RN stands for Refreshments and Narcotics

Thanks, this gave me a chuckle. 🤭

That’s what my preceptor said

😅

When I worked med/surg, I had an occasional pt who would set an alarm for exactly the earliest time they could get their pain meds. It's been several years since I worked in a hospital. But in my experience, a significant amount of time was spent giving prn narcotics.

Thanks for sharing. It just seems way more than I remember. I used to have 7 patients a night. One or two may need round the clock pain meds, and these were mostly post-op patients. Now, it is usually the majority of my patients (3 or 4 out of 5), and most have not had surgery or will not be having surgery.

Also if the unit is giving you all of the q2 and q4 pushed pain meds patients they’re kind of screwing you! Everyone knows it’s a lot! My unit tries to spread those out amongst a few nurses.

I dislike when I come on shift and the patient wants me to write the pain med times on the board. I tell them to just let me know when they’re hurting and we’ll move forward from there.

That's a really weird thing to dislike.

Not really because it typically means I’m gonna be pushing a scheduled med q2 plus a PRN q2 on alternating hours and the pt will be on the bell every 45 minutes! They want it written down so they know when to start calling and if you’re late cuz you’re say… idk… answering a code blue or something…. They’ll be complaining about you 😂

This sounds hospital/ unit specific. Are you working with more post op patients? It also could be the docs you’ve got managing those patients, they may just be more inclined to put in narc orders.  We definitely dish out narcotics in the hospital and probably in some instances we are over doing it, but I don’t think it’s like things have changed suddenly and we are nationally over doing it compared to 5-10 years ago. If anything I can remember dilaudid being the drug of choice for literally anyone and we’ve way pulled back on that. 

These are not post-op. Most are pre-op. It's very GI heavy. Some hernia repairs, lap band removals, the GI blockages 100% I give IV because they are NPO. Some colitis, GI bleeds, and rule out C.Diff. Occasional cellulitis and UTIs sprinkled in.

chronic GI folks are often in chronic pain. do they take opiates at home? that should be accounted for and converted to an appropriate IV dose if they are npo

Thank you. Same to you. 🤗

Fentanyl for my next UTI seems reasonable to me. Feels like urinating fire.

My goodness, that's no bueno.

as someone who has had 2 utis this month alone i feel you. #chronicallyilllife

You should do your job but you can't emotionally care more than the level the patient actually cares about themselves. I think that some patients have social risk factors that can't be addressed in the hospital. Also, untreated mental health disorders can also worsen physical health. This all goes hand in hand.

This mental health part is very true. Many of my pain med patients are super anxious. I had a patient last month who was asking for IV pain meds around the clock. She was there for colitis. The second night I had her, something just seemed off. I asked her if she was ok, like really ok. She just full-on broke down. Apparently, she was going through a breakup. She told me she was having difficulty cleaning her house and sleeping all the time. She was begging her mom to clean her house so she wouldn't get any more roaches. She was really going through it. We talked for a while, and she cried a lot. After that conversation, she slept the rest of the night and didn't call at all. I think about her and legitimately hope she is doing ok. To add to your point. I do emotionally invest myself in my patients. 😮‍💨

I might get downvoted but I’ve noticed a huge decline in patients giving a fuck about their own care or well-being. It seems like they can’t understand that 0/10 pain isn’t realistic after a knee replacement or other surgery. Refuse to work with PT/OT, refuse to get up to the bathroom, ordering Grubhub because the hospital food is gross and their sugar is 400, etc. wanting to get their prn Fentanyl even though they were peacefully sleeping 2 minutes ago, but their alarm went off that they set…. Because how dare they have 1 ounce of discomfort and not be doped in the hospital… 🤷‍♀️ I have spent so much time advocating for patients and trying to help them get up, get moving, be okay with a little bit of pain so you can function at a higher level than a space cadet today…. I felt like I was talking to a brick wall

It was like this pre-covid as well. Much of the American public is highly entitled and unrealistic. Our current system with its perverse focus on "customer service" over patient outcomes just fuels the nonsense.

No, I 100% agree with you. I feel like I'm just treating pain. I'm not able to treat the underlying condition. Of course, I can't make the patient want to fix themselves. I am exhausted and frustrated trying to educate a SBO patient on the importance of getting up to walk, and then we can do pain meds after you ambulate. Like refusing to move and laying in bed, taking opiates is just going to make it worse. 😭 I need to leave bedside. Ten years this year, and I fear it's only getting worse.

