I just need some advice on this one, and it's making me NERVOUS.
- 1Mar 7, '13 by sherabearI 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!
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- 6Mar 7, '13 by GrnTeaQuote from nozyrozy40Alas, I can't expand on this much. You (and the other nurses) must have learned in nursing school that it's unethical to deceive a patient like this; it amounts to administering a placebo, which you can't do without a physician plan of care, and the physician plan of care for placebo cannot be implemented without the patient's awareness and permission. I know this sounds goofy, but the point of a placebo is not deception.I see this all the time....doing something you know is wrong just because others do it. You got caught, you're under investigation....own it. Next time, do what YOU know is right.
Take your "reeducation" and recognize that the rest of your floor will probably get the message too, one way or the other. And as your mother probably once said, "If your friends were jumping off a cliff, would you do it too?"
- 7Mar 7, '13 by catlvrOP, I wonder who turned you in or how the pt found out that they were not actually getting the Ativan...you've learned your lesson about honesty and careful documentation, but it sounds as if you have an unsavory character where you work. I absolutely despise this aspect of nursing.
- 3Mar 7, '13 by Keep_CalmWow. That just sucks all around. I know how hard it can be dealing with patients/residents like that, but as GrnTea said, you cannot deceive a patient like that and yes, it's your fault. Valuable lesson learned by all.....BUT--and this is what I HATE about where I work too--why wasn't this problem addressed properly instead of nurses lying to the resident? UGH! Plus the nurse that oriented you did it!?!? The blame goes to others as well. I hope for the best outcome for you.
- 0Mar 7, '13 by sherabearI don't think the resident every found out. The night nurse must have said something, because I reported off and let her know about the PRN pain meds she had received, but told her no ativan this shift...I have only ever given her ativan once, at her request. The night in question, the resident just asked for 'all her night pills', and then asked about her sleeping pill, which I assumed was the trazodone she gets, and asked to make sure that all her pills were there.
The day nurse and other evening nurse have both OPENLY ADMITTED to not giving the ativan, which is why it mostly just sucks that I am the one on unpaid leave during investigation. I s'pose from now on, I'll just ativan her up.
- 2Mar 7, '13 by Rags2Riches RNWorking in dual diagnosis I have encountered similar situations. When I was orienting one of my preceptors says that if a patient is ordered Ativan and they can have it (i.e. enough time has elapsed and they're not maxing out) then administer it. She always told me that if the doctor didn't want the patient to have it then s/he would discontinue it. That's really been my motto, even though I try to offer alternatives like Vistaril which of course never does anything for them. If the nurses didn't feel the patient needed it then they should have mentioned it to the physician to either discontinue it or increase the frequency. Now as far as what you did, honestly it depends on the exact words that were exchanged. You stated in your original post that your preceptor "will tell her that all her pills are in her med cup and administer away." That might be a true statement, perhaps all of her scheduled meds are in the cup. Now if the patient asked if the Ativan was in there too (when it really was not) and she/you said yes, then that is false and rightfully grounds for some investigation or at the very least a teaching moment for you & your co-workers.
- 3Mar 7, '13 by Nurse_Let them risk their license. Protect your own.
My question is why is the patient asking for it? Does she want company? Is she really anxious? What was the Ativan order for?
Depending on your doctor's orders, indication of use can be really specific. Like: Tylenol 325mg PO every six hours for temp of greater or above 100.1. Can you give the tylenol for pain? NO! The order was specifically for what it is indicated. That's why we always have a clarification of order.
So why is she taking the Ativan? Is it for anxiety? Do you think she's anxious? If not, you have to explain to her. That's your job. If she needs a stronger dose, you have to rely that to the physician. The doctor does not know how much ativan she takes, and its your job to follow up on that. Is her anxiety getting worse? If it is, does she need a better medication to manage it?
Just because other nurses openly admit it to you, it doesn't mean they will risk their license to openly admit that in court. You have to protect yourself because, guess what... you are the newbie, it's easier to get rid of you.
- 1Mar 7, '13 by WeepingAngelYeah, unfortunately, "but everyone else does it!" doesn't really leave you with a leg to stand on.
Also just FYI I just had a patient who takes Ativan at bedtime occasionally, it doesn't make him act obviously less anxious, but he does say that it helps his mind quiet so he can relax and sleep.