Chemical restraint and lazy nurses

Nurses Medications

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Ok so I work as an lpn in LTC. We hae a resident who is a bother so to speak. He continually tries to get out of bed at night and has had a few falls. I know he is worrisome BUT

I worked 7-3 this week (I'm PRN so I work all the shifts) an I started to notice that in the mornings, this man was heavily medicated. He has an order for Klonopin 0.5mg QHS which evening shift is happy to give just to help keep him in bed. I've worked the shift. I've given it to him myself. But I wasn't aware of the level of sedation he was under until I worked day shift this week.

Hes so over medicated in the AM that the first day I worked, I thought he was in a coma and had had a stroke. Did neuro checks and watched him closely. He didn't fully wake up until around lunch. Which means he didn't eat breakfast and apparently NEVER does due to the over sedation....not a good thing.

So I approach the NP about my concerns. She D/C the Klonopin to my relief. The next morning he was awake, alert and verbal and ate ALL of his breakfast meal! Wonderful!

Well the 3-11 shift throws an outright fit about the Klonopin DC. They call the NP at home and have her reinstate it. All bc they didn't want to have to run to his room and put him to bed every time he tried to get up.

I know now it's annoying. I've worked that shift and gotten frustrated with him myself BUT I was unaware how sedated he was in the AM also.

Im upset that the Np gave in to the pressure from the nurses and gave this med back! I informed her that they were wrong. That it is illegal to sedate someone just bc they are annoying....apparently she needed reminding!!!!! This is abuse! There are laws protecting this man. But no one cares. My DON, the ADON, the NP. I feel like the nurses threw a fit and she gave them what they wanted bc she favors them. Sorry if I'm not here to discuss manicures with you. I don't kiss ass. I care about my patients and that is all.

what is the deal??? Why am I the only one who cares??? What should I do? Opinions welcome.

You're not the only one who cares, for sure. But you were obviously the only one with the integrity and initiative to do the right thing--you are quite a wonderful nurse..... Would that there were many more like you, the world would be a better place. Kudos also to your NP who took the appropriate action.

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Specializes in Critical Care/Vascular Access.

I get the impression that there's a lot more going on here than the OP is saying. I don't think she's (he?) intentionally be deceiving about it or anything of the sort, but I don't think she's seeing the whole picture herself, which in turn is skewing her perception and recounting of the situation. I'm saying this because I see similar situations at work fairly regularly when one nurse gets worked up over a situation involving coworkers not doing something they're "supposed to", when in fact the accusing nurse has missed some important information regarding the issue. The more worked up you get, the less aware you are of the whole situation.

But maybe this isn't the case, and the OP is, in fact, completely right about the situation. I still find it odd that 0.5mg would sedate a person that heavily for that long, but it's possible, so with that in mind, would it not be reasonable to suggest a change in the evening dosage? That way you are not taking away all the meds that probably help keep him manageable at night (and in turn keep him safer), but you're reducing the sedative affects on him? If he gets 0.25mg in the morning, maybe that would be good for evening as well. Also, the dosages (or necessity) of the other meds he's getting should be seriously looked into. Are melatonin, geodon, and the clonazepam his only meds all day long? I think it's also possible that the one morning you saw the patient alert and oriented was not necessarily due to holding the last night's dosage, there could have been other factors involved.

To the OP, while I appreciate your passion, it seems like emotions are starting to play a bigger role in this situation than calm, rational thinking……..please don't get angry and lash out at me, I'm just making an observation from reading through this thread.

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Op- you've read the suggestions provided to you. In your own words there is "neglect" by nursing staff and fraud by the person doing the care plans for the residents. As a nurse you are REQUIRED to REPORT, as set out in any BON in the US. So by not reporting you are facilitating both neglect and fraud, no matter how good your intentions may be and how much you care for this resident.

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There's a few things want to point out:

Giving someone klonopin, depakote, risperdal, whatever as a sedative when said someone has a dx of dementia with manic episodes of unsafe behavior, it is NOT automatically chemical restraint.

I don't know this resident. Maybe he has impaired renal function and the klonopin is building in his system. Maybe he's just really sensitive to it. Maybe 0.5 mg really IS sedating him well into the next day. It's possible.... But I rather doubt it.

But, OP, let's say you're right and this resident getting this dose of klonopin really IS causing excessive sedation. Even then, you're WAY out of line in how you're talking about your fellow nurses. They are administering a SCHEDULED medication, commonly given to dementia patients, with a VALID doctors's order to do so. And you accuse them of being lazy or worse?

And on what basis should the night nurse withhold this scheduled klonopin? Clearly, he's not sedated when it's time for THEM to give the med.

And do you realize klonopin is an anticonvulsant? Maybe he's not taking it just so the night nurses can sit and eat bon bons. Very bad things could happen if nurses decide to willy nilly hold a drug like klonopin.

Perhaps I was unkind in saying the OP was making all this about her. But all the posts stress that she's the only nurse that cares. That no one else does. That all the other nurses are lazy. That, but for her, no one at this facility would be held accountable.

