I am wondering if it is hard to stay non-judgmental about patients who come in frequently seeking drugs. We start out as new nurses being taught to always treat the pain even if we don't think it exists. How do you continue to have a positive attitude vs. oh its him again attitude?
Angie
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February 11th, 2009 at 8:21 am
This subject set off an immediate reaction in me– since when were nurses put in charge of judging their patients?
I would strongly reccommend educating ones self about the DISEASE of addiction and the behaviors that accompany it. Drug seeking behaviors can actually be viewed as a cry for help. Active addiction is not driven by “wants” but by “needs” – the need for the addict to feel normal and without self education a nurse will not gain that understanding.
As a nurse in recovery I had my attitude changed for me when I became addicted to prescrition medication and was confronted by drug control agents for diverting from work.
Did I divert because I wanted too? Not hardly. Were my actions within my normal scope of behavior? Not at all. Did I wake up one morning and tell myself I wanted to be an addict, to engage in behaviors that were disgraceful and deadly? Did I want to risk dying? The answer is NO. But addiction doesn’t care who you are, what occupation you have – it’s an equal opportunity disease.
I have an article on this site that may offer some insight – hopefully it is in an archive. Memoirs of a Recovering Nurse Addict.
Please don’t put yourself in the position of judging – for many folks that job belongs to their GOD.
Instead utilize your skills to ASSESS the real needs of a patient that is suspected of drug seeking, provide them literature and contact information related to treatment centers, AA/NA meetings. Will the majority of “those” patients be delighted with your efforts? Maybe not on initial look, but you might be the one person who plants the seed of hope in someone suffering from a socially unacceptable insidious, chronic, progressive and fatal DISEASE.
Thank you for letting me share my thoughts
dede
February 11th, 2009 at 1:36 pm
Dede is right, it is never our place to judge patients, for any reason. We are there to provide them care, but that doesn’t necessarily mean we HAVE to give them the drugs they may be seeking every time. Keep in mind, we’re taught to treat pain every time because we can’t PROVE whether or not they are in pain. And pain is different for everyone else. But pain has different causes. And in many cases you can try something besides their drug of choice first. We had a “frequent flier” who came in regularly stating crippling pain and requested a particular medication for it. This patient was younger, early twenties or so. She was very thin, and used recreational drugs that killed her appetite. We didn’t want to keep giving her the meds she requested, but we have to treat the pain she is complaining of, and we thought of an interesting way to do it. Because she hardly ever ate or drank anything, she was really hungry and dehydrated. We started hanging an IV of regular saline on her when she arrived. Now, we couldn’t tell her we were giving her the medication she wanted, but we told her it would help, and after a bag or two she was much more comfortable. Partially from her dehydration, and I’m sure partially from the placebo effect, as she didn’t know the bag wasn’t medicated. This approach worked well for this particular patient.
Keep in mind though that if a patient complains of pain, there could be other issues as well. Sometimes people with severe depression with have similar complaints, and I know when a patient comes in requesting a particular pain medication (particularly a narcotic) it’s easy to assume they’re drug chasers, but many people live with chronic pain, and after so long learn what kind of medications work and which don’t.
February 11th, 2009 at 9:06 pm
This is a really touchy subject, but I would just like to add one thought… There are patients who we “label” drug seekers, however if you are able to actually manage their pain adequately and relieve their symptoms – the “seeking” behavior stops almost immediately. Working in pain service, I have seen people whose entire personalities changed once they FINALLY received relief of their pain. I know this is not the case for all patients, but once you are able to see it happen for yourself, you will have a whole new perspective.
Don’t let those who do abuse the system destroy your outlook and prevent you from being an advocate to finally bring relief to someone who’s been hurting for a very long time. That one person you help – who truly does obtain adequate pain relief – you will have changed their entire life!
Pain is a more terrible lord of mankind than even death himself
– Albert Schweitzer
February 23rd, 2009 at 6:39 am
I remember in nursing school being taught that “pain is whatever the patient says it is, whenever the patient says it is.”
I try to understand that people with chronic pain do need help, but when a person is barely awake and requesting the usual cocktail (4 mg Dilaudid, 25 mg Phenergan and 50 mg Benadryl), I have to wonder.. how much pain can you be in if you are barely coherent?
The hospital is not a grocery store where you can shop for your favorite medicines. I can’t stand when patients come in and tell me that they can only take Dilaudid, but they need 4mg minimum, not 2mg like the doctor prescribed…. or the patient who comes in for chest pain, and before I can even do the EKG, is asking for prescriptions for his muscle relaxers and pain meds…. or the patient who comes in for severe pain, but is on the phone, watching TV and asking for a box lunch, then starts moaning and writhing in the bed when they see me walk past….
February 23rd, 2009 at 1:37 pm
I hate nurses and doctors that judge patients! This is so difficult to work with them. I have seen many doctors/nurses that think they are psychic. Very very few are. Keep the judging out of nursing. Learn good communication techniques. Learn about pain and the underlying reason for a patient’s psyche. Learning the why provides much insight. Please nurses open your eyes and ears. People have pain, it may not be like your pain. But then again it’s not about you. It’s about them.
February 24th, 2009 at 2:38 am
Amen……leave the judging out of nursing. People who are drug chasers are most likely addicts and addiction is a DISEASE, but like many nurses they don’t have the knowledge base…..one, because not much if any education is given in nursing school about addiction. As nurses and healthcare professionals we have a duty to educate and provide resources to the true drug seekers about rehab, detox, AA/NA meetings but first we must educate ourselves and change the mindset that addiction is a moral deficiency. I was always taught that if a patient is in pain, then they should be treated for that pain. I would rather be wrong about a drug seeker than not give a patient the pain relief they require….and as professionals we need to open our eyes, think outside the archaic box we live in and educate ourselves about the disease of addiction. It is real and devastaing for more than we will ever know.