Withholding prns??!!

Nurses General Nursing

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I have never in my nursing career been so angry!!

That said I need advice. I work on an acute Ventilator unit where pain and anxiety reign supreme. After dealing with 2 pts who were in such a state that one was ripping her skin to shreds and the other was pulling at her trach/trach tubing so badly that the tubing and HME were filled with frank blood.

After trying relaxation, diversional and communiction techniques to no avail (done by myself, resp therapy, 2 other nurses & the CNAs) I asked the med nurse (A float, unfamiliar with the floor) if they were due for their prn meds.

Ready? She told me that the off going med nurse had told her under NO circumstances were these pts to be given their prns!!

:(

I showed her the MD order, I showed her the VS I had taken other than the normal elevations you would expect to see with pain/anxiety they were stable & then I told her that she needed to use her own nursing judgement at which point she started to cry. ( I still feel like a turd) She did give them at my request with a positive effect inside half an hour.

I then went to the Nursing Supv. explained the situation & she asked me to write it up. I explained that this would be a fruitless gesture as the offgoing nurse is favored by my UM. This nurse gets away with yelling, swearing ( daily ) and has even thrown the med keys at other nurses. Withholding prns is not new for her, she has been seen telling pts no she will NOT give then pain meds as they are NOT in pain.

In the end I did write it up & gave a copy to the nursing supv & the DON, bypassing my UM. However I know that I have effectively put my head on the chopping block. I know there will be hell to pay from my UM no questions asked.Her response to our various complaints r/t this nurse is always "oh thats just her way", "Oh, thats our girl". How much more frustrating can you get??!!

I know in my heart I did the right thing. On further investigation it was discovered she had given the same directives to another float nurse.

Other than letting me vent, TY. I would like to know if anyone has any idea if this is a state reportable offense? besides the fact I don't think that there will be any repurcussions for her, only me.....This whole thing has really gotten to me & I want to make sure that I do everything I should but I don't want anger to cloud my judgement!

Oringinally posted by Cooker 93

I am in the position now and when the patient says they are in pain (even though I work in Psych), and if they have a PRN order and if it isn't soo soon, I give the PRN. If the Doctor didn't want anything given, he wouldn't have written the order.

Being a brand new nurse and also in the Psych field, I do run into this. I have a preceptor (I'm a nurse intern) who has been doing this for a looong time. She often tells me NOT to give the PRN. I too, feel that if the doc didn't want the pt. to have it, he wouldn't have prescribed it. Right now, I'm sorta "stuck" when this happens. Yes, sometimes it is all too obvious that the desire for a PRN is "drug seeking" or "attention seeking" or even sometimes just because they've heard another pt. asking for a PRN. HOWEVER, I too was taught in school that pain/anxiety are whatever the pt. says they are, so the witholding of PRNs goes against my grain also. (And totally so in areas such as med/surg.!!!)

In my case, as soon as *I* am in "The Position" (which won't be long), I will handle such instances by giving the PRN (and if there's a choice, the one I feel is most appropriate) and when it seems, in my nursing judgement, to be for other than "legitimate" reasons, I will bring that up with the doc and suggest that the PRN order by changed or D/C'd.

And personally, in this field, if a pt. is aggitated and a PRN is ordered, I feel that, for everyone's safety, pts. and staff alike, it is much preferable to offer a PRN (if the pt. desires it) than risk injury to *anyone*.

Any feedback from more experienced nurses in the psych field?

Melissa

In answer to the narcotic counts they are fine. In fact the numbers don't change when she is on duty. She just likes to have "control". Her answer IS tylenol for everything.

Please keep in mind I DID write this up. I skipped my immediate supv. for 2 reasons. 1) It was the overnight shift and I gave it to my immediate nsg supv at the time. 2) It really will get swept under the rug if i had given it to my UM.

Many nurses who had heard of the incident (gotta love the gossip mill) Came to me saying that they were glad I had gone a step above UM, however, they also offered their condolences.

Back to work for another night, Will see all parties involved in the am. Should be interesting to say the least huh?

BTW, I also attached a handwritten "to go" report that the off going nurse had given her i.e.: crush, whole, PT you know what I mean. On that list next to these pts it stated NO Ativan/Percocet.

Kicking myself for not keeping a copy.

I used to work on a sub-acute vent unit. We handed out the PRNs hand over fist just to keep the patients from driving the staff nuts. People with anxiety can provoke anxiety in everyone they come in contact with...and it will spread from room to room like a fungus.

I vote we hunt this nurse down, hit her with a paralitic, intubate and let her lay totally helpless on a vent with a rate of 12 for a couple of hours. Flipping sadistic wench.

Yes, I have issues.

I guess that more than a few of us have encountered "Keeper of the Key" types and they top my list of people who don't belong in nursing. Pain is subjective and doesn't lend itself well to objective judgement. Give the med. If it's ordered, give the med and leave it up to the MD to evaluate "seeking" behaviour, etc.

Excellent job. You did exactly what you are supposed to do--be an advocate for the pt. I recall when I was doing CNA work a pt on hospice was not being given her prns by a particular nurse. I called hospice direct and talked with the pts nurse who came out pronto and took care of the situation. This facility nurse had a thing about prns unless it suited her. She would use them to keep people going until the next shift so she wouldn't have to call 911. One time I told her if she didn't call 911 for a resident I would. Turned out the guy had aspirated. But when she felt anxiety she called 911 for herself. When it comes to a pts well being, I never mind putting my butt on the line.

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