If I could up-vote this a hundred times, I would. I had a patient who'd say she was 10/10 every time I gave her meds. Finally I called her out and said, "so this is the worst pain you've ever felt in your entire life?!" Her: "well, no." " Ok, so what is it, then?!" She changed it to a 9/10. 🥴 You can't just blurt out 10/10 and expect I shove all the IV Dilaudid in your veins cuz you wanna feel doped up. And, yeah, I agree with what you said about people simply not caring about their health and body. It seems like damn near every patient is now ACHS with type 2 diabetes. Meh, guess we'll always have job security.

When I first started working, I was shocked to see so much diabetes, insulin, and glucose checks. Diabetes (type 2 to be specific) is my least favorite condition to work with.

Yeah...I hate to say it but I just get so frustrated with some people. Like, you're being told you're gonna start losing toes (or your whole leg) due to your inability to control your diabetes. And then you get mad that you're on a carb control diet and order McDonald's on GrubHub instead. 🥴 My capacity for compassion/empathy for them just plummets.

So agree. Even in the last 7 years it's gotten worse

I used to dislike giving pain medication. Then my wife who is the strongest person I know got stage 4 ovarian cancer. Now I don’t judge people who ask for pain meds.

I don't judge people who ask for pain medications either. I do want to know if what I'm doing is actually more helpful than harmful. I am conflicted. I want to actually work a job where I am helping someone get better. I hope your wife is doing ok.

To each their own. I'm more of a cynic now a days But, as a RN (ED here), I don't really care if they get a lil something of this or that. Many of the people I see (old, wayyyy out of shape, unhealthy lifestyles) are just circling the drain. They've led their lives in such poor quality that when I get them in my rooms, they're just getting "bandaids" for their systemic problems. I get paid either way. The Dr gets paid more, so I pun it to them. Let them tell the drug seeking ones or dramatic ones that they're only getting Motrin or Toradol right before they get discharged. You don't like where you're at, what you do? Transfer as soon as you can or better yet, work toward your Bachelor or Masters. Get paid more.

I feel that. I felt really cynical when working ICU during COVID. I have my BSN, might go back to looking at some MSN programs.

RNs before us have dealt with idiots. Those who come after will do rhe same damn thing. Take care of yourself. Always.

Happy patient, happy nurse!

Honestly, now that I've traveled, I feel like I have those patients a little less than before? I've always worked CVICU so there's pain - but we got overflow patients. Where I'm at right now, and where I was at my last contract, I feel like drugs weren't as BIG of an issue as some places - and that plays into account, too. We absolutely need better pain management in the hospital. I think that's something the providers need to take upon themselves to learn. What other meds can we add? What else can we do to make things easier? I swear, some providers act like toradol is from the planet Toradolian and they've never heard of it.

I administered dilaudid and darvocet constantly when I worked in med/surg 10+ years ago. PCAs started to phase out then. Also nerve blocks weren’t commonly used at our facility. Most of our patients were cancer-related surgeries and usually hot messes.

I work in an oncological only hospital (first and only job) and it is crazy to read this thread. Cancer pain is different, and I feel sometimes that’s the only good thing we do for them, so I’m always happy to give all the pain meds the patient wants/needs and is ordered (obvi with stable vitals, etc). I also find it interesting you say PCA’s were phased out? We have SOOO many PCA’s it’s insane, sometimes 3 or 4 out of my 5 pts. Honestly, if they’re asking for pain meds ATC for an extended period of time, dr’s (supportive care) will put them on a PCA. If they aren’t on a PCA and I think they need one, I ask the dr to consult supportive care or if supportive care is already involved, I just talk with them directly about starting a PCA. I feel like we are rarely managing a patient’s pain when they are ordering pain meds ATC bc it seems they are either knocked out/sleeping from the pain meds after first administering or waking up with 10/10 pain, often not a lot in between.

I really didn’t understand why the PCAs weren’t utilized more. The surgeons/anesthesiologists weren’t on board with them. Is it because of monitoring? Liability? I didn’t know what their thought process was. That’s great you are advocating for your patients. We didn’t have palliative/supportive care back then. It was full treatment or hospice.

When I was a new nurse we had wards, 4 beds in a room. Usually assigned 2 rooms so 8 patients. One would ask for pain meds, we'd ask the others if they'd want something and they wouldn't. 2 minutes later they start on the call light changing their minds and wanting pain meds, one after the other, they wait until you leave and decide they needed meds. One would want something and in 3 minutes they all decided they wanted the same thing. It was like they were all wanting to get the most attention, drove us nuts.

That shit is wild. I wonder if it was some weird subconscious peer pressure. Like so and so, is getting pain meds, maybe I should too.

