Frustrated new nurse - help!

[lauhu3]

I work in home care and I have been working with the same client for a year now. I decided to leave home care because I feel like I am not being heard or thought of as a professional by my client or her family. I feel as though my opinion about the client's health keeps falling on deaf ears and it has really taken a toll on my confidence as a new nurse.

Here is the most recent suggestion I have made. My client takes several different vitamins that have been prescribed by a holistic doctor and the meds are bought OTC by her mom (who is also a nurse, fyi). The MAR says to give 1 tab daily HS but doesn't state the dosage, which means she would be getting 50mg of a vitamin and then the next bottle that's bought could be 100mg or 25mg. I have mentioned to the other nurses, client, and mom that we should get a dosage written on the MAR so it stays consistent, but it never got done because the doctor who prescribed them isn't working anymore. I also suggested that we write down what dosage she is getting now so that when it's time to buy another bottle the mom knows which mg to get.

Nothing got done and eventually it lead to this - which might be minor and some might say I shouldn't worry about it, but for the sake of learning lets pretend it's something more serious. Recently she ran out of her probiotic that stated on the bottle "give 1 tab 3 times daily" that we gave twice a day according to her MAR. She got a new bottle of probiotics that stated on the bottle "give 1 tab daily" which means she would be getting over 2 times the amount of probiotics as before. Another nurse pointed it out to me and said she held her second dose that day. I agreed that it was a good catch and we should make a note of it. I wrote a note in the communication book about how the dosages were different and said I think we should hold her PM dose. The mom worked the following night and wrote a note in the communication book that says "nurses need a doctor's order to change medications and family must be involved with any changes" and "do not change meds and give according to MAR".

How am I suppose to give a med according to a MAR if there is no dosage? I thought nurses were allowed to hold a medication? What did I do wrong here and how is it that I keep getting shut down when I am trying to make improvements? Do you think I am not being treated like a professional because I am 20 years younger than the other nurses?

I am starting my new job on Monday at a nursing home and I will be the only nurse working on overnights, which means I am the one who needs to make all the calls. I want to be a leader but my past experience with this family has almost taught me to say nothing if I see something wrong, and if I do say something I get shut down and scolded in a way that is visible for the other nurses to see.

[jadelpn, LPN, EMT-B]

In this instance, Mom could prepour all vitamins. If the holistic practioner wasn't working anymore, who was writing the orders at this point?

I wouldn't rewrite a MAR without a mg dosage on it. As you noticed, too much cause for error. And unfortunately, even some vitamins can cause some side effects--so it is important that everyone is on the same page as far as exact dosages.

I could use the example of asprin. 81mg or regular strength? 81 is ok, but regular and you have a patient who is c/o upset stomach. Oh, wait....it just says give one in the morning. It is an OTC med, isn't that OK?!?!?!?!

Sounds like a control thing to me all the way around, especially with Mom being a nurse.

In your new position, you will have a MAR that is more than likely double signed, you will have things more exact. It is not reflective of you what happens in a private home under home health/private duty. There's a WHOLE lot of dynamics going on that are out of your control. Not so in a facility. Oh, there may in fact be dynamics...but none regarding the depth of this kind of power struggle with med dosages of vitamins.

Best wishes!

[SleeepyRN]

In this instance, Mom could prepour all vitamins. If the holistic practioner wasn't working anymore, who was writing the orders at this point?

I wouldn't rewrite a MAR without a mg dosage on it. As you noticed, too much cause for error. And unfortunately, even some vitamins can cause some side effects--so it is important that everyone is on the same page as far as exact dosages.

I could use the example of asprin. 81mg or regular strength? 81 is ok, but regular and you have a patient who is c/o upset stomach. Oh, wait....it just says give one in the morning. It is an OTC med, isn't that OK?!?!?!?!

Sounds like a control thing to me all the way around, especially with Mom being a nurse.

In your new position, you will have a MAR that is more than likely double signed, you will have things more exact. It is not reflective of you what happens in a private home under home health/private duty. There's a WHOLE lot of dynamics going on that are out of your control. Not so in a facility. Oh, there may in fact be dynamics...but none regarding the depth of this kind of power struggle with med dosages of vitamins.

Best wishes!

I second this. Couldn't have written it better myself.

[canoehead, BSN, RN]

I wouldn't give meds prepoured by family...but I'd give them blister packed by a pharmacist. If you can throw the whole mess over to the pharmacist, more power to you. But I bet he'll have the same issues you have.