I need your feedback, fellow nurses. I was so upset by what happened today that I want to make sure I don't react out of anger.

I am a clinic nurse, and work for several providers fielding calls from patients all day long. Part of my job includes triaging requests for med refills, and our clinic prescribes a lot of narcotics for chronic pain. I am very very meticulous and careful to look at patient history, diagnosis,how recent their last visit was, and what the provider has stated in their last dictation before I send refills to the providers for approvals. I often deal with abuse, people who become dependent, "lose" prescriptions, request early refills, etc, etc. I had a BAD experience several months ago with a patient who became infuriated because I questioned her escalating usage, and encouraged her to pursue a pain consult with a specialist, as a provider had suggested in a recent visit. She was very angry that I told her she needed to see a provider for further refills.

Today, 3 days before Christmas, this patient comes to the clinic to see the provider. Several of my patients have been giving me thoughtful small gifts and cards, and generally given the season things are upbeat and friendly. After her appointment,the patient asks for me specifically because she "has a gift for me". I had not personally met her before, only talked with her on the phone. I walk up to her (not knowing who she was at this point) and she hands me a nicely wrapped gift. I thanked her graciously, and apologized for not recognizing her. She tells me who she is, and of course I recognize the name. I give her a quick hug and wish her a good holiday; I figure she had remorse over abusing me on the phone several months ago. When I get to my office and open the "gift", it's a Fleets enema kit, with a note that says, "Maybe this will loosen you up". My boss, her provider, is at my door laughing, stating, "she told me she had a special gift to loosen you up" ...so clearly she had told him she was going to give this to me.

Here's my question to all of you.

I just felt sorry for the patient. Anyone who harbors that much resentment for that long....over narcotics....is just plain sad. But I am FURIOUS at my boss. This was an abusive, hateful thing to do to your support staff, and I think it was his responsibility to tell the patient he would not allow it. Further, I think he should have explained that not refilling a narcotic medication is a decision based on safety and well-being of the patient...NOT from "being uptight".

I feel completely unsupported, and want this provider to contact the patient with direction that this was over the line, and it is not acceptable to treat his staff in this manner.

I saw NO humor in this. I take more abuse from patients than these providers have ever had in their entire career, and it's usually over narcotics.

By the way, the provider sent this patient home with the narcotics she requested.

What do all of you think. Am I totally off base here???

Thank you all so much. HELP!

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New Nurse Trish

Dear Nurse Trish:

It's abuse if YOU think it's abuse. It doesn't matter what other people may say or think. You feel unsupported, and God knows that nurses need all the support they can get. Talk to your boss and express your feelings. Personally, I think your bosses comment was unnecessary. Hang in there.

MJ

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Sanity is madness put to good use. George Santayana.

http://nurse-ratcheds.blogspot.com

Loosen up!! Is it abusive..yes.. by your boss/colegues/friends...no. The gift was from the patient. From what you have written the doctor did not know what was in there, for all he knew it could have been a bottle of oil, WD40 spray, a packet of prunes.

You had a falling out with the patient when you were doing the right thing, and as a result the patient felt she had to 'get you back'. You can either ignore it, or laugh it off the next time she is in. Ask her for another as the last one didn't work!

Most of all, maybe you shouldn't be accept presents, but rather state that a present to the facility (a box of choc for all that work there) is more appropriate as you all work as a team.

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'Think not of yourself as the architect of your career but as the sculptor. Expect to have to do a lot of hard hammering and chiselingand scraping and polishing. - BC Forbes'