I've started working prn at a new hospital in a different county from my previous job. At my full time job (a med surg floor) we see our share of drug seekers. We may have one drug seeker as a patient every few shifts. They almost always have another underlying medical problem. But at my new job the amount of drug seekers is absolutely ridiculous. I will have 1-2 drug seeking patients every shift. And yes they usually have underlying medical problems. But seriously 8mg of morphine and 25mg of phenergan IV every 3 hours for a patient with DM? Where is your pain? Your abdomen? Well you're eating soup and drinking coffee so it must not be too bad. I guess because this hospital is the only hospital in that particular area we see more drug seekers than my other job. At my full time job the hospital is 1 of 2 major hospitals in that particular county.
I have never given narcotics like I am having to give at my new job. I have patients who are getting Morphine 4mg IV every 2 hours for SBO and this has been going on for over a week!! And you wonder why your bowels haven't started moving????? I had a patient 2 nights ago call for her morphine and phenergan and when I got down to her room she was snoring!! Then when she woke up 2 hours later she was furious that I didn't give her the medicine while she was sleeping?
These people aren't fooling me? How do they fool their doctors so easily? Or do their doctors just not care? The same people come into the hospital over and over every few weeks with the same issues and spend their entire admission higher than a kite. I know addiction is a disease but when doctors are enabling the disease they surely won't get better!!!
And the truely scary part is this hospital is full of new grads... These new grads don't even blink an eye about giving large amounts of narcs over and over every 2 hours.... This is a serious accident waiting to happen......
Oh come on... I never said he was faking a SBO? I said the morphine wasn't going to help his GI motility.....
Some of y'all are really ridiculous. This is my VENT thread and if you don't like it please leave.
And I am not this horrible nurse most of you are probably picturing. I medicate my patients as ordered and I show them compassion. I just started this thread to show my frustration at how some patients are so easily able to manipulate their physician into ordering absurd doses of meds while they are in the hospital. If you work on the floor then you all know what I mean.
I'm not directing this towards you Southernbee... I thought that was an excellent post.
Even if it was, that would have been ok, after all, it IS a vent thread, lol.
I dont want yall to think drug seekers dont get on my nerves either, cuz, omg do they ever! being a drug addict in recovery, i always tell them "dont even go there with me" type things, lol. i'll give them their ordered meds when it's due or it's time but dont even bother trying to manipulate me into giving you more cuz it wont work, honey.
my husband is a drug/alcohol counselor. a big part of their job is calling the addict on their own crap. i am SOOOO jealous cuz he can tell his patients "shut up and go to your room!"
And for those that might imply it isn't the nurse place or the doctors place to question if someone is truly in pain or not....I know the teaching pain is what the pt says it is....but doctors have been sued for "getting" people hooked on narcs. And like if or not we are in a very drug manipulated world.
I agree and for those who 100% buy into the "pain is what they say it is" mantra, how easy would it be to tell this to Michael Jackson's and Anna Nicole Smith's children.
Thank you for adding your insight. I did not think that a tolerance is somethig that lasts once the person is clean for a period of time though. How do you know that 8mg of morphine won't work on you? I'd also discuss it with your team and see if there isn't a better choice for someone with your history.
With regard to the OP, you do have to be careful if they are withdrawing from something like ETOH than can be life threatening. Of course they know this and will milk it. I normally just give them what want to shut them up and keep my milieu safe. Sorry if that sounds lame but its the practical thing to do on a psych floor most times. My biggest issue with drug addicts is that they have absolutely no tolerance for any type of discomfort at all. For Pete's sake, life itself is uncomfortable folks! :angryfire
i was just using 8 mg of morphine as an example as thats a pretty normal dose for a "normal" person. if a medical professional came at me today with morphine i would panic. unless something traumatic were to happen to me and i couldnt speak for myself, morphine will never go into my body again. i know my disease entirely too well. luckily for me, since getting sober, ive discovered that toradol actually works, lol. i threw a PE once a few years ago. the nurse came in my room with a syringe and took my IV line to inject the med. i asked what it was and she said 'something for pain'. HA! you never saw a fat woman that couldnt breathe jump off a table so fast in your life! i thought she was trying to give me morphine or another narcotic and i freaked out. it took her and my husband a minit to get me calmed down enuf to believe them when they said it was only toradol, lol. (i worked for the hospital and always told all caregivers i'm in recovery).
but the thing with addiction is this...
although, especially now after almost 6 years, that 8mg of morphine would probably be effective for me, it wouldnt be effective very long. the way my addictionologist explained it to me is that after about a week on a "normal" dose, due to the disease process of addiction, my tolerance would then start to go up. thus the reason that addicts usually have to take a higher dose than most people. addicts are hard to treat for pain. on one hand, you want them to be as pain free as possible, but on the other you have to be careful to give the amount needed because of their increased tolerance while trying not to just get them high. i dont envy any professional trying to treat us at all. we are more than a pain in the butt and hard to treat.
nope, dont envy you guys at all. i cant imagine what it's like for you guys because i know that everytime i get a new patient thats a "pain clinic" patient i think "just shoot me now".
Specializes in med-surg, psych, ER, school nurse-CRNP.
"Pain is what the patient says it is"
Horse manure.
There, I said it. I've been saying it since nursing school, and I'll keep saying it until my dying breath.
Seen it all, too. My most memorable on was a benzo, not a narc. I worked Psych, I was the only staff on the floor, no one in the med room, could not leave to get the crazy so-and-so her Valium for the "panic attack" she wasn't having. Finally managed to get up there within 20 minutes of her asking, brought it to her room, and found her sitting in the floor, rocking and ignoring everyone. Offered her the med, she never acknowledged I was there. Took it back, documented, wasted it, and told the doc. He canceled the order!
