I just need some