experienced psych nurse please chime in

[Isitpossible]

we have a paranoid schizophrenic patient who refused his PO meds.. kept politely stating "no thank you." There is no order to give IM for Po refusal. However, there are orders for PRN IM for severe agitation/aggression. I finally convinced pt to take the meds PO, however he didn't swallow it and ultimately spit it out. Co-worker immediately prepares IM. Pt is crying, no please don't give me a needle, I will take it by mouth, please give me another chance. Co-worker doesn't do second chances. He gets IM. I keep finding that seasoned RNs do things a bit different and its difficult . The PRN clearly stated increased aggravation. Co-workers rational, he was acting up last nite, up all night, and were not doing this again tonite. Though I love my job, I feel ready to leave at times based on other peoples actions. Its very hard to be the newer nurse all the time... I would never talk to management, because Im not looking to throw anyone under the bus... How long before I feel confident enough to say, NO, Give patient another chance or NO hes not being aggressive to warrant the IM... ugh, sick of this....

[Retired APRN, MSN, RN, APRN]

I agree with the other respondents. This is a very, very serious issue. The patient's rights were violated, and from what you describe the other nurse broke the law. You stood by and watched and did not bring it to anyone's attention.

I understand how frightening it can be to face the very real possibility of repercussions for doing what is simply the right thing. You do not have to start out by being confrontational. As others have suggested, start off slow. Ask your charge, head nurse, nurse educator or someone in similar role about the situation. Something like, "There was no order for IM if PO refused and the patient was not agitated. Could you explain the rationale to me? I don't get it."

But if you are not doing anything about it, you are in silent complicity.

If this is a common situation at your facility, look for another job. At least I would. I wouldn't want to stay at a job where patients' rights were not respected, where they were getting suboptimal care, where nurses were performing illegal acts and perhaps even assaulting patients.

[Davey Do]

You have my admiration, Isitpossible, for bringing such a difficult subject to light.

What you choose to do about it is up to you.

I can only echo the facts, perspectives, and opinions of the others.

[Isitpossible, LPN, LVN]

You stood by and watched and did not bring it to anyone's attention. I know, that's why I feel so badly. I didn't stick up and do what I felt in my heart is right. I have been a nurse 1yr, and Im up against seasoned nurses who take over the unit, take charge and Im left feeling like a complete failure when I don't agree with their practices. I wanted to give him PO again, like he requested and I failed. I will discuss with my manager, but I feel like the first thing she will ask is WHO??? i only work there on weekends and never get to really see my nurse manager. There is a supervisor there, but I have addressed issues with him before, and he clearly flip flops. For example, a patient became very aggressive throwing chairs etc. I requested to put him on a 1:1. Initially supervisor response was "great idea"... that was early in the day. Later, because he couldn't find additional coverage for that 1:1, he then said there was no need for patient to be a 1:1. That time I did stick to my beliefs, and he basically threatened me advising that he would have to tell my nurse manager. I told him, Im completely okay with that...Your threatening to tell my manager because Im trying to keep a patient and staff safe? Unbelievable. So this is just one issue Ive dealt with and again, being new I feel like I honestly don't have the confidence to address all issues I see.

[Psychcns]

Agree that you should discuss with manager or somebody higher-up using approach people suggested above. Ask about the rationale for force medicating in non emergency situation. Maybe there is something you are not aware of. Sounds more like bad practice. If there is an untoward event you may be found at fault for not coming forward. Does anyone else have difficulty with this practice.

[Isitpossible, LPN, LVN]

yes, there is another new nurse on my unit. she feels exactly the same way, but doesn't know what to do about it either.

[Psychcns]

Is there some way the two of you could meet with your manager in confidence, just about forced medication issue. The 1:1 issue is something else and if you bring up too many problems you risk becoming the problem. Read your policies and the joint commission regulations and any other regs you can find. Ask your manager about guidelines to practice. You have to make sure you are practicing within the guidelines and policies. Somehow you have to make this the managers problem-she is the leader. Maybe she should arrange some patient rights inservices. You may also want to call your malpractice carrier about what is your liability in this kind of situation. Also call your BON-maybe..

[Orca, ADN, ASN, RN]

You stood by and watched and did not bring it to anyone's attention. I know, that's why I feel so badly. I didn't stick up and do what I felt in my heart is right. I have been a nurse 1yr, and Im up against seasoned nurses who take over the unit, take charge and Im left feeling like a complete failure when I don't agree with their practices.

Being seasoned doesn't automatically make one right. Medicating for personal convenience is never correct. I had to report an instance of this myself when I had been an RN for less than a year. She worked night shift. I worked swings, and I found out about this from her tech when I stayed over to work a double shift one night.

If a patient had a PRN order for an IM medication for agitation, this nurse would chart that the patient was agitated and give him/her an IM medication so that he/she wouldn't wake up during the night. Her tech apparently believed that this was common practice. The first night I worked with her, a young female patient awakened about 2:00 AM, walked into the hallway and sat down in a chair. The tech asked me if I was going to medicate her. I told her no, because the patient was calm and quiet and she wasn't bothering anyone. The tech acted surprised, then she told me what my colleague was doing. This nurse was terminated about two weeks later, after the investigation was completed.

If nursing management backs you, you have solved a major problem. If they don't, then that facility has much larger issues that you don't want to be part of. I had much rather be accused of doing too much in a situation like that.

[macfar28]

In my state and hopefully others, it is a restraint anytime hands are placed on the patient in a way other than to assist stablizing for the procedure, in other words, without their consent. By your description it was also a chemical restraint and should have been documented as such. As others have stated, this would be a major event in the eyes of the regulating agencies.

I would run, not walk, out of that facility once you can secure alternative and satisfactory employment (or even before if financially feasible). I also agree that you have a duty, while scary, to report the things that are happening. Do you have security cameras that record some of these incidents that will confirm your story? While I'm no legal eagle, I also wonder if the whistleblower law might protect you should they turn it on you and terminate.

Good luck and know that 1 year of experience or not, you are doing right by your patients and your license.

[bymysoul2squeeze]

You shouldnt give an injection unless the patient is on an Involuntary protocol that clearly states he/she should be given the IM if refuses pill . It is a common practice to do what you described because the staff doesnt want to "deal" with the patient. I guess your coworker had to flat out lie in his notes that the patient was aggressive to justify that IM.