Is nursing in practice this different from school?

Specialties Psychiatric

Published

  1. Advice?

    • 1
      No big deal
    • 1
      Kind of a big deal, just never be the witness to those wastes
    • 9
      Tell management

11 members have participated

Please bare with me, this is my first post after years of lurking!

I've been working my first job on a unit for almost a year. Due to the nature of the unit, we receive a higher ratio of aggressive:docile patients and oftentimes either A) Call for med orders (Ativan, Haldol and the like) or B) Give current PRNs.

Most recently, the other nurse's patient became very agitated and there were no PRNs ordered that would have helped the agitation. This nurse called the doctor, and he ordered Ativan 1mg IM to give now and q6h PRN. The nurse asked me to draw up the Ativan while she put the order in. She came to look at it before giving it, grabbed the vial, and drew up the rest of the med (for a total of 2mg). Stunned, I asked how we were going to waste it. She said we will still do the standard waste with a witness. I told her I was uncomfortable witnessing the waste and she told me that everybody on the unit does it. She called one of the other nurses in and sure as ****, he had no problem "witnessing the waste." They told me this is part of the lecture all new nurses receive, that nursing in practice is NOT nursing in theory from school.

Is it just me? I was stunned when the second nurse walked in and was totally ok with it. I confided in one of the aids and the aid says that happens all the time and it's never a big deal. So either I'm new and naive, or my unit is rather corrupt. Which is it? Thanks!

0 Votes
Specializes in Complex pedi to LTC/SA & now a manager.

Not standard practice in any place I've worked. That's practicing medicine without a license.

0 Votes

I posted this in the patient medication forum but haven't gotten much response. I wanted to anonymize that I was dealing with the psychiatric field but perhaps those in different fields would have differing thoughts than those in the psychiatric field.

Please bare with me, this is my first post after years of lurking!

I've been working my first job on a unit for almost a year. Due to the nature of the unit, we receive a higher ratio of aggressive:docile patients and oftentimes either A) Call for med orders (Ativan, Haldol and the like) or B) Give current PRNs.

Most recently, the other nurse's patient became very agitated and there were no PRNs ordered that would have helped the agitation. This nurse called the doctor, and he ordered Ativan 1mg IM to give now and q6h PRN. The nurse asked me to draw up the Ativan while she put the order in. She came to look at it before giving it, grabbed the vial, and drew up the rest of the med (for a total of 2mg). Stunned, I asked how we were going to waste it. She said we will still do the standard waste with a witness. I told her I was uncomfortable witnessing the waste and she told me that everybody on the unit does it. She called one of the other nurses in and sure as ****, he had no problem "witnessing the waste." They told me this is part of the lecture all new nurses receive, that nursing in practice is NOT nursing in theory from school.

Is it just me? I was stunned when the second nurse walked in and was totally ok with it. I confided in one of the aids and the aid says that happens all the time and it's never a big deal. So either I'm new and naive, or my unit is rather corrupt. Which is it? Thanks!

0 Votes

So what you witnessed was illegal. The nurse who did this basically ordered and administered a scheduled medication by herself.

Does this happen-absolutely but let me ask you how comfortable are you breaking the law?

I work in a different branch of nursing as a nurse practitioner but if you call me for an order I am almost always trying to find the lowest effective dose. if I think the patient is doing great on 1 mg of Ativan when it comes time to discharge the patient I am going to convert that to a PO dose. All of the sudden the patient isn't doing well because they are underdosed. So in addition to breaking the law you are causing harm to the patient.

0 Votes

So you're saying the physician ordered Ativan 1 mg, and nurse intentionally administered Ativan 2 mg? Illegal, no question. And certainly not standard psychiatric nursing practice. I've been in psych nursing for almost 30 years, and I've never worked anywhere where I was aware of anything like this going on, certainly nowhere where it was a common practice. If I were in that situation, I'd start looking for another job pronto, and think seriously about reporting this to the unit leadership. One of these days, the !@#$ is going to hit the fan, and you don't want to end up getting caught up in the fallout.

0 Votes
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I posted this in the patient medication forum but haven't gotten much response.
Duplicate threads have been merged per the site's terms of service.
0 Votes

Scottaprn - I am not comfortable with it whatsoever. In fact, I'm so uncomfortable with it that I am horrified at my reaction: "How are we going to waste it?" (Seriously?) That was in no way an acceptable reaction. I don't want to get sucked into those practice habits, by being told by the only other nurses that I have nearby to defer to teaching me things that aren't actually so. What was going through my head was: "Wait! What? We need to waste that 2nd mg. We can't waste it if it's injected into the patient!" And only when I was able to sit down and process my emotions through the ordeal, figure out what was causing the sick feeling in my stomach: that what she did was illegal and apparently that's how the *entire* unit is operating. Which, in effect, just furthered my anxiety in dealing with the nurses that do this. And therefore leading me to this board!

0 Votes

I work on a psychiatric unit and have never done this or witnessed any of my nurses doing this. It's wrong, and god forbid it's a fatal dose. Lots of explaining to do!!

0 Votes
Specializes in psych, addictions, hospice, education.

The practice you described is illegal and WHOA!!! Don't be part of it. Sooner or later someone will get tangled in the details of it and record something incorrectly, and the person who monitors controlled substance administration and disposal will figure it out. Then someone will be in trouble.

And, what if the dose is too much for the person? Who takes responsibility then? What about the patient going through the too-big-a-dose?

What's the rationale for doing this? Does the doc not order big enough doses, in nursing's opinion? Even if that's the case, nurses can't prescribe and/or give dosages different than ordered.

There's so much wrong with the scenario...I'm verclempt! I think it's a sign that the people working there could be less than honorable...

0 Votes

To RNMamaof2 ---- You lacked some information in your post -- 1) was 1mg Ativan wasted from syringe down the sink (not the right way, but ok) or was the entire amount of 2mg Ativan delivered to pt. Did you waste the 1mg with RN before medication given without it really being wasted? I'm pretty sure you mean the entire amount was delivered, but I just want to be sure, as you will need to be sure for court. I am not being dramatic, I want you to see that the way we were taught is right!! When it comes to legality, liability & our license, we need to be doing what is legal, safe & ethical just like they taught us in school. What that RN said to you is called bullying - & both of you could loose your licenses for that entire transaction! I am also a newish nurse (1 1/2yr) & love when I am able to handle just the way I was taught. If that had been me in the med room, I'd be walking out refusing to witness - & into my program directors office - or calling her on phone. No way am I going to loose my license for someone else - & when it comes to medications & pharmacy - I am super paranoid that I might do something wrong & get fired & license revoked - (we all make enough of "duh" mistakes without adding blatant recklessness & illegal into the mix) Part of working as a nurse is making up your mind what kind of nurse you will be --- the kind we were taught to be, or the one that has no problem with illegal acts. My unit co-workers & myself hold each other to legal, safe & ethical standards. All I can say is that if your unit does not work that way, you need to say something & maybe look for another place to work.

0 Votes
Specializes in Mental Health.

The nurse needs to administer what the physician ordered end of story... However where I work Ativan 2mg is the standard, I only really see 1mg for underweight patients or sometimes substance abusers. Nurses need to be assertive when getting orders from physicians and recommend what will probably work the best for a patient.

0 Votes
+ Add a Comment