sitting with drug seekers.

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So my job is primarily sitting with people for various reasons, one of them being people who are aggressive, or suicidal. 9 times out of 10, these people are wanting drugs at a pretty constant rate...the problem is when they are told that it isnt time, or when the doctor cuts them off completely. they act like its my fault or something..any ideas on coping with these guys?? 8 hours in a room with someone constantly freaking out because they didnt get their q4 dilaudid right on the dot get very very tedious. :blink: and now im just griping, but really hate it when their families show up, and either get them all riled up, or start fighting, etc.

Specializes in Med-Surg.
I do not understand how it is so difficult for some nurses to give the q4 dilaudid right on the dot, it is their freaking job! I do understand that every now and again emergencies happen and a nurse may not be able to get to it right away but if this is happening often it is because the nurses suck. Some nurses are just lazy or rude and think they are little gods whose job it is to decide who is worthy of getting their SCHEDULED medications on time. It is the nurses JOB to get the pain medication to the patient on time and it appears that the nurses you work with are not doing their jobs.

Must be sarcasm. This can't be serious.

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Number one- as a nurse with Lupus and rheumatoid arthritis I live with chronic pain and I know firsthand that I cannot judge someone else's. So please don't label people as drug seekers. Number two, everyone has different tolerance, threshold and reactions to pain. Although it may be just someone with "back" pain, that pain may be very hard for them to deal with. Number 3. I understand you have a frustrating job and I commend you for it.. That's something that takes a special person. Try comfort measures like distraction techniques, touch and message therapy, ask a CNA For a warm blanket for the patient, etc. Hopefully that will hold the person off until the meds are given.

If I have a patient who I know is gonna ask for meds in the dot even if it is a prn I try to give it before they even ask. Granted that doesn't always happen cause I'm only one person with 48 patients.

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Unfortunately most of the time you cannot please them unless the nurse is sitting by a clock with a syringe of dilaudid in her hand. Which is impossible because there's a good chance the nurse has multiple pain management patients who all expect the nurse to be in on the dot. When I have patients who require ATC pain medicine (PRN by order, but scheduled per the patient),I try my very hardest to get it on time, for the patient but also for the ease of my day. I'll even go in 15 min early before they have the chance to call, if I know I'll be tied up for a while with another patient. I do know various nurses that approach these patients differently though, making them wait just because they are sick of them, which is very sad to me and really just makes for a more stressful day.

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Specializes in Psych, Addictions, SOL (Student of Life).
exactly!! the nurse could have someone going out on them, and this person will be throwing temper tantrum because she didnt magically appear in the doorway at 7pm or whatever time they start demanding it. also, that is the point of my post..they dont need it! they will be snoring away, or running their mouths, kicked back and laughing..and here comes the time they are allowed to have more medicine and its like they become different people...and they get snotty with me, the sitter, because i cant force the nurse to come dope them up on time! :yes:

Okay, as a CNA (you) and even a lot of licensed nurses have a lot to learn about the difference between acute and chronic pain. As I start this explanation I would ask you to bear in mind that I am and alcoholic in recovery over 10 years so I know a thing or two about medication addiction/dependence. I also have Ulcerative colitis and Fibromyalgia so I know a thing or two about chronic pain. When you are determining a person's pain tolerance you explain the pain scale, ask what their current level of pain is and finally what is their acceptable pain level. So in my case I would answer that current/Always pain level is 4 to 6 and acceptable level is up to 6. Understand I am ALWAYS in pain. But I work, talk eat, sleep, laugh, watch TV, read etc. At this time I choose not to use opiates but I have them on hand if they should be needed. Person's with chronic pain often do not have significant changes in vital signs.

It is not the nurse's job to determine if a patient needs their pain or anxiety medication. If it is ordered and it is within the time frame and the resident is awake and alert then give the F*&^%$g medication. It will make your job easier and keep the patient comfortable.In some cases not getting their meds within their customary time frame can cause very real painful and life threatening withdrawal states.

I have found that with chronic pain patients it is helpful to tell them daily that you will absolutely try to respond in a timely manner but there may be a wait if I am with another patient.

If I feel a patient is receptive to talking about alternatives to Opiate or Benzo medication I will let the doctor know so an addiction specialist (yes there are such things) can be brought in for a consult.

Hppy

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Okay, as a CNA (you) and even a lot of licensed nurses have a lot to learn about the difference between acute and chronic pain. As I start this explanation I would ask you to bear in mind that I am and alcoholic in recovery over 10 years so I know a thing or two about medication addiction/dependence. I also have Ulcerative colitis and Fibromyalgia so I know a thing or two about chronic pain. When you are determining a person's pain tolerance you explain the pain scale, ask what their current level of pain is and finally what is their acceptable pain level. So in my case I would answer that current/Always pain level is 4 to 6 and acceptable level is up to 6. Understand I am ALWAYS in pain. But I work, talk eat, sleep, laugh, watch TV, read etc. At this time I choose not to use opiates but I have them on hand if they should be needed. Person's with chronic pain often do not have significant changes in vital signs.