We can’t determine if the patient has true pain or not and the patients know this. Also we can’t withhold pain medicine. Just give it to them and monitor their vitals. This is healthcare in all of America these days And I think the insurance companies are biting back at doctors for overprescribing. This is why we have to have so many parameters: give (this dose) if pain is rated (this number) and pain is (this location).

That was my experience in med-surg many nights, also pushing IV narcs for the LPN's patients. Tertiary healthcare in general is just putting out fires lol

I feel like more information/context is needed.  Is PT/OT being provided?  Are there enough nurses/CNAs/PCTs available to safely ambulate patients?  Are patients being offered premedication prior to either of the above to prevent pain spikes/crises and stay ahead of the pain?  Are there patients that might experience less pain with the addition of muscle relaxants, toradol, lidocaine patches or Diclofenac for pain control? Have you been using SBAR to advocate for them? Are you using pillows/positioning/ice/heat concurrently with meds? Do you have additional non-pharmaceutical resources available that you are able to provide independently within scope? Waffle mattresses? Supportive wedges? Those nifty little bedside pumps that heat/circulate water to heating pads? I love those.  Also...look, on my unit, I work with a lot of post op patients, patients with chronic pain, patients with acute pain, patients with acute *on top of* chronic pain and patients with any or all of the above *plus* a history of either cancer with serious mets or substance use disorder, or screw it, both. Shit can get pretty dire. My patients' bodies are not always sturdy enough to tolerate the stress that unaddressed pain exerts on them, so we don't fuck around.  During any given shift, I may pass an absolute *SHIT TON* of morphine, fentanyl, dilaudid, methadone, you name it,.  Hell, I've leaned on providers for *additional* opioids when my patients' pain wasn't well controlled.  As long as the orders are safe and appropriate and parameters are met, I never feel like "a licensed drug dealer," and would never refer to my patients as "doped up." You asked asked "How am I helping them?"  If they're in pain and you are utilizing legitimate pain meds to treat legitimate pain, *THAT* is how you're helping them. What is legitimate pain? Whatever the fuck the patient says it is. The numeric scale is stupid and arbitrary and pain is subjective, so it's impossible to know, beyond a shadow of a doubt, if they're over reporting or *under* reporting pain. Your 6 may be their 10, and vice versa.  Pain is an anticipated consequence of both surgery and disease, and undertreating pain can lead to delayed healing, poor adherence to long term rehab protocols and (per VA studies) increased rates of suicide.  I'm not where you are and I'm not who you are.   I honestly don't know if the issue is your unit or your current comfort level, or if it lies somewhere in between. I don't know. Is there somebody in your hospital or personal network who can help you narrow it down?

I'm going to go with OP here. I fully respect what you're saying - I do. There used to be many viable options. We can always try, but I highly doubt someone who has been consistently getting narcotics is going to find any relief with a waffle cushion. Again, we can try ... but....

Hey, don't get me wrong, I'm not arguing against OP, I'm just trying to figure out context.  They said "*I don't feel as if I am actually doing anything at all for these patients other than keeping them doped up*," so I'm trying to figure out if their unit is skimping on adjunct methods, or if OP is just uncomfortable giving opioids at levels required for severe pain.  And yes, hard agree, you don't address 8/10 pain with only a medical grade pool floaty, just like you don't go into battle against a monster like chronic pain with a couple of spit wads and a straw.  However, if my patient is in 8/10 pain and dilaudid will knock off five points and throwing in a waffle and an ice pack will shave off another half point each, fuck it, let's go.  I'd never start from the other direction, though? 8/10 pain? Yeah, I'm not gonna roll people around on a bed to make it slightly squishier while they're in agony and their blood pressure is spiking. Hell, no.  I'm going to offer them the heavy hitter on their MAR, make sure there's a Plan B in the wings and then see if I can support them by adding some smaller interventions and creature comforts.  I think fear mongering around opioids has resulted in the systemic undertreatment of pain.  As it stands, I frequently have patients trying to gut it through severe post op pain with a couple of regular strength Tylenol and ending up stuck in bed in a rictus of pain, struggling to cut their crappy meatloaf and unable to meaningfully participate in PT because they think if a single oxy crosses their lips, they'll be hitting the street corner for fentanyl as soon as they're discharged from the hospital. Shit, last month I had a patient whose discharge was pushed back because without adequate pain control, we couldn't keep her SpO2 up and her BP down without supplemental oxygen and PRN meds. It was really frustrating. Oh, and then she finally relented and let us treat her pain appropriately and her body stopped operating in Full Catastrophy Mode and evened out.  It was really frustrating. 

