To the cynical nurse

CoolhandHutch, MSN, RN · Jul 3, 2011

.....even the frequent flyers crump. It's just a matter of time.

tokmom, BSN, RN · Jul 3, 2011

so true isn't it? We do become very cynical and narrow minded at times. That is what years of doing this job will do.

linearthinker, DNP, RN · Jul 3, 2011

I don't think you should be proud of being naive, but neither do you need to be cynical. My position was always this: it is not my place to either believe or disbelieve the patient. It was my responsibility to assess and report objective and subjective symptoms. I did that. Providers wrote orders and I implemented them. I could give a **** if the patient is seeking or not. Not my problem either way. I gave what was ordered, period. I did not apologize if it wasn't what the patient wanted, I referred them back to the person with the legal authority to change it.

I have never understood why anyone cares if a seeker gets their fix or not. What difference does it make? It impacts my happy life not one iota. Live and let live. And if their life is as a big a hot mess as I suspect, too bad so sad for them. Deciding that they are "seeking" and interfering in some small way that might get them less drug or less often is not important enough to me to bother. Worst case scenario, some scum of the earth drug seeker gets high. What do I care? Let 'em. If I lived that life, I'd want to be high too. I opt to assume a) their life sucks (ie they have psychological pain) and they need to escape or b) they have genuine physiologic pain. Then I implement legal orders and forget about it.

Believe me, taking that approach will save you a lot of grief. Resenting the hell out of people who are getting something you think they shouldn't (not *you* the OP, but general YOU) is a surefire way to unhappiness and dissatisfaction. Opt out.

LegzRN · Jul 3, 2011

How are you naive if you're not the one ordering the medication? Who cares as long as it shuts them up while your gritting your teeth to the tune of "LEVEL ONE TRAUMA ETA NOW."

mrsmamabear2002 · Jul 3, 2011

I don't think you should be proud of being naive, but neither do you need to be cynical. My position was always this: it is not my place to either believe or disbelieve the patient. It was my responsibility to assess and report objective and subjective symptoms. I could give a **** if the patient is seeking or not. Not my problem either way. I gave what was ordered, period. I did not apologize if it wasn't what the patient wanted, I referred them back to the person with the legal authority to change it.
I have never understood why anyone cares if a seeker gets their fix or not. What difference does it make? It impacts my happy life not one iota. Live and let live. And if their life is as a big a hot mess as I suspect, too bad so sad for them. Deciding that they are "seeking" and interfering in some small way that might get them less drug or less often is not important enough to me to bother. Worst case scenario, some scum of the earth drug seeker gets high. What do I care? Let 'em. If I lived that life, I'd want to be high too. I opt to assume a) their life sucks (ie they have psychological pain) and they need to escape or b) they have genuine physiologic pain. Then I implement legal orders and forget about it.
Believe me, taking that approach will save you a lot of grief. Resenting the he!! out of people who are getting something you think they shouldn't (not *you* the OP, but general YOU) is a surefire way to unhappiness and dissatisfaction. Opt out.

:yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah:

CaregiverGrace · Jul 3, 2011

i agree with the previous post. It is easy to fall into that trap of second-guessing a pain med administration, but ultimately it is not in the nurse's role to determine "seeker" vs "non-seeker". Of course, a nurse can inform the doctor of other issues with the patient that may prevent pain-med administration (such is patient is clearly drunk, or high, or has a clear past for drug abuse/rehab) but to say "well, this person in my judgement is not in the amount of pain they claim to be" is bad nursing practice. You can assess and report any contraindications to pain med admin, but including personal judgements of the patient's need vs dependency is simply not performing your duties properly.

Art_Vandelay · Jul 3, 2011

I could give a **** if the patient is seeking or not.

:lol2: :lol2: :lol2: :lol2: :lol2: :lol2:

eriksoln, BSN, RN · Jul 3, 2011

My wakeup call regarding the cynical approach fortunately came with a patient I hadn't cared for. I did though sit at the nurses station and partake in the conversations.

It was an older woman, who asked for her pain meds frequently on top of many other requests (yes, the usual "move my tissue box, pour the water for me, fluff my pillows" stuf). She was getting on everyones last nerve. Eventually she was discharged, was told to F/U with her PCP and a pain clinic regarding her generalized pain.

Well, she came back a few months later, with mets to the bone. That was the source of the generalized pain. She died, under hospice care........about a month later.

Yeah, real eye opened there. I basically walked away from it with the attitude being described here in the above posts. I don't care if a few seekers get high of my work, I'd rather just believe everyone about pain and be sure that never happens to anyone under my care.

KittyLovinRN · Jul 3, 2011

I work in a cynical ER...really who doesn't?! Last shift being cynical caught up w/ us. I often hear from my co-workers that I am "so naive," regarding the drug seeker patient. I have always interpreted this statement as an insult or perhaps indicating I have a weakness. However, after witnessing a patient who was being treated as a "seeker" turn into a code, I quickly realized I will take the "you are so naive" reputation any day. I guess I just want to remind everyone that we need to remember that our patients come to the ER for help and if they rate thier pain 10/10, we should treat it as just that, because what if it really is a 10/10...

I hope you're my nuse the next time I go to the ER for my kidney stones. I'm an RN and kidney stone patient and going to the ER is LAST on my list of favorite places to go because I am seeking relief but asking for it is OUT of the question. I made the mistake once of telling the doc I had taken a dilaudid PO at home (prescribed by my urologist) and I got stares from both him and the nurse like I had been doing illegal drugs! :mad:

They always put me through a CT scan before giving me anything that will adequately relieve the pain. I once heard someone behind the glass in the CT scanner say "Oh my GOD" as my scan showed up on their screen with my 7mmx9mm stone stuck in my right ureter....

Sometimes it's nice to prove it to them though

himilayaneyes · Jul 3, 2011

Quite frankly I could care less whether the patient is a drug seeker or not. If the MD ordered the meds and the patient says they're in pain. I give it. The patient leaves me alone and life becomes a little easier. Pain is what the patient says it is. Not our job to make a call as to whether it's real or not.

~Mi Vida Loca~RN, ASN, RN · Jul 3, 2011

I work in a cynical ER...really who doesn't?! Last shift being cynical caught up w/ us. I often hear from my co-workers that I am "so naive," regarding the drug seeker patient. I have always interpreted this statement as an insult or perhaps indicating I have a weakness. However, after witnessing a patient who was being treated as a "seeker" turn into a code, I quickly realized I will take the "you are so naive" reputation any day. I guess I just want to remind everyone that we need to remember that our patients come to the ER for help and if they rate thier pain 10/10, we should treat it as just that, because what if it really is a 10/10...

Yea I get pretty tired of the insults because I try to have a positive attitude towards nursing, am enthusiastic and truly enjoy helping other people. I am always scoffed at about how that won't last long. Last time someone said that I turned around and said "Bet me". They didn't know what to say. I have met MANY nurses that have been in the field for a long time and still truly enjoy what they do and the good days far outweigh the bad. So I know it's possible and I am not the type of person that would allow myself to turn into such a negative person anyway.