I'm having a lot of trouble discerning the gray areas of nursing. OTC medications mostly. I'm a new nurse, I just passed my NCLEX last month, had a couple weeks of orientation, and last night was my first solo night at a LTC facility.
When is it okay to "bend the orders" for OTC medications? In school, I would have said, never, you always need an order. But since I've been at this new job it seems common practice to bend the rules. For example we have a resident who always asks for tums. They are OTC but she doesn't have an order for them. We would give them to her anyway. This happened for about 2 weeks before we got a prn order for the tums.
It doesn't seem like a big deal. Tums certainly won't HURT anyone.
So last night, one of my residents was complaining of shoulder pain. I gave her PRN Tylenol at 4 and 8pm. At 10pm she rang her call bell. She was practically in tears saying her shoulder was hurting. Well I checked her chart and she didn't have any other prn pain medications, it was too early to give her more tylenol. She did have an order for a bengay patch at 5am. I asked the resident when the pain is worse for her and she said at night when she lays down she has the worst pain, not in the morning.
So I put the bengay patch on her shoulder, she went to sleep, and I left a note in the doctors book to consider changing the order to have her patch applied at bedtime.
Apparently this was a big NO-NO. I got chewed out by the night nurse when I gave her report because now she won't have enough bengay patches to get through the weekend. I guess I really don't see what the issue was, especially since I ran it by the nurse in the other hallway and she agreed with what I did.
I felt like crap on my drive home, but at the same time, I still feel like I made the right choice. Am I over thinking things here? I mean it's a bengay patch..