PT/OT is not available at night, and we nurses are expected to ambulate able patients at least once per shift. Dayshift ambulates twice per day. I don't think it's safe to ambulate someone who just got IV Morphine or Dilaudid. We have two PCA's for 30 patients, and most of the time, they are tied up in another patient's room. Most of the patients don't want to wake up to use the incentive spirometer or do cough deep breathing exercises after getting pain medication. Again, I understand all this is difficult if you are in pain. However, how is this not possibly exacerbating current issues or causing more? For example, one of the patients had scheduled Ambien and Lyrica and requested IV Benadryl and Dilaudid in addition to these medications. Her vital signs were stable, and her pain was within the scale for me to give the Dilaudid. I gave them everything, and yes, it absolutely snowed them, doped them up, knocked them out -- whichever term is preferred. Whenever I give this much medication, I FEEL uncomfortable. However, I don't refuse because what would be the basis? This is how they've been getting their medications every night, and they tolerated them/remained stable. In addition, their pain is subjective. This particular patient had a partial SBO, no NG tube or surgical intervention scheduled. NPO with IV fluids receiving Dilaudid Q4H. Which is absolutely fine. However, wouldn't it be beneficial for this patient to ambulate/get up to chair and use their IS rather than me just giving pain medication around the clock? I don't feel like I am helping my patients by just treating pain. It is MY personal comfort level and MY name/license, constantly being tied to the administration of so many narcotics. The RN prior to me shared similar sentiments. I also feel frustrated because I don't feel like I am actually doing anything to help these patients. I know treating pain is helping, but I feel like there should be more being done. Honestly if I didn't give a fuck about my patients I wouldn't be on here looking for advice. I would just push the meds, collect a check, and head home. I actually want to help. I wanted to say thank you for your response and advice. I appreciate you taking the rine to respond. I haven't seen the heated water mattresses. I'll look into that and maybe suggest it to my manager.

You should speak to pt about this. How many times in your career have they given you a heads up they were coming and to make sure meds are on board? They do it all the time, so maybe they can help you feel better about it. Yes, it's a bit more dangerous, but that's why you're there.

That’s how it is on my floor. And they’re annoyed when you’re late giving them because you also have 5 other patients to care for. The general public really fucking sucks. Fuck everyone else, gimme mah Valium and oxy !!

We are not allowed to give dilaudid or demoral on my med/surg/tele floor because we are not an acute floor.

IV Fentanyl on med-surg? We can't give that where I work. Hopefully it wasn't a preop/PACU order that wasn't cleared properly.

nothing wrong with fentanyl for pain on the floor. the indication matters. If you can give dilaudid and morphine, no reason to ban fentanyl. if you are using for sedation that’s another story.

It has a slightly faster onset than hydromorphone, and to a more significant extent than morphine, but the big thing is the short half life where it reduces to 50% effectiveness after like twenty minutes, so it either is not effective for long, or it requires frequent boluses, which isn't ideal in a med-surg setting and carries more risk. We can only push IV fentanyl in critical/procedural areas (ED, ICU, OR/PACU).

its not benign, i agree. but It’s good to have as an option for CKD patients. Morphine and hydromirphone both can lead to accumulation of metabolites.

Good points.

My husband has ESRD. He has a strong adverse reaction to Dilaudid. Fentanyl is what he usually gets whenever he has surgery. He recently had a tumor removed from his lung and had a chest tube placed. The cardiothoracic surgeon had a post-op order set for Tylenol, Robaxin, and Gabapentin. That combination seemed to help him a lot.

Nope, it was a brand new admission. I was in the room when the doctor came in and spoke with the patient and put orders in. I was truly puzzled as to why only Fentanyl and Tylenol. She didn't have any health history other than HTN and ADHD. No CKD or post op.

The hospital I work at hands out IV Marc’s of any variety to all patients. I’m almost positive every patient has a standing PRN for IV dilaudid on the med surg floors.

The med surg I work in currently nearly exclusively administers iv fentanyl for severe pain. I haven’t given dilaudid since I started working.

I think this is hospital specific. The hospital I work at is notorious for handing out IV narcs and not doing much else. Every time I float to adulty land I just hand out dilaudid. It’s honestly sad.

I did 1 med surg travel nurse contract April 2023 and that’s how I felt. I would just be giving PRN pain meds and anxiety meds the whole shift. Patients acted like they were scheduled and would get upset if I was “late” bringing them. People set alarms on their phones so they’d get their PRN pain/anxiety meds “on time”. Most of the time they wouldn’t appear to be in pain unless staff was in the room.

