (pole, catheter, blood and all), but not him. He had ripped out his IV (for the second time) and his bed was now covered in blood while he stood in the bathroom smoking. I managed to get him back to bed and hooked up again just in time to give report. I felt like I had been hit by a truck. I was completely frazzled. The funny part of this is that while I was coming apart at the seams, I never thought about how I looked to any one else. Well, I went in tonight for a couple of hours and I saw our RT. She stopped me and asked me how I managed to stay so calm that night. I told her I thought she had the wrong person. ;-) She said she had watched me all night chasing after this guy and I seemed to be so cool and calm. She said she even left it in her report that she wondered what it would take to "rattle" me. HA! I told her she had missed the part where I had a little break down. I guess I am just glad to know that I at least look like I have it all together and know what I am doing. I hope my patients see me the same way. ;-)

I work night shift on med/surg in a very small hospital. Our rule on nights is 2 nurses for up to 18 patients. Once we get 18, we can have 3 nurses, but if we have say 17 "needy" patients, we usually call someone in to help with the 2100 med pass. I have had as many as 8 patients on nights. It is a handful, but can be done safely (with teamwork). If we get in a bind, we can usually depend on someone from ER to come help us out for a moment. On the flip side of that, we always have at least 2 nurses on the floor. So I actually worked one night when we only had 4 patients for 2 nurses. ;-)

Christine-- Sorry that you had the rough day, but it sounds like you handled it really well.

You guys are great! Yes, it does feel good to vent (to people who understand what I am talking about). I went in for my extra shift today and things went like clock work. I really needed that. My nursing supervisor pulled me aside for a few minutes to talk about a few "errors" I had made Tuesday night, but told me that she was in no way coming down on me. She said she thought I had handled myself well. I told her that I had learned quite a few lessons that night that I would never forget. I just might make it after all. LOL! ;-)

Ok, I can now officially say that I have had the night from #@**! To start off with, my hospital is in the middle of some renovations (which makes things interesting to say the least). As soon as I hit the door yesterday, I had two patients fresh from hip fx repairs (by fresh, I mean they hit the floor about the exact same time I did!). One is a middle aged alcoholic on watch for withdrawl, the other is 100 years old (almost 101--not kidding). Another pt claims that someone gave him meth without his knowledge which induced a MI. Straight away (before report), I had to go do assessments on my two new surgery pts who seemed fairly stable at the moment. I went to get report, stepped out on the floor and all hell broke loose. My 100 y/o became non-responsive with no bp to be found. Telemetry reports showed she was in a sinus brady rythm in the 30's! (did I mention that I am in the middle of hanging blood at this time? for my first time EVER)) OK guys, I'm new and I will readily admit I had not a clue what to do. I immediately turned her on her head (trend) and called for my charge nurse. Within minutes, the ER doc arrived. We increased her fluids (after a bolus of NS) and the situation was resolved (for now). Not more than 2 hours later, same thing. Only this time, my meth/MI guy across the hall went into respiratory distress. Called RT for him and played the same game with the 100 y/o as before. Crisis adverted for the moment. Left 100 y/o in trend for the rest of the evening. Seemed to help (for a while). Now it is getting to be about 4am and I have not charted one thing! I have passed all my meds, but have not done any real assessments on any of my other patients. Did I mention that meth/MI guy has now pulled out his IV? LOL! After spnding a great amount of time on the phone with the dr, I run through and do quick assessments on my pts (at this point they were all breathing and that was about the extent of my assessment). I sat down and charted everything I could remember, but wonder now if it even made any kind of sense. During my charting, one of my other pts who is completely "with it" mentally decides to have a horrific nightmare on me. She apparently thought someone was after, ripped out her IV, stripped off her clothes and was standing in the hallway naked and covered in blood. Got her woke up and reoriented her. She was terrribly embarassed. Pt redressed, IV restarted and now I realize that her antibiotic that was supposed to be hung at 1300 the day before was still sitting there. It had technically expired so had to remix it myself, fill out an incident report and get it going. Now, I can finish my charting...yeah right. So I am sitting there wondering how I am ever going to get finished and this twit I work with asks is I could help her with her chart checks!!! (she has been a nurse for 10 years and has not offered to help me once tonight. not to mention that chart checks were the least of my concern.). I simply looked up at her and asked her if she had lost her mind! So it is now 30 minutes after my shift and I am getting close to being done when 100 y/o craps out on me again (the next shift was still in report), so back on the phone with the doctor AGAIN. Another bolus, more trend. By the time I was finished it was an hour and a half past my shift. I apologised to the next shift for everything I had done or not done and told them if they would just let me sleep until noon, they could call me then and let me have it. They assured me this would not happen. I told them not to make promises until they saw the mess I had left for them. I did get a call from work around 1100, but it was not from the nurses, it was from our lady that does our schedule. They need help tomorrow (today 9/1), can I come in from 7a-1p. Sure I said and back to sleep I went. I felt like a horrible nurse guys. I did not give my patients the care they deserved last night, but I gave them ALL I had. To be honest, I only got one bathroom break last night and did not have time to eat anything. I left this morning ashamed for all that I knew I had missed, but also proud that everyone was still breathing when i left. I think I held up OK under the pressure (not that I am ready to do it again anytime soon) but my poor charge nurse (who normally has nerves of steel) literally went into the bathroom to cry last night. Please someone tell me that everyone has had these nights and it will be ok. how do you handle these situations and what else could I have done? Just for the record, my 100 y/o was on her way to CCU while i was on my way out the door this morning.

SC

I work at a very small community hospital (43 beds) and my start off pay was/is $18.50/hr + $1.75/hr for nights and + 8/hr for weekends (love those weekends! ;-) There are 3 larger hospitals within 30 minutes of my home that start off in the $20/hr range, but I absolutely love this small hospital and it is only an 8 minute drive for me.

I graduated in May 05 as well and started working a couple of weeks later. I know exactly how you feel. I work nights on a med/surg unit and I am often still hard at work up to 30 minutes after my shift and still leave every day feeling as though I forgot something or missed something all together. I just feel like I'm missing something some where.