I just need some advice on this one, and it's making me NERVOUS. - page 4

I am a new grad LPN. I started my very first nursing job last week, and have been orentating since last Wednesday. On the wing that I will be working on, I have 1 resident in particular that asks for... Read More

  1. Visit  lemur00 profile page
    3
    Actually if the OP gets the physician to order it as a scheduled med, the nurses who are currently not giving it will give it if they have to sign for it. So that would be a way to ensure she does get the med and therapeutic levels are reached. Same theory as pain meds ATC.

    Quote from anotherone
    I would suggest no such thing to the dr .
    morte, Hygiene Queen, and SE_BSN_RN like this.
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  3. Visit  Bortaz, RN profile page
    8
    Why do you think she didn't need it?
    Why was it prescribed if no one is willing to dispense it?
    Why not give her the meds as ordered?
    Since when does "PRN" = "If the nurse thinks she needs it"?

    If I were a resident stuck in a ****-smelling, loud nursing home away from everyone and everything I love, I'd want some ativan 4x a day too.
    ElSea, LTCNS, Sun0408, and 5 others like this.
  4. Visit  lmccrn62 profile page
    0
    I am sorry for your predicament but we cannot deceive a patient. It's unethical. I agree this is similar to using placebo because someone doesn't believe a patients pain or anxiety. Our job is to always do the right thing and document our findings and discuss with the physician if we have concerns. These types of medications are based on subjective findings. So how can we say a patient is not anxious or have pain? We can't. As a new nurse stand by what is right and do the right thing whether anyone agrees or not. Just because others do it will not work for you. It gives you a clear conscience and doesn't put you under any scrutiny. Good luck.
  5. Visit  WhereIsMyCallBell profile page
    1
    Document, document, document! Follow up to see if the med was effective. ONLYthe pt. can tell you that. If the patient tells you and other nurses no, not effective. Then this may be something to have the MD address when he does rounds with the RN, or charge nurse when a pattern is established. If pt. tells you the med. is working then leave well enough alone and give poor pt. her med. when asked for within reasonable time limit. Okies, I have said enough now. lol = x
    SleeepyRN likes this.
  6. Visit  SE_BSN_RN profile page
    0
    As a new nurse, I would have been asking questions. Ask the person orienting you, your immediate supervisor AND your DON. I would imagine they would be happy to explain their reasoning to you, especially with you being new....even though we all know ethically and morally it is wrong to lie to someone! You should know you can't do it just because everyone else is! If the pt has ativan scheduled every 6 hours, and asks for it every 6 hours, than give it. You should have an anxiety/behavior monitoring sheet to track behaviors. If no one is giving it, it may get d/c'd. In our LTC here, if we don't use prn's once in 90 days they get discontinued due to non use. If the pt has severe anxiety, and needs it/is asking for it even more than every 6 hour, the physician needs to be notified. Some people do very well at managing their anxiety, others do not. You learned a hard lesson, and though the odds aren't in your favor, chalk it up to a learning experience and move on.
  7. Visit  morte profile page
    1
    Acutally, PRN is "as needed", not as wanted....
    Quote from Bortaz, RN
    Why do you think she didn't need it?
    Why was it prescribed if no one is willing to dispense it?
    Why not give her the meds as ordered?
    Since when does "PRN" = "If the nurse thinks she needs it"?

    If I were a resident stuck in a ****-smelling, loud nursing home away from everyone and everything I love, I'd want some ativan 4x a day too.
    BSNbeDONE likes this.
  8. Visit  morte profile page
    0
    as has already been pointed out, your exact wording is going to prove to be very important.
    Did she ask if her ativan was in the cup? Did you tell her the Ativan was in the cup? If no and no, you should be good to go. But someone mentioned you are working with a skunk, be careful.
  9. Visit  dream'n profile page
    0
    Question for the OP; Did you sign that you gave the med (which you didn't) in the MAR as given? I have a feeling that you did.
  10. Visit  MunkiRN profile page
    3
    I'm as much concerned about some of the responses on this thread as I am about the actions of the OP. While it is most definitely wrong do deceive a pt, the reaction of "it is not our job to question the orders of a doctor" also has me worried. Let me clarify, it is ABSOLUTELY our job to question. If as a nurse we feel a medication is inappropriate, not working, or unsafe then we need to say something! To simply say well thats what the MD said to do so I'll do it is scary. You are the pt advocate with knowledge of each medication you give, if you don't know why a medication is being ordered then it's your job to find out! If you feel a different order should be in place OP, then you talk to the MD and see what they think. But to simply keep blindly giving medication is not good nursing.
  11. Visit  BSNbeDONE profile page
    0
    For sherabear......

    We've all played the fall guy in this career at one time or another......some of us, maybe a few times until we mastered the concept of a thick skin with still a heart of gold. I sympathize with you in that respect. So just as a friendly FYI, some of these old folks are left with nothing but memories of times gone by and the only family that they have is the nurse that will take them under his/her wing and show them that someone cares. In your particular situation, the Ativan may be the key to freeing the resident from those thoughts and times soooooooo longed for that is probably causing a lot of emotional discomfort. My family will tell you thatim the last person to condone frequent narcotic use. Hell,I've never even taken a drink in my life and my oldest child is 32. (I'm saving my experience for later years in the nursing hime, too!) But when I encounter elderly patients in the hospital, my heart goes out to them and I just can't help but to wonder what they are missing at this point that they so thoroughly enjoyed during younger years.

    I know we deal so much with science and numbers that we forget that 205-B actually has a first, middle, and last name. And think about it, some of these folks have been on this stuff since before you realized that nursing school was not a place to teach new others how to breast-feed. So you're not going to be the one to detox them.

    Some of the posts here were rather 'unkind'. But what I will say to you, not to undermine you in any way because I have to say this to myself A LOT OF TIMES as a med/surg nurse, integrity is doing the right thing even when you KNOW no one is looking. Im not saying create a hostile or awkward working environment. I'm saying, pay attention to your trainers but do what you knowin your heart of hearts is right. I would say TRUST NO ONE but you will find out quickly who to trust in your co-workers and who to avoid after extending a quick smile while keeping it moving.

    Good luck and always keep side job so that there wil be no break in employment......
  12. Visit  GLORIAmunchkin72 profile page
    1
    "Since when does "PRN" = "If the nurse thinks she needs it"?"

    Does not the nurse need to 'assess' before giving a PRN?
    morte likes this.
  13. Visit  KRSLPN profile page
    0
    I have read through all 4 pages of responses to this post.
    The bottom line, as I see it is this, IF the patient has the med ordered prn and they ask for it, WHAT seems to be the problem? Give it to them as ordered, now see, that would take approximately 10 seconds to remove the med from the narc drawer put it in the med cup, give it to them and sign it off, now that wasn't too hard, now was it?
  14. Visit  Bortaz, RN profile page
    0
    Quote from GLORIAmunchkin72
    "Since when does "PRN" = "If the nurse thinks she needs it"?"

    Does not the nurse need to 'assess' before giving a PRN?
    Yes. And with anxiety meds, that assessment is fulfilled by "did pt say she has anxiety and needs the med?"


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