Withholding prns??!! - page 2

I have never in my nursing career been so angry!! That said I need advice. I work on an acute Ventilator unit where pain and anxiety reign supreme. After dealing with 2 pts who were in such a... Read More

  1. by   Tink RN
    Don't feel like a turd ... the nurse you made cry needed to cry. She was stupid to accept such a request from the nurse leaving her shift. Geez ... that is horrible. Not to mention illegal.
  2. by   jude11142
    It's terrible that you were put in this situation, but you did the right thing. These poor patients.

    As for other instances, it stinks that you are being told, "that's our girl" etc..........I would be so mad too.

    I have a nurse that hates giving out any prn pain meds/tranqs etc...She happens to be the regular full-time nurse on the floor and is best friends with DON(not that it should matter but...). There have been many times that this nurse tells the oncoming nurse, "don't give her/him any percocet or valium, just give tylenol"......Huh? Give tylenol for anxiety/agitation???? I tell her that I will see how the patient is first.......A few times, when she comes in the next day, she takes a fit, yelling, "who gave so and so this or that?". I don't know how or why she gets away with this, really I don't. Our patients come first, and secondly, who the hell is she to insult us other nurses by telling us what to give and what not to give? I have seen patients that are in severe pain and the nurse is giving them tylenol instead of a prn pain med.......I have confronted 2 such nurses and asked them, "why aren't you giving them a pain pill"......believe this or not, but here are the answers given. "so and so, said not to give the strong pain meds, to give tylenol"....... Once, I blew up......"did you assess their pain?"......."you are their nurse right now, not so and so".......I just don't get it.

    I hope that there are not many nurses out there that are like this. Those who are, need to be reeducated on pain control/psych meds..........actually maybe they should be out of nursing period.
  3. by   jnette
    Boy, do I ever agree, Jude !

    Whassup with that thinking, anyway? WHY do they do this? I just don't GET it....
  4. by   meownsmile
    This whole senerio makes me wonder if the med count is actually accurate. This kind of smacks of a diversion scheme to me.
    And it isnt right and your UM and med nurse know it, so whats their excuse, and whats next on the list if they are that uncaring and torturous.
  5. by   traumaRUs
    Whew - don't get me started on the subject of people who shouldn't be nurses! Give me a break! Report these people and I mean both of the nurses (the one who gave the order and the one who followed it). In Illinois, we have long term care ombudsman who follow all non-hospital care placements. Please think of how many other times this nurse (the one who gave the order) has done this???!!!!! Please, for these poor patients write it up! Believe me, if one of my family members had prn meds with held without a solid medical reason, the entire facility (including the company who owns it) would be on the chopping block. You are following your conscience - go with it. Take care.
  6. by   Cooker93
    When I was in nursing school back in the old days, my instructor called the nurses who didn't like to give out PRN pain meds "The Keeper of the Keys". They held the keys to the Demerol and Morphine etc... and they KNEW your patient wasn't in THAT much pain. I am in the position now and when the patient says they are in pain (even though I work in Psych), and if they have a PRN order and if it isn't soo soon, I give the PRN. If the Doctor didn't want anything given, he wouldn't have written the order. And if he didn't write the order and the patient c/o pain, I call and get them an order.
  7. by   live4today
    Where I work, if a patient says they are in pain, they are in pain.......medicate as prescribed no matter what.

    If they want their pain meds changed or increased, get the order and give them their drugs.

    If the family of the patient says they are in pain and you disagree because it wasn't the patient himself/herself saying "I'm in pain"....it becomes a PR issue because the family member trots up...no...storms up to the Nurses station in search of "whose boss that shift" to report you as a noncaring insensitive excuse of a human being.

    Our hospital is big on pain management. I am big on medicating them for pain when the patient...not the family member...says they need or want something for pain.

    What bothers me are the drug seekers who are known drug addicts still using. I think our hospital becomes those patients crutch for continued drug abuse because they will give them the Ativan, the Morphine IV every 2 to 4 hours, the Vicodin, the Percocet, etc.

    In your patients case however, you were right to do what you did, and the other person was stone wrong.

  8. by   -jt
    <I know that I have effectively put my head on the chopping block. I know there will be hell to pay from my UM no questions asked.>

    Well if she does, calmly remind her that there are whistle blowers laws in many states now, NY being one of them, and if there is any retaliation against you for blowing the whistle on this nurse as you were obligated to do to protect your pt, your manager's actions against you can cause the hospital to be sued. And they wont be too happy about that.

    Also, I too was wondering about the narcotics counts.
  9. by   jnette
    The pain is what the patient SAYS it is. Period. Withholding pain meds further deteriorates the patient's condition by the body having to deal with or fight against the pain.. slows the healing process.

