Ok....I work in LTC. We have recently started using a new place that deals with our "psych " pts....now..normally the way this worked was the doc would order a psych consult and then the psych person would come and eval them and make RECOMMENDATIONS for which he would either agree or disagree. Well...with this new one...its a FNP and she is evaluating every single person we have and OMG....I cannot begin to describe how terrible it is....for example....on my unit...i only have about 3 with behaviors that actually cause true problems.....and she has wrote orders for one of mine who is basically a vegetable....to be on the exelon patch and namenda and she ordered ATIVAN too which I got d/cd. one of mine with behaviors was on 0.5 mg of ativan bid with 1mg at hs...which was helping with her....she cut her ativan to 0.25 bid, put her on lamictal 100 bid, cut her risperdal and put her on an extra dose of lyrica.....at hs i give this pt....100mg lyrica, 1mg ativan, 5mg ambien, 0.25mg risperdal, 10 mg elavil ....another pt on another unit is about 80 lbs and she put her on the following at hs....2mg ativan, 1 mg klonopin, lunesta, ambien, vicodin........its unreal.....on top of this...she has loaded almost everybody up on depakote too....ones that have no behaviors at all....i have another one who is pleasantly confused never bothers a soul....on depakote 125 bid for "mood disorder" and since she started depakote....ive caught her chewing on wooden railing in the hall which she NEVER did before. I read the sheets this fnp wrote out....shes putting false info on these sheets.....shes putting on there that she's talked to these pts and they have told her they c/o nervousness...and that they cry intermittently which isnt true. I do the psychotropic meetings every few mos w/ the doc and don and her.....she lied to me to my face in front of them and told me that day nurses tell her that these things go on or that the ones that have problems are "beautiful" ......i told her she was misinformed and the doc just threw his hands up and said " and thats why i want my evening nurse in here. the nurses know more about these people than anybody" .....I told one of the day nurses what she had said and i asked her if it was true...she confirmed that it wasnt true....she told me that the fnp comes in and gets a bunch of charts and sits at the desk for half the day and comes up with all these ridiculous orders and that she never asks the nurses a thing. the doc and all of us nurses cant stand what this fnp is doing to our patients and we have complained to all the above people to no avail. the don and adon back her completely and told us that she is the psych professional and expert and that we are not. And i would be ok with that assumption if i saw a difference in my patients that benefitted them....all i see is a bunch of pts that are turning into zombies...i hold all the meds that i can find supporting facts to hold it. as soon as we get this mess d/c'd.....it comes right back...the whole purpose of our psych meetings is to do reductions.....we do that and she adds 3 to 4 things later on. I am no nurse practioner but my god...im with my pts at least 6 days a week and i think that if anybody knows them ....i do. Does anyone else have any suggestions on this? Or has anyone else dealt with this kind of situation? What helped? what didnt?
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