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Nola009 Nola009 (New Member) New Member

So, as a nurse it's my #1 priority to serve your narcs on a platter...

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You are reading page 2 of So, as a nurse it's my #1 priority to serve your narcs on a platter.... If you want to start from the beginning Go to First Page.

Rich or poor a butthole is a butthole. Unrealistic demands are common in every setting. Do your best to get those meds out when due, don't look for a fight or personalize it. People generally don't give a crap about anyone but themselves. I was sending a resident out via EMS due to respiratory failure and as I was running back and forth with the giant oxygen tank, taking vitals and trying to reach supervisors, physicians and family members I was tripping over a LOL who parked her w/ch in the doorway and blocked my way-SHE NEEDED HER EYE DROPS. Her daughter reported me, I was told to apologize to them both.

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After my appendectomy, I was miserable and in horrible pain. I was in the ER for over 13 hours because the doc who treated me heard the word fibromyalgia in my history and decided I was there seeking pain meds. He let my appendix rupture and the infection got into my blood. Never mind the fact I was vomiting literally every 5 minutes and could not straighten my legs because I was in so much pain. He then decided to tell me it was my history of endo and called my ob and made an appt. even though I was telling him that this pain was different. He was trying to discharge me and I begged him repeatedly to examine me. He finally gave in and when he touched the lower right quadrant I came up off the table. I finally got my CAT Scan where I was promptly rushed to surgery within 30 minutes because of the infection. I spent about a week in the hospital with IV antibiotics and a nurse who was always late on my meds. I'm not talking 30 minutes, I'm talking hours. I was miserable and in pain and she was ignoring call lights and just letting me lie there in pain. I finally snapped. I knew I wasn't her only patient but dang letting me only getting a few hours of relief here and there was unacceptable to me. And between the treatment of the doc in the ER and now I'm in the hospital for what should be a routine surgery and not being given my little bit of relief is crazy to me. That was my first real experience with this rationale that people who need pain meds don't really need them because we are all addicts. I know there are plenty out there, but it saddens me when everyone gets lumped into one category. When I am a nurse, this is one area I hope to be able to help, those with chronic pain.

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Rich or poor a butthole is a butthole. Unrealistic demands are common in every setting. Do your best to get those meds out when due, don't look for a fight or personalize it. People generally don't give a crap about anyone but themselves. I was sending a resident out via EMS due to respiratory failure and as I was running back and forth with the giant oxygen tank, taking vitals and trying to reach supervisors, physicians and family members I was tripping over a LOL who parked her w/ch in the doorway and blocked my way-SHE NEEDED HER EYE DROPS. Her daughter reported me, I was told to apologize to them both.

See... I would have said 'for what?!! Prioritizing appropriately?!' That's what gets on my nerves. Of course we give pain meds. Of course. But the sole function of my education, hard work, and licensure IS NOT to be your narc (or eye drop) waitress. Omg.

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I have to agree with Nola on this one. Post op ortho surgery patients frequently end up in SNFs for therapy.

I always find it suspect, when the patient 2 weeks post op, needs more meds more frequently than they did on day one.

We can argue about residual pain, chronic pain, phantom pain....

Nola's just venting about a very particular kind of patient. Since I'm familiar with SNF post op patients, I can sympathize.

Yes, many get more and more

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Personally....if I had all of my rights removed and my personal belongings taken away from me and I no longer had any say over my personal life or my daily living...that I had to be told when to get up, when to eat, what to wear, how to wear it, wait for someone to help me go to the bathroom...I'd rather be drugged so I didn't know how disrespectful I was being treated.

If the only relief I got was from pain meds and the only thing I could control was when I got them YOU BET I'D WANT THEM ON TIME!

I think the fools who think long term pain can be handled without relief need to have chronic pain and I want to be their nurse.

I think we as nurses need to pause for a brief moment and consider the patient and how they feel. How would you feel in their position? How would you feel if this was your Mom? I think we need to remember it is the patient that we are there for and we need to be thankful we have sick patients so we had jobs.

I think taking a moment to put ourselves in their shoes can be enlightening.

While I agree with you in general, it is just not physically possible to give everyone's pain medication "exactly on time." And it does get frustrating trying to keep up only to have folks lambast you for being five minutes late.

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If pain meds are ordered, and there is no valid reason to withhold them, just go ahead and give them. You can argue addiction, etc., till the cows come home, but you won't win. If the physician sees fit to order them, and the patient wants/needs them, and there is no reason not to, just give them and don't let it get to you. You can discuss your concerns with whomever ordered them, but the patient sees you as the nurse who won't give their meds on time, and management will, too. Regarding post-op pain, yes, sometimes they get used to it and need more in order to obtain relief. Physical therapy is telling them to take their pain med so they can work with them; the family members are constantly asking them if they are in pain; no wonder the patient becomes focused on it.

Edited by applewhitern

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Yes, many get more and more

Playing devils advocate, from a point of view of "been there done that more times than I care to admit!", don't you think it's possible that after surgery when the patient is mostly laying in bed with not much exertion, they don't have high pain med needs. Then, when they are transferred to rehab/SNF for therapy their activity increases and their potential for pain increases as they begin to work more on range of motion, weight bearing, ambulating...the list goes on and on. As they work with therapy more and more their pain med requirement might increase at the same time to keep up with PT's demands. Eventually in their recovery, pain will start to diminish, but all you notice at first is "this patient needs more pain meds now two weeks post op then they did right after surgery."

Also, remember that it is beneficial to patients AND their nurses to give pain meds when due (or asked for if PRN) so that pain does not become unbearable to the point where you end up "chasing" the pain. If you let the pain get too bad the patient will be less able to participate in therapy, get out of bed, etc. because the pain is so severe. Unless there are more urgent things going on, pain meds should be a priority (over just finishing a med pass, etc.).

