To the cynical nurse

Nurses Relations

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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...

Specializes in Float Pool-Med-Surg, Telemetry, IMCU.

Posted by KittyLovinRN:

"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...."

:eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek: !!!!! I sincerely hope no one would begrudge you a Dilaudid after that.

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Specializes in Pulmonary, Lung Transplant, Med/Surg.
Posted by KittyLovinRN:

:eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek: !!!!! I sincerely hope no one would begrudge you a Dilaudid after that.

I don't even have to ask for it after the CT...funny how that works, but at least it does.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I'd rather be cynical than naive, cos if ur the latter, you get cheated, robbed and/or taken for a ride every time. Being cynical has also stood me in good stead I must say; I always listen to that '6th sense' - or inner voice, whatever you call it - I have, warning me something re a person/situation. I'm a bit fey, so I always listen to what my gut feeling & instincts tell me. When I DON'T listen to them, I always, ALWAYS end up in trouble or berating myself for being such an idiot.

Some sad stories here though I must say.

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Specializes in Emergency Dept. Trauma. Pediatrics.
I'd rather be cynical than naive, cos if ur the latter, you get cheated, robbed and/or taken for a ride every time. Being cynical has also stood me in good stead I must say; I always listen to that '6th sense' - or inner voice, whatever you call it - I have, warning me something re a person/situation. I'm a bit fey, so I always listen to what my gut feeling & instincts tell me. When I DON'T listen to them, I always, ALWAYS end up in trouble or berating myself for being such an idiot.

Some sad stories here though I must say.

It doesn't have to be either or. I have a pretty good "gut feeling" and "intuition" but I would far more tip the side of naive over cynical. The only people that have ever cheated, robbed, or taken me for a ride is my own flesh and blood or people that were supposed to be the ones I could trust or count on.

Patients, strangers, associates I have never had do wrong to me. Even with me being "naive". I have had friends chastise me for "putting myself in harms way" while trying to help someone. That you can't trust people, it could be a set up, it could be this. Well I am still here and I will always continue to be the same way.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.
It doesn't have to be either or. I have a pretty good "gut feeling" and "intuition" but I would far more tip the side of naive over cynical. The only people that have ever cheated, robbed, or taken me for a ride is my own flesh and blood or people that were supposed to be the ones I could trust or count on.

Patients, strangers, associates I have never had do wrong to me. Even with me being "naive". I have had friends chastise me for "putting myself in harms way" while trying to help someone. That you can't trust people, it could be a set up, it could be this. Well I am still here and I will always continue to be the same way.

My post certainly wasn't directed at any one personally, but you seem to have taken it that way. I was merely relating what has been MY EXPERIENCE only.

I'm sorry to hear ur own flesh & blood have cheated you in the past. Didn't you have any gut instincts about that? I suppose having a gut instinct doesn't mean one has to be cynical, but it DOES make me more wary, I must say. And I also will continue to be the same way, because it has stood me in great stead, though I will always continue to be professional towards patients, & not just think of someone as 'that alcoholic' or 'that druggie' (but it IS hard some days).

Cynicism has it's place in the nursing world I believe, and is not always a bad thing.

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Posted by KittyLovinRN:

"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...."

:eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek: !!!!! I sincerely hope no one would begrudge you a Dilaudid after that.

The problem is not AFTER the CT. It's before! And it could take a very long time to get the scan done. Shame on the cynics who have never been on the receiving end of their cynicism.

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Specializes in ER.

I think its inevitable all ED nurses develop a certain level of cynicism, because of what we deal with. Sadly sometimes it gets in the way.

Recent story - a local alcoholic rocked up in the waiting room, as he does most nights, and knew all the things to say to get a gurney for a few hours. Crushing chest pain, numb left arm, tingling jaw - all a well -reheorificed script.

This time though he was shaking so much from the drink I could not get reliable vitals or an EKG, so I just (somehow) took bloodwork and left him half an hour for the librium to kick in before trying again.

