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

[sherabear]

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 PRN Ativan at least four times per day, and other nurses have openly admitted to not giving it to her but telling her that they have. This resident does not exhibit any overt signs of increased anxiety at all, and her behavior doesn't change whether she receives the medication or doesn't. The nurse I was orientating with did the same thing; she will tell her that all her pills are in her med cup and administer away. Like I said, there are no changes in behavior; she believes she got her ativan, so she doesn't ask for another one for 6 hours (she gets it every 6 hours PRN). I did the same thing last night, but suddenly I'm under investigation, despite the fact that it's been going on far longer than I've been there. I'm suspended without pay pending investigation, and I'm just wondering if anyone knows what typical outcomes are. My nurse manager just said that re-education would likely be the result, but that doesn't make me any less nervous!

[blackvans1234]

Nurses shouldn't play god.

If a patient is saying they would like ativan, they should be given ativan if it is ordered. Who am I to judge if they are having anxiety, depression, etc.

With all the people in the world walking around with anxiety, suicidal thoughts, depression that nobody ever bats an eye to, how do you truly know what your resident is thinking / feeling?

Learn from it and move on.

[LadyFree28, BSN, LPN, RN]

Nurses shouldn't play god.

If a patient is saying they would like ativan, they should be given ativan if it is ordered. Who am I to judge if they are having anxiety, depression, etc.

With all the people in the world walking around with anxiety, suicidal thoughts, depression that nobody ever bats an eye to, how do you truly know what your resident is thinking / feeling?

Learn from it and move on.

^This!!!

[pedspnp]

The patient is on the call light constantly, that is enough to set off an alarm that this patient is suffering from severe anxiety. Did you have to go through a psych rotation, if you did you should know that anxiety manifests its self many ways. Just like pain it is what the patient says it is. Never with hold a medicine with out orders or parameters, basic nursing 101.

[lemur00, BSN, RN]

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.

I would suggest no such thing to the dr .

[Bortaz, MSN, 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.

[lmccrn62, MSN, RN]

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.

[WhereIsMyCallBell]

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

[SE_BSN_RN, BSN]

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.

[morte, LPN, LVN]

Acutally, PRN is "as needed", not as wanted....

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.

[morte, LPN, LVN]

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.

[dream'n, BSN, RN]

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.

[MunkiRN, BSN, RN]

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.