It is not the nurse's job to determine if a patient needs their pain or anxiety medication. If it is ordered and it is within the time frame and the resident is awake and alert then give the F*&^%$g medication. It will make your job easier and keep the patient comfortable.In some cases not getting their meds within their customary time frame can cause very real painful and life threatening withdrawal states.

I have found that with chronic pain patients it is helpful to tell them daily that you will absolutely try to respond in a timely manner but there may be a wait if I am with another patient.

If I feel a patient is receptive to talking about alternatives to Opiate or Benzo medication I will let the doctor know so an addiction specialist (yes there are such things) can be brought in for a consult.

Hppy

So very true.. The body physiologically adapts to changes that pain creates. So chronic pain patients may have a BP of 100/60 but still have a pain level of 10.

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i get what you are saying...but no. these people want to get high. they dont suffer from chronic pain at all. i had one lady faking a seizure. it was cringeworthy, to say the least. anyway, i just had to get it off my chest because 8-12 hours in a room with these people can get very stressful!

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exactly!! the nurse could have someone going out on them, and this person will be throwing temper tantrum because she didnt magically appear in the doorway at 7pm or whatever time they start demanding it. also, that is the point of my post..they dont need it! they will be snoring away, or running their mouths, kicked back and laughing..and here comes the time they are allowed to have more medicine and its like they become different people...and they get snotty with me, the sitter, because i cant force the nurse to come dope them up on time! :yes:

We had a nursing instructor tell us that she did NOT want to hear the word "drug seeker" come out of our mouths as pain is subjective, and we cannot judge someone's pain. When instructor #2 took over the lecture she laughed out loud and told us that she cannot stand the ER pt who is laughing on their phone one minute, and rating their pain an 8-9 the next, and that she absolutely refuses to give these pts 4 of morphine for a "tummy ache" regardless of what is ordered.

If you want my advice, I would consider changing your outlook to ultimately make your life a lot easier. These pts can be total PIA, and I would go bonkers sitting with some of them all day, I commend you. However, they may actually be in physical pain, or maybe it's emotional and the dilaudid helps, or maybe it's psychological and they are convinced they NEED it...no matter the reason, the pain is there, it is real, and they do in fact "need" the dilaudid (or other opiate or maybe benzo for anxiety). When you try to meet people on their level, they know it, and they tend to treat you better. You might even earn their trust, which is what this pt/caregiver relationship is all about. Your shift may change drastically, and that is a beautiful thing!

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oh, i would never EVER ever call anyone that or say that "out loud". my job is just to tell the nurse and document etc etc. which is why i posted here, so i wont completely lose my mind! :laugh: i like sitting, most of the time..but wow.it has to be the most tedious job ever created. and i dont mind the griping about the medication, im talking about those who get almost aggressive about it, as in..throwing stuff, cussing me out, kicking the wall, stuff like that. i can complain with the best of them, i know how to tune it out!

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Specializes in Psych, Addictions, SOL (Student of Life).
i get what you are saying...but no. these people want to get high. they dont suffer from chronic pain at all. i had one lady faking a seizure. it was cringeworthy, to say the least. anyway, i just had to get it off my chest because 8-12 hours in a room with these people can get very stressful!

First off all I get your frustration and need to vent. To say that sitting with difficult patients is easy would be a lie. Your employer should be giving you training in how to positively redirect a person in distress. When I worked in drug rehab I saw plenty of faked seizures but we still treated them as seizures non-the-less. The point is this is not about you and you have absolutely no idea if a person is in pain or not! Stop saying they are not in pain. Until you walk even an hour in the shoes of someone who has constant unremitting pain even at a level of 1 or 2 you cannot fully appreciate what it is like. Are there patients out there who abuse the system to get high absolutely but Dilaudid is a very short acting medication with a sharp fall-off in relief as it leaves the system. PS you don't get high from opiates, you get down. If you want to see a real drug addict in action go spend some time on the detox ward of any in-patient drug rehab facility. I actually hope you are never in pain and have to deal with the kind of narrow-minded judge mentalism so many here are spouting. It's a disgrace. Dealing with difficult patients is a part of the job. If you don't like it quit.

I am going to climb off my soapbox now and get something useful done with my day off.

Hppy

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you absolutely can get high from certain opiates. you can get high off of cough syrup. at any rate, i thought this was the CNA forum? i was hoping for input from other CNA's or nurses (the nurses also do sitting where i work) who might also have the difficult and sometimes rewarding job of sitting. no need to make my post into something it isnt, for that matter.

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i am off today, so i refuse to do ANYTHING useful. :roflmao:

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Specializes in Oncology.

A nurse that believes this!

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