In that half an hour, one massive STEMI. Ended up in the CCU, and still there I think.

What should I have done differently?

Spend an hour or more TRYING to get a pulse rate, when he was shaking so much I could not even find it the old fashioned way? Mess around trying to get an EKG when there was so much shuddering that it looked like the picture on an old tv screen when you couldnt get reception?

Or leave him a while and move onto to deal with other patients? There was another MI going on which was evident and needed urgent attention, as well as a couple of acute asthmas. To be honest I did not believe this guy becuase I've heard him give the same story so often.

I guess I was wrong to NOT persist in trying to get vitals, but be honest, how many think the same thing when the same drunk turns up in the same ED, same week, same story?

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Specializes in OR; Telemetry; PACU.

I wear my Naive Badge with great honor because I feel that I will then be keeping a more open mind to situations. I have never understood why a seeker should be treated any differently. They see their pain as an off the charts 10 because their neuro system is out of whack. To me that is not the time to have them rehab...there are facilities for that. I've worked in a cynical ER too (GREAT team, just seasoned). I was told to Buck up little buckaroo and stop babying my patient. I did have to stand back and look at the situation and assess myself at that point...I was babying too much. :nurse: I can be cynical and I catch myself sometimes...it can be an ugly little beast if you don't keep it in check. And it's just never good for the patients or families.

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Specializes in critical care.

I don't understand why it has to be an either/or. Why not just give people the benefit of the doubt while at the same time keeping your radar up. It is possible to be caring and smart at the same time. "Hope for the best; prepare for the worst."

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Specializes in pediatrics, palliative, pain management.
Posted by KittyLovinRN:

"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...."

:eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek: !!!!! I sincerely hope no one would begrudge you a Dilaudid after that.

The problem is not AFTER the CT. It's before! And it could take a very long time to get the scan done. Shame on the cynics who have never been on the receiving end of their cynicism.

So what is the fear around giving the Dilaudid pre CT? That the patient isn't "really" in pain? Or that some how the dilaudid will change the CT results? There is so much lately about requiring "proof" in order to give pain meds. My attitude is there are 2 ways to practice nursing - 1) believe our patients - or at least listen to them and seriously consider what they are saying or 2) assume they are lying and make them "prove" themselves.

Seems very similar to legal systems -- is it innocent until proven guilty or guilty until proven innocent? What world do we want to live in?

Just things to think about .....

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Specializes in med/surg, AIDS, trauma.

i would consider myself a cynical nurse after 30 yrs but i also know my limits and have a very keen 6th sense. if someone is seeking i follow the drs orders and also call the dr if pt still c/o's pain. we are not going to "cure" the addict on this or any other admission or visit to the e.r. i just do my job to the best of my ability and try to show compassion to the best of my ability. p.s. i am a recovering addict.

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I was labeled a drug seeker at one point. Major (and I mean MAJOR) pain in my mouth and swelling in my gum that was labeled as gingivitis 5 days later turned out to be a massive Staph infection that resulted in periodontal surgery and 3 days in the hospital.

It was especially disappointing because I had waltzed into the ER 4 times in 5 days seeking relief from the pain and some kind of diagnosis (because I had no health insurance and couldn't get a dentist appointment for 6 weeks) and instead was treated like a drug addict.

I couldn't eat, sleep or talk for a week. I was having to call off of my shifts at work. I had been having high fevers throughout the day that I was breaking myself with tylenol. I could tell when I was talking to the attending physicians and nurses that they weren't taking me seriously. They might have thought they were being sly about their cynicism but a sober person can see right through it. Only when I blacked out on the Bus and was carried away in an ambulance did anyone take me seriously.

Was I a drug seeker in a way? YOU BET YOUR BOTTOM DOLLAR I WAS. People in pain are obviously going to seek relief from the pain, but that doesn't mean someone isn't also looking for a diagnoses.

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