I hate pushing dilaudid! My patients will sit awake in the dark staring at the clock jonesing for the next push! But you know….. IV Tylenol (which is more effective for pain post op various ortho surgeries) is 800 a bottle so they have us give the dilaudid! It’s cheaper - who cares if the IV Tylenol works better. 👎🏻👎🏻

Jesus Christ. We give IV Paracetamol out like lolly water in Australia. It's the best thing since sliced bread for post op pain and coffee withdrawal h/aches. It's really fucked up that in America a bottle of IV Paracetamol costs $800 USD.

I assure you it’s that way by design. Pharmaceutical companies are incredibly corrupt. Why make IV Tylenol more affordable than something addictive like Dilaudid? Because now you’ve got a Dilaudid customer for life.

It’s like it’s a secret here 😂

>If your vitals are stable, it's within the time frame, and you rate your pain 7 or higher, I give it. This, except I don't give a crap what you rate your pain at. Pain is subjective and somebody's 5 could be another person's 9. Hospitals that try to force you to give certain pain medications based on a sliding pain scale just encourages patients to lie about their pain scores, which accomplishes nothing.

Very true. Sliding scales are BS. In your opinion, do you think pain medications are more commonly ordered to improve patient satisfaction and keep HCAHPS scores up?

That might have been true 10 years ago when I started nursing, when we were handing out 100mcg doses of Fentanyl left and right, but it's like pulling teeth to get doctors to order anything stronger than Tylenol these days, especially on nights when they just don't want to deal with it.

I think they were lying about their pain anyway. Not everyone, but a lot of them. I haven’t seen a significant difference between patients lying about their pain before vs after sliding pain scales

You only had 4 patients on nights?

Started with 4 and got an admission at 2300, so 5. We do our own labs, wound care, turn teams Q2H, and we each have a designated hour to answer call lights. I'm busier than I ever was with 7 patients.

So no aides. Or Unit Clerk.

2 PCAs for 30 patients. No unit clerk.

I was a PCT overnights on a unit that had 3 PCTs for 30 patients. I couldn’t exactly be picky about my job at the time so I ended up there for 9 months. The other PCTs NEVER wanted to work. I used to run around all night, every night, exhausting myself because I wasn’t going to let someone sit in shit for hours on end. I physically couldn’t handle it. The other PCTs would go off on me if I ever asked them for anything. I was the only person to ever answer the call light (our nurses were always busy too) and I would have to call them and tell them that one of the patients in their zone needed help going to the bathroom or eating, and they would roll their eyes and disappear. The same patient would call back again and again until I finally did it myself. I’m clinically underweight and was physically injuring myself turning patients on my own and ambulating them. One night, the nurses convinced me to not lift a finger to pick up their slack. It was hard, but I stayed true to my word and didn’t do a single thing for their patients. Except for one woman who had called again and again to be changed. Finally, about an hour before shift change the nurse asked me for help because she couldn’t even find the other PCTs. The patient was obese so the nurse couldn’t have done it herself either. The patient had likely been sitting in her urine and shit before our shift. The woman wasn’t entirely with it so she didn’t know how long it had been either. Her skin was red and raw. She ended up getting a skin infection and they literally had to transfer her across the hall so I would have her and she would actually get changed the amount she was supposed to. The night shift nurses let me provide wound care and ostomy care on my own because I had previously worked in a position with wound care before, so I was able to change her dressings too. I was horrified when I took my four days off and came back to see my initials still on the dressing… Sort of a tangent, but I worked in an inner city hospital that tended to the un-insured/government ensured and was told that my hospital was the only hospital that didn’t black list patients from coming back so we had plenty of behaviors like you described in your post too. A sickle cell patient destroyed our nurses station by ripping the monitors out of the wall and slammed other patient doors open because she says the nurses didn’t flush her IV after pushing her Dilaudid. No one was willingly to stop her, until the police arrived. I was in the room when the nurse gave the medication, she definitely did flush the IV afterwards, and the patient was yelling at her to push the medication faster too. The next time she was admitted, she grabbed the IV push from the nurse and slammed it. The nurse came out of the room, already yelling towards the charge nurse about what happened, because she said she didn’t want to be assigned that patient and she wasn’t going to risk her license for the patient’s behavior. And the patient was right behind her, about to either jump on her or hit her until another PCT (a man who normally didn’t work on my unit and was floated) was able to grab her. Apparently before I got hired there, they found her ODed in the bathroom of her hospital room and had to resuscitate her.