Good luck. I would suggest finding another job seeing as you find this particular SNF not a good match for your personality.

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Thank you... I had a bad night. A few things went wrong, but the squeaky wheel was the son of the pt yelling that one measly pain pill was half hour over due (sheesh), it's getting to be a PROBLEM (hey, im prn there), he demanded to speak with on call mgmt (ok, sure) and proceeded to write down every med I gave (wth) all night. Wow. Found out after the fact he'd ben doing that for awhile (um, couldve told me in report, it would have been nice to not be ambushed). I don't know about this individual, but it seems as though some of these folks first BECOME addicted post op at our SNF where the narcs flow free. Then they go see your people in the ER later, I dont know? Whatever the case is, I don't wanna be treated like a narc waitress. I had a lot of other things, pts that needed my attention and this guy ate up too much of my time with his yelling and threatening behavior. To top it.all off, 5 min after I gave the med said pt was.walking around no probs/distress. Yeah, I know that this place isnt for me. That's why I went from FT to PRN. I'm just trying to get enough experience built up so that I can move on. I DO have a lot of adorable/decent, and nice pts, but these "bad apples" (mostly family members) really spoil it

They try the patience of Job! Those are the days I wonder why I became a nurse! :facepalm:

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It sounds to me like the OP is simply frustrated with patients who are rude and demanding, and who don't choose to realize that one nurse cannot give meds to fifteen or twenty people at the exact same time. Admonitions to "put yourself in the patient's shoes" seem a little unnecessary, especially since we've all pulled our hair out at one time or another over patients who get on our last nerve. I was an ortho/surg nurse for seven years, and I'm pretty familiar with the common narcotics. Even after major hip surgery, narcotics were never scheduled, always PRN. I agree that a nurse can't really fight a patient's addiction -- that's the patient's issue to deal with -- but I know how demeaning it is to feel that all you are doing is feeding someone's narc habit. There are better ways to deal with chronic pain than to rely on q 4 hour narcotics.

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If pain meds are ordered, and there is no valid reason to withhold them, just go ahead and give them. You can argue addiction, etc., till the cows come home, but you won't win. If the physician sees fit to order them, and the patient wants/needs them, and there is no reason not to, just give them and don't let it get to you. You can discuss your concerns with whomever ordered them, but the patient sees you as the nurse who won't give their meds on time, and management will, too. Regarding post-op pain, yes, sometimes they get used to it and need more in order to obtain relief. Physical therapy is telling them to take their pain med so they can work with them; the family members are constantly asking them if they are in pain; no wonder the patient becomes focused on it.

I have not and would not withhold unless respiration s were less than 10. I do my best to get these people their meds (allmeds) on time, but it's really starting to get on my nerves how absolutely RUDE people (mainly family members) can be about these meds in particular. Like that's the only thing a nursing education is for.

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It sounds to me like the OP is simply frustrated with patients who are rude and demanding, and who don't choose to realize that one nurse cannot give meds to fifteen or twenty people at the exact same time. Admonitions to "put yourself in the patient's shoes" seem a little unnecessary, especially since we've all pulled our hair out at one time or another over patients who get on our last nerve. I was an ortho/surg nurse for seven years, and I'm pretty familiar with the common narcotics. Even after major hip surgery, narcotics were never scheduled, always PRN. I agree that a nurse can't really fight a patient's addiction -- that's the patient's issue to deal with -- but I know how demeaning it is to feel that all you are doing is feeding someone's narc habit. There are better ways to deal with chronic pain than to rely on q 4 hour narcotics.

Here's my humble two cents:

1. Most posters do not want the OP to be eaten ALIVE by the ugliness and vulnerability of pts and their families; unfortunately they come to us with train-wreck to disaster-related baggage.

2. As someone who has worked in LTC, SNF, and Rehab-my specialty being SCI pts who are a BEAR to deal with-that's putting it mildly-I've had to check myself and maintain professionalism and boundaries to be treated with respect; it takes practice, and many develop quickly, over time, or not at ALL...most nurses on her want her more towards the former than the latter.

3. Chronic pain is a *****...it I was a BEAR to deal with after my traumatic injury; my family was in upheaval and my life and world, as I knew it, was OVER, so yes, I was a train wreck, and best believe, if a nurse faltered, I cut into them with the quickness in terms of how I wanted to be treated; I could SMELL a nurse that didn't like giving pain meds ATC; I've learned most patients have that "sense" with nurses, and will grill their you know what.

Per the OP's concerns about addictions and such, it could be a possibility of such interactions, but then again, I don't know and I won't go further into more assumptions; however, it's something to think about when interacting with patients; interact as much, keep them in control of their schedule if they want to; that may be their ONLY sense of control; remind them that you have other pts, but encourage them to meet you at the cart at a designated time, if possible-engage the pt.

In my current experience, I found engaging those chronic pain people in having control of pain, and most if it is a knee-jerk reaction to something more; I'm not sure how the OP's employer is set up, but in my setting; people who have issues with continuing pain issues is counseled on pain management; as well as even a psych consult if the pain medication is a cover for something more; not to get into details, but once I had engaged with several pts, they started seeing psych, and most had a nurse underlying issue which was effective with therapy, or pharmacological methods; their request for pain medication decreased; they also engaged in gradual dose reduction in order to resolve their acute episode, unless they had an existing condition that they didn't disclose before; then they were adjust ion according to the pts needs.

I know this was a vent thread, but what I have learned in the 14 years I have been in this business, venting is only GOOD when you can DO something about what is bothering you; in some way...your not going to win every battle, but the thick skin that is your armor in such situations does help in the trenches. :yes:

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