Giving PRN at family request

[MelissaLPN]

I am have been a nurse for two years and work in a LTC facility. I have had several " run in's" with family requesting PRN medication for the resident( residents who are not oriented). I go and assess the resident and determine that they do not need the prn medication. When I try to educate the family about the medication they insist. I had a man phone his wife so she could speak to me and insist that " mama" needs an ativan. I spoke with an experianced ltc nurse who says " give them what ever the family is requesting or they will have you written up." I want to know is this true? Should I save my breath? I had a resident who was not alart, resp 10 with family demanding she needs morphine. When I tried to educate them on resp depression they looked at me like I was the devil and then complained to the social worker. I need help. Should I shut up and give what ever they want? Should I keep trying to educate? I feel so inadequate. The family just talks me in circles until I am exhausted and even I don't know what I am saying.

[Plagueis]

Unfortunately, I know a few nurses who were written up for not giving a PRN pain med at the family's request, despite the fact that the nurses assessment didn't warrant a PRN. So some places may "punish" a nurse if they don't please the family.

t

[steelydanfan]

Unfortunately, I know a few nurses who were written up for not giving a PRN pain med at the family's request, despite the fact that the nurses assessment didn't warrant a PRN. So some places may "punish" a nurse if they don't please the family.

t

Well, I guess it's time to find a new job?

Really, I can't relate to that experience, but having taken care of many pt.s with off-the-wall families, I have truly never had a family that couldn't be calmed with a simple discussion of the pt's condition at the bedside. Stand at the bedside and point out all the reasons WHY you believe the pt needs no further analgesics. When they offer up THIER observations, (rattling, color, are the biggies);again explain the medical reasons for such, and again reassure.

One caveat here, MANY nurses are disinclined to medicate pt.s appropriately out of fear that it would do some harm. All nurses need a a sound base in the appropriate use of pain medication and anti-anxiolytics. If you are NOT comfortable in such, please take a course.

[MrWarmHearted]

What does the MAR and your facility's protocol say?

[DizzyLizzyNurse]

We had a Hospice volunteer like that. The pt would finally fall asleep and then the volunteer would wake her up (the pt was already a nervous wreck) and I don't know what the volunteer would say or do but then she'd come down saying Mrs X needs an Ativan. She's all wound up." Well maybe if you hadn't woken her up and said/did whatever she would be napping and be fine!!! Used to drive all us nurses batty.

[evolvingrn, BSN, RN]

We had a Hospice volunteer like that. The pt would finally fall asleep and then the volunteer would wake her up (the pt was already a nervous wreck) and I don't know what the volunteer would say or do but then she'd come down saying Mrs X needs an Ativan. She's all wound up." Well maybe if you hadn't woken her up and said/did whatever she would be napping and be fine!!! Used to drive all us nurses batty.

HAHA some of our volunteers can be that way, well-intentioned but in need of an ativan themselves, none-the-less I always give family some weight in deciding to do a prn. If i don't do a prn i spend quite a bit of time educating them. For instance i had a pt moaning with each breath... at first request i gave pt pain medicine because it was appropriate due to facial grimacing, bracing of the body ect......they requested more a short time later but this time there was no grimacing and no signs of pain other than the exp. moan which was more respiratory in nature. When i pointed out how relaxed her face was, her hands and the rest of her demeanor her family was okay with not doing another pain med at that moment. but i always really push their imput and tell me to put the call light if they even suspect pain.... It gives them a sense of control , they are a great pair of eyes for me and regardless its a good time for education.

[AltaEnfermera]

I was too. I spoke with the volunteer's field supervisor and explained the situation, and she assured me she would "deal with it". I don't know what that means, but she hasn't been back. It wasn't so much that she was concerned about the patient; I would have been more than happy to explain my rationale had she not been disgustingly patronizing and spoken to me like a child... Not that that doesn't happen often . Some people have a hard time believing that my 12 y/o looking self is actually a nurse, lol.