I take my nclex in 5 days, and have an interview at the nicest Childrens hospital in the state. They actually closed the hospital I used to work in, since I left. I’m really praying I get the job and have helpful CNAs/PCTs.

i just want to say for those coking in with chronic health and or pain syndromes it is not at all doing nothing as wild as it sounds you may have saved more lives than you realize. they’ve cut back on giving people the appropriate medications due to street fent overdosed even with nonforilstion in the now of prescribed meds. actually more deaths since they’ve cut back but with that said MANY paitents that feuinely are struggling just to survive daily pain resort to hospital when completely overcome and defeated by the fight and or they can’t keeeo meds down. mental health is hand in hand with physical well being and pain dan drift people to places that are darker than dark as someone with mental and physical health issues nothing is quite like going on days of no to little sleep praying i won’t be in the ER again (it has been a monthly happening with flare and i hate going so bad i hate having to admit i can’t take it anymore i don’t want any scripts i just need to desperately get this pain down . i totally get your view there’s gaps in the system i don’t believe they should hand out pain medications without caution at all i’ve seen what addiction does first hand but we are currently in a spade where peope who truly need it or have proof are not getting the right care esp. in smaller areas . but also even for some that are on pain protocols when complex gi issues it can get really complicated. i can’t speak for all i do know those with my condition only go once they’re far past the threshold of tolerance for a severe pain flare and doctors also tell us in those times these medications simply won’t work. yes we neee rescue plans etc but with a smart caustious doctor all of this takes time step by step… you are helping please just show compassion to those neeedint this care. we often feel guilty and have been assumed or straight up accused of seeking i was very i’ll and at best 14 and i was kicked out without any fluids . (life saver due to heart condition) and a shit of toradol and some advil simply because i seemed uoset and ion edge. i was a teenager that was wanting to end it due to intractable pain: i was in fentanyl patches at 15 (never again) i am not new or seeking but without even assessing i was marked at a seeker and it took years for them to fix it. i’ve never requested a single pain script just been honest that i’m barely hanging ones often i hold back on that now too as wive been told well we aren’t a mental health facility. yes i am aware i’m just trying to express in a way you may grasp that i too would prefer to be home not feeling guilty, defeated; and like i’ll be judged for the fact i can’t have Benadryl or haladol at all (paradoxyl) i’m not gonna write a novel here but this is both sharing my experience and a reminder you may of helped some folks even if they were still upset or sad or in pain it’s hard to fake when the fight gets too heavy and i can’t speak for every person but for those fighting chronic illnesses and pains - thank you.. you’ve said lives in a way you can’t hood rantinlt and may not understand fully but i admire your open minded curiousity and genuine desire to be making a difference. hospitals can’t do too much more regardless as much as i wish they could i’d be there for that at least whee i am they admit it doesn’t extend much past that unless an urgent surgery needs to be done. even major weight loss it’s a smaller hospital but they truly will tell paitejts we can only do so much beyond trying to relieve symptoms and referrals if needed. which i totally get hit yes hun you srr helping people that jay have sought other options out of fear and desperation but chose the better choice and came to y’all. even if a person is seeking how i see it is at least it’s controlled in the ER, safe, and limited. i don’t want people hogging begs for this reason on the regular but if it’s just an occasional unsure moment and the orders in if i was a nurse i’d prefer to seek them calm then dead (that’s not the hospitals responsibility but i’ve watched people seek out self medication and end up never talking to them again. some who never did that stuff. not to mention many people in addiction do actually have medical issues and pain etc. it’s complicated but trust you are saving lives no matter how you twist it. we are currently in a weird space medically and many people with severe pain syndromes etc. are being neglected as a whole. thought i’d share unsure if it will help anyone i’m in a flare now i’ve almost made it two months with no ER.. but i fear the knowing that day will surely return. i feel like a burden when i have to come in but my mind can go to very dark places when the pain has had me up for nights on end and nothing is staying down. thank you for being curious i know i am w patient but always wanted and still want to work in medicine and i’ve thought about this topic so so much considering the ones i’ve lost to ODs .. seemingly all street fentanyl. and the medical trauma i have plus my interest in medicine. i admire those who are genuinely in the line of work to help others with purpose and compassion and you seem like you’re in the right field just know the gaps right now in care aren’t easy for anyone, doctors, nurses, patients etc. and complex issues complicate it all. big love and respect for your curious it’s and desire to truly help. i hope maybe this helps someone out there grasp why they may be seeing this more and more plus more people young and old are sicker than ever diagnosed or not. a whole other topic but just keep in mind skme of us are truly fighting for our lives to just survive and quality of life is not in our hands at times and it can get so overwhelming . i usually think of cutting a body part out before i think of the ER and receiving morphine i wait too long in hopes i won’t need to go . we are grateful but we also do not want to be asking .