    Watched an interesting report on TV not too long ago on how ppl's brains respond individually and differently to pain, and how it is indeed so very INDIVIDUAL. And that pain should/MUST be treated according to what the patient states it is.

    This really ticks me off. As said above.. wonder how often and in how many places this goes on?
  10. by   Agnus
    1. This is reportable. I would especially report it to my S. BON since this is an ongoing offence by this nurse.

    2. The ONLY nurse who may give an order to withhold medications to another RN, is an advanced practice nurse. Then the order must be written and signed. However, If your state does not grant prescriptive powers to an APN, then even she can't do this.

    3. The float nurse was in the wrong for not advocating for the patient, and for allowing another RN to direct her paractice. If a decisions is made to withhold a med it must be reported to the MD. If a prn is preceived necessary and is withheld it must be reported to the MD.

    4. Withholding prn's under these circumstances violates the standared of practice and any state board will have to respond.

    5. Report to BON because this is the agency who can and will disapline individual nurses.

    6. You may want to report to other agencies as you deem appropriate such as JACHO, etc. but definately the BON.

    Common protochol for going up the Chain of Command is you need to notify every link in the chain that you are proceeding up the chain. So you would have done well to tell the firstline supervisor that you were going to take this up the chain. Sometimes we don't want to discuss an issue with a first line supervisor (because the problem is the supervisor)but you need to tell them that and that you are going to their supervisor with the problem instead.
    Taking a problem to you supervisor is the first step. You are always free to move beyound that if you do not get satisfaction. Your credibility and professionalism come up though if you skip a link.

    I am guessing that the supervisor has a vested interest in protecting the offending nurse. Maybe personal maybe not. It could just be she is afraid of loosing someone that she feels will be hard to replace. Or she doesn't want to offend her because the supervisor is the type that has to have everyone like her.

    See what your BON says about reporting. Are you obligated to report or do they want you to take it up the chain first.

    As far as JACHO and various state agencies go it is customary to report to the chain of command first then to the agency. However, if this is ongoing and unresolved report it yourself.
    Last edit by Agnus on Aug 3, '03
  11. by   Agnus
    Originally posted by PJMommy
    The behavior this nurse is displaying is unexcusable. Orders to not give pain meds...without any explanation as to why...is absolutely ridiculous.
    And illegal. M.D.s have been disaplined for this.
  12. by   autumn-moon
    Oringinally posted by Cooker 93
    I am in the position now and when the patient says they are in pain (even though I work in Psych), and if they have a PRN order and if it isn't soo soon, I give the PRN. If the Doctor didn't want anything given, he wouldn't have written the order.
    Being a brand new nurse and also in the Psych field, I do run into this. I have a preceptor (I'm a nurse intern) who has been doing this for a looong time. She often tells me NOT to give the PRN. I too, feel that if the doc didn't want the pt. to have it, he wouldn't have prescribed it. Right now, I'm sorta "stuck" when this happens. Yes, sometimes it is all too obvious that the desire for a PRN is "drug seeking" or "attention seeking" or even sometimes just because they've heard another pt. asking for a PRN. HOWEVER, I too was taught in school that pain/anxiety are whatever the pt. says they are, so the witholding of PRNs goes against my grain also. (And totally so in areas such as med/surg.!!!)

    In my case, as soon as *I* am in "The Position" (which won't be long), I will handle such instances by giving the PRN (and if there's a choice, the one I feel is most appropriate) and when it seems, in my nursing judgement, to be for other than "legitimate" reasons, I will bring that up with the doc and suggest that the PRN order by changed or D/C'd.

    And personally, in this field, if a pt. is aggitated and a PRN is ordered, I feel that, for everyone's safety, pts. and staff alike, it is much preferable to offer a PRN (if the pt. desires it) than risk injury to *anyone*.

    Any feedback from more experienced nurses in the psych field?

  13. by   Squeeta2
    In answer to the narcotic counts they are fine. In fact the numbers don't change when she is on duty. She just likes to have "control". Her answer IS tylenol for everything.

    Please keep in mind I DID write this up. I skipped my immediate supv. for 2 reasons. 1) It was the overnight shift and I gave it to my immediate nsg supv at the time. 2) It really will get swept under the rug if i had given it to my UM.

    Many nurses who had heard of the incident (gotta love the gossip mill) Came to me saying that they were glad I had gone a step above UM, however, they also offered their condolences.

    Back to work for another night, Will see all parties involved in the am. Should be interesting to say the least huh?

    BTW, I also attached a handwritten "to go" report that the off going nurse had given her i.e.: crush, whole, PT you know what I mean. On that list next to these pts it stated NO Ativan/Percocet.
    Kicking myself for not keeping a copy.