Said that if she was that torn up about it, and wanted to act the fool, we weren't going to BEG her to take her PRN. She was one that needed to be treated like a child, it worked well. She never pulled that stunt again.
She also wrote on her d/c interview that I "caused her to injure herself" by "refusing her her meds". She was taken into a room and told that if she wanted to fling accusations about, she could prove her "injury" or hush. Needless to say, not a mark on her.
We had the luxury of having docs that just did not put up with that. Would that they were all that way.
Specializes in med-surg, psych, ER, school nurse-CRNP.
I also remember a poor lady, a young mom, who had cancer and was terminal, and was actually en route to another facility, but reached our town and was in such dire straits that she could not go on. She had a special PCA that her onco had given her with I think fentanyl in it. She also had orders for q1h Dilaudid, and a second PCA with something else. I had her for one night.
This poor woman was in utter agony. Her Mom was in the bed with her, her whole family was there. I bet I spent 8 of my 12 hours in the room. I was giving Dilaudid 5mg every hour (more like every 45 minutes, I'd have it pulled without even asking because I could hear her moaning. I would ask her if she needed meds, and she would usually refuse until the family told her it was OK. At one point, her father came to me at the Pyxis and said "She's starting to feel it again", and he was so startled that I was there already pulling the meds without being asked that he nearly cried), and I finally called the anesthesiologist who was consulted to ask for more orders. He refused. He came up HIMSELF and gave her Ketamine.
She died the next day. Her family sent the charge that night and I a thank you card, care of the floor. The NM let us open it ourselves, and we both broke down. I think that may have been my saddest case as a nurse, and the ONE time I was perfectly willing to pour the pain meds to someone without thinking that they were seeking.
We will stop seeing drug seekers when hospitals ban together with a policy that states pain will be treated with NON-NARCOTIC medications (ie., ibuprophen and Tylenol) until an underlying cause can be determined. Suggest it to the docs - sometimes they'll agree! I know of one hospital that actually instituted a similar policy, having frequent flyers sign a 'contract'. It's cut down on the abusers:D
Kudos to you for mentioning it.... I think it should be a policy all across-the-board
I work as NP in a community health center and we have more than our share of drug seekers. I think it's easier to "say no" in an outpatient setting, because the patients are ambulatory and not usually in obvious distress. We either send chronic users (who are often legitimate) to a pain management clinic or have them sign pain management contracts that limits the amount of narcotics they can have and subjects them to random pill counts and drug tests. Still, many still get what they want despite numerous notes in the chart that their drug use is suspicious. That makes me crazy!!! I sometimes wonder if I deny opioids to people who really need them, because I have been burned by the drug seekers. The whole "pain is what the patient says it is" can be tough to deal with from a provider's perspective.
I work as NP in a community health center and we have more than our share of drug seekers. I think it's easier to "say no" in an outpatient setting, because the patients are ambulatory and not usually in obvious distress. We either send chronic users (who are often legitimate) to a pain management clinic or have them sign pain management contracts that limits the amount of narcotics they can have and subjects them to random pill counts and drug tests. Still, many still get what they want despite numerous notes in the chart that their drug use is suspicious. That makes me crazy!!! I sometimes wonder if I deny opioids to people who really need them, because I have been burned by the drug seekers. The whole "pain is what the patient says it is" can be tough to deal with from a provider's perspective.
I do believe that sometimes providers deny pain meds to people who really need them. Not intentionally, but for fear they may become a seeker, or are seeking. I was in a 4 wheeler accident 5 years ago where I broke a few ribs. Doctors would not give me anything. After a month of pain I begged for something and I was prescribed 6 flexeril tablets. It took me a year to get back to normal from that accident.
we will stop seeing drug seekers when hospitals ban together with a policy that states pain will be treated with non-narcotic medications (ie., ibuprofen and tylenol) until an underlying cause can be determined. suggest it to the docs - sometimes they'll agree! i know of one hospital that actually instituted a similar policy, having frequent flyers sign a 'contract'. it's cut down on the abusers:d
i'm not trying to stir things up but almost exactly a year ago, i reached down to put my recliner's leg rest down and our 17# cat jumped up at the same time and i reached out over and around her (if that makes any sense) and put my legs down. immediately, i felt a searing burning pain in my right shoulder. i put ice on it but when it got worse instead of subsiding, my husband drove me to the er. i was triaged and given a new ice pack. when i was finally seen, the physician said i didn't need an x ray or ct scan, i had "just pulled a muscle." that was 12/29. on 01/4, my ortho's office opened again and he saw me that day and ordered an mri. i had a 7.5 cm tear in my rotator cuff. same side i'd had repaired 20 years ago... when my ortho checked with the er doc, the er doc said he hadn't pursued it "because nobody tears their rotator cuff using a lazy boy." but i did... and i don't use any narcotics at all and only extra strength tylenol.
while i fully realize this a thread about drug seekers, some people in pain do get overlooked. my husband said i looked like both eyeballs were in the same socket that night and that was unfortunately what the doc decided was melodrama. not all of us moan and text and eat burritos when we hurt.
southernbeegirl, BSN, RN
903 Posts
Even if it was, that would have been ok, after all, it IS a vent thread, lol.
I dont want yall to think drug seekers dont get on my nerves either, cuz, omg do they ever! being a drug addict in recovery, i always tell them "dont even go there with me" type things, lol. i'll give them their ordered meds when it's due or it's time but dont even bother trying to manipulate me into giving you more cuz it wont work, honey.
my husband is a drug/alcohol counselor. a big part of their job is calling the addict on their own crap. i am SOOOO jealous cuz he can tell his patients "shut up and go to your room!"