Sorry, I don't buy it.

It's like when posters here talk about how EVERYONE on their unit is "mean" and a "bully". And they're just an innocent victim.

99.999% of the time when some one says EVERYONE else they work with is mean or lazy or rude or uncaring, they are failing to realize the problem isn't everyone else. The problem is them. And this is usually glaringly obvious to anyone on the outside looking in.

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OK so its scheduled. It still seems like it was ordered because his sundowning was causing him to be agitated and a huge fall risk. And you're jumping to conclusions if you think just because this guy is sleeps till noon, that means the night nurse doped him 'cause she's lazy. You owe your nursing co-workers the professional courtesy of NOT making such assumptions. Really, you seem very quick to judge your nursing coworkers. You imply they are lazy because they give a doctor ordered sedative to counter his sundowning. What would you have them do? Short of a 1:1 which, as you must know, is almost never in the budget. You say your facility does not have meetings and is very poor at care-planning. OK..... join the club. This does not mean your nursing coworkers are lazy, "criminals" or anything else of the sort. I'm sorry, but it really seems to me that you're making this all about you, and how you want to be painted as the tragic martyr or the heroic whistle-blower or something. Your co-workers are doing the best they can with what they have. Sure, it would be great if we could provide our demented residents with the 24/7 one-on-one care they need to keep them safe. You know and I know that's not possible. When you have one nurse and two aides responsible for 40 demented residents some of them are going to get sedatives as part of their medication regimen.[/quote']

Did you read anything I wrote?

You defend the evening staff so much it makes me wonder if you are the type of nurse they are.

Allow me to tell you what I replied to others...the particular nurse was playing on FB and posting pics of themselves at work OUTSIDE. No nurse in the building to keep an eye on the residents who are at risk for fall. No they're too busy playing and it's easier to pop a pill in this mans mouth than do your job.

If you can't read the whole post then take your opinion elsewhere. I'm not a martyr. I'm a damn good nurse and I make no apologies for it. Not to you or anyone else.

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You're not the only one who cares for sure. But you were obviously the only one with the integrity and initiative to do the right thing--you are quite a wonderful nurse..... Would that there were many more like you, the world would be a better place. Kudos also to your NP who took the appropriate action.[/quote']

Thank you for being nice. Unlike some of the others. My heart is in the right place. I

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I get the impression that there's a lot more going on here than the OP is saying. I don't think she's (he?) intentionally be deceiving about it or anything of the sort but I don't think she's seeing the whole picture herself, which in turn is skewing her perception and recounting of the situation. I'm saying this because I see similar situations at work fairly regularly when one nurse gets worked up over a situation involving coworkers not doing something they're "supposed to", when in fact the accusing nurse has missed some important information regarding the issue. The more worked up you get, the less aware you are of the whole situation. But maybe this isn't the case, and the OP is, in fact, completely right about the situation. I still find it odd that 0.5mg would sedate a person that heavily for that long, but it's possible, so with that in mind, would it not be reasonable to suggest a change in the evening dosage? That way you are not taking away all the meds that probably help keep him manageable at night (and in turn keep him safer), but you're reducing the sedative affects on him? If he gets 0.25mg in the morning, maybe that would be good for evening as well. Also, the dosages (or necessity) of the other meds he's getting should be seriously looked into. Are melatonin, geodon, and the clonazepam his only meds all day long? I think it's also possible that the one morning you saw the patient alert and oriented was not necessarily due to holding the last night's dosage, there could have been other factors involved. To the OP, while I appreciate your passion, it seems like emotions are starting to play a bigger role in this situation than calm, rational thinking……..please don't get angry and lash out at me, I'm just making an observation from reading through this thread.[/quote']

I appreciate your well though out and unbiased opinion and you've given me a lot to think about. Medically and emotionally.

I really appreciate it :)

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Op- you've read the suggestions provided to you. In your own words there is "neglect" by nursing staff and fraud by the person doing the care plans for the residents. As a nurse you are REQUIRED to REPORT as set out in any BON in the US. So by not reporting you are facilitating both neglect and fraud, no matter how good your intentions may be and how much you care for this resident.[/quote']

Thank you. I have a lot to think about

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I would definitely do an anonyomous call to the state department if you have patient concersn about your facility.

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That's a good question. And you have wonderful suggestions. I wish I actually had a say in his medication regime. The issue is that yes, he is Over sedated and no one in my facility cares enough to think it through or try any modifications....

Don't you have an ombudsman? Isn't that the person you should be reporting this to?

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When you have one nurse and two aides responsible for 40 demented residents some of them are going to get sedatives as part of their medication regimen.

Why? Because it makes your job easier?

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What I don't understand is why the OP is posting this on AN instead of reporting it to whomever it is she is supposed to report it to if she feels that this man is being chemically restrained. Asking the opinions of anonymous people on a message board and getting snarky comments accusing you of trying to be a "hero" isn't accomplishing anything.

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