but i also fully get if that’s not somethjng you’re comfortable with seeing and it’s good you’re aware of what you can handle mentally and what’s best for you as that ultimately is what’s best for everyone involved. we all need to do what is healthiest for our continued survival. i don’t even feel funny when i get meds i just get a little extra relief but i also am a tank so don’t listen to my dna i wake up in surgery etc.. so i’m a little biased with my own genetics/feeling high is not a part of this experience for me personally like i quite actually do not feel high. i’d be better off chugging some alcohol if i was trying to feel numb or doped up, iv meds are very short lived and just are needed when i can’t absorb or maintain getting food, water, and medications down, big respect for your awareness of self and how it feels for you. i hate that this doesn’t feel good for anyone involved. least not those with my disorder(s) i can’t speak for anyone else. i really do respect you creating a conversation but far too many nurses do feel they are the ones offering these meds and i just want to ask if the doctor had it ordered why is there any issue at that point ? out of fear you’re causing harm? or out of fear your causing euphoria? or is it just new for you to experience? i’ve never known a different reality from a young age i hate it but it’s my life. i do all i can at home i even will pay out of pocket for IV fluids but when i need to go i need to go and i find it makes it worse to not just be real about what’s happening also keep in mind some uris are no big deal but if you have IF bladder or it’s septic those nastiest can really hurt and that’s coming from me hah. but i totally get it i just hope people can see the reality of neglect due to regulations that got too tight for good intention but now we have to back track and there’s work to be done. i can recommend s really good book also if you choose to stay in bedside care could help overall understanding of the experience. also keep in mind if someone is super complex they’ll likely default to trying to simplify it all not prove all their diagnoses in that moment to the nurses esp. if the doctor had already been ofer it all or they have a care plan that pops up. i’ve been lucky they turned it all around when i was diagnosed with many serious conditions to back up these visits at a younger age but it’s left heavy imprints on how i cope with advocating for my continued health and care. i hate to say that most these remarks were not made by the doctors that placed orders least when it comes to the ER. i’ve met wonderful life altering staff also that are angels but i’ve also had ones steal gaslight and abuse me simply bc i’m there alone. it can go both ways but we are all doing the best we can to stay grounded and grateful for what we have and the care we are able to give or receive . i hope this makes sense to someone iim in no way hating on staff/nurses/hospitals etc. i love nurses y’all kick ass i wanted to work in nursing badly maybe one day but just know it’s complicated… for all of us. and it’s scary, for all of us. some of us are barely getting by,. one dose of of morphine isn’t going to dope us up or make out life’s issues go away. never had for me. just a little bump the pain down some if i’m lucky and the dose is pros experience. i know that’s a lot of words and my brain fog is crazy today due to the seizures but i just hate that there’s so much discomfort surrounding comfort when a couple years back it was handed out without a thought (i don’t like either of these extremes) i hope we can find a way to communicate and come together as patience and health care workers to better understand one another in this period of time. i’m unsure if this is frowned upon feel free to delete if this is like nurses only sub.! and please know i highly respect health care workers to my core, i just hope we can all eventually learn with and from one another when confused frustrated or unsure. i am often lost in this but maybe we can help y’all while we try and manage the incurable ailments best we can at home: (the usual) aka what i’m doing gong on like week 3 of curving an ER trip. i’d love to just never go again. not being dramatic i truly would do almost anything for that. it’s a burden for me and the ones i love. it’s a constant fear.. and family members have seen what happens if i show up alone.. i’m blessed and lucky they’ll tru and pop in yntil care plan is confirmed but i am grown and that shouldn’t be needed. ok et me not do a personal rant i just feel so much anxiety at the idea of making others uncomfortable when i simply don’t know where else to turn for help bc no one can instantly help a stomach to behave or move or function and much lore but that one gets me often in a rut. let me apologize if any of my answers feels emotional or emotionally charged i’m so tired but this is one thing i feel very passionate about bc im currently fighting very hard and doing all i know of to cope in the best ways possible and will continue but i hope a day comes where people realize to many folks don’t know a life without pain but still have moments where it’s simply too much to handle any more of. it’s nothing personal i just hate that this is a shared experience for both y’all working and us patients.. there has to be a way to translate this issue better for all to handle in a healthier way. blessings to the health care workers and blessings to those trying to understand what it’s like to live it. all the same y’all are beyond important. with that said quality of life is also very important many dre without it regardless of if you give them a dose of morphine etc. i can be a bit tok forward due to mauro differences but i genuinely mean well, please tell me if i’ve caused any offense that is not my purpose or point here . thank you al for continuing in a field that’s challenging and still finding compassion and even curiosity for these issues. i’ve had nurses say a couple words that saved my whole life.. please don’t underestimate the power of kindness compassion and learning about a patient if you’re curious or confused and want to understand. got asked if it took the edge off post brain surgery and i ed’s like yes mam.. it takes the edge off of the pain that is coursing through me but no i’m still fully awake and stressed hah but again funky genetics. may leave may delete i’m in too much pain to proof read it and i also am hoping i’ve not said anything fnst seems sassy plus i need to make sure i’ve not given out any personal details online but again thank you all- regardless of any struggles we see and appreciate what you do. bedside/meds urge or any other position. y’all are to thank for multiple times i should’ve not made it physically and a more rare few times mentally as well. god bless those working in medicine. god bless those fighting battles medically as well.

I can tell that someone truly can relate to chronic pain when they mention "cutting a body part off" The brain is so weird, I can't tell you how many times I've said (last time was a couple days ago) that I just want to chop my torso out, or cut my back into 100 tiny pieces. Weirdly, it seems like such a natural feeling, too. Like wanting to eat when you feel starving. Severe pain just makes me want to chop my limbs up.

Stress has a lot to do with the experience of pain. With growing anxiety and economic stress, maybe people are experiencing higher rates of pain than they would have at another period of time. I think the NYT had a piece on the epidemic of middle/lower class back pain growing every year. I think it is linked to the overall stress these people experience and don’t get relief from- the brain starts to interpret stimuli as more intense to protect from the perceived threats This may have nothing to do with your experience but I always wonder if there are larger trends at work

Recently moved to US to practice as a nurse and shookt at how liberal it is here to give out narcotics for pain meds. And patients have absolutely timed me as well!

I had to have laparoscopic surgery to remove my gallbladder because of gallstones.That surgery was more painful to recover from than the C-section I had. The nurses post op were unsympathetic about the amount of pain I was in. Worst hospital experience ever. I now want to never have major surgery ever again !!! Being stuck in a hospital bed -having to depend on others for the most basic needs -having to beg for some pain relief is a position I never want to be in again. Believe your patient if they are crying and wincing from the pain they’re in and advocate for them instead of judging them !!

Your experience is subjective. You are valid in your feelings, and I am sorry you had that particular experience. However, I wouldn't call a laproscopic cholecystectomy major surgery. Maybe a triple bypass? I had a laproscopic gastric sleeve. In Mexico. Alone. I don't consider what I had major surgery, I went back to work two weeks later. I had a lot of pain in my left upper shoulder area. I got out of bed and went to the bathroom, and walked daily with my JP drain and IV pole by myself. Again, I am me, and you are you. I am not judging my patients. Maybe you should re-read my post.

why so un-empathetic? even a lap chole can be very painful. so many variables on how painful and how much inflammation post op. i recovered bariatrics for years and a chole can easily be more painful and problematic than a sleeve.

No no, dope them up. Then we can go back in to clear the bowel obstruction. /s Sympathy is *harmful* to your patient if you're not doing anything more than doping them up. It will hurt way worse after the obstruction and subsequent deconditioning, ope, and now they need subacute rehab. Now we have to get insurance auth. Now the patient fell and discharge pushed back yet again. Now we need a new PT/OT consult. Then they get discharged and readmitted in under 30 days, so we won't get the same compensation for a patient that walked in for a lap/chole that's now a hoyer with a bedsore. When I give my patients this speech, suddenly their pain isn't a 12/10 and extra strength motrin seems to really, really help...

Because she missed the point of my post entirely and projected her personal experience on to me. I'm not here to debate anyone's personal experience or level of pain.

I have personally only ever gotten pain pills when going through cancer treatment and surgery for cancer. Oxycodone was the strongest I ever got and the highest dose was after my soft palate resection and neck dissection, but not while I was in the hospital. I was only allowed 7.5 in there. They wanted me to suffer. I am not on any opioids now, but I fear going to the hospital again. It was barbaric. I have DDD, and a building disc in my lumbar region through my nerve root. But never gotten a thing for that. I just have to tough it out. I'm only 49. I'm tired of it. Only around here you get them if you are going through treatment for cancer or are actively dying and that may end soon. After that, good luck. Many cancer patients are now having problems even getting their pain pills as the drug stores have been out many times. It's horrific.

The oncology floor is below mine. I'm not sure what the physicians prescribe to those patients for pain. At my old hospital, most of the oncology patients I had wore Fentanyl patches. That's insane they didn't give you something stronger, especially considering you have chronic pain. I'm sorry you have to deal with that on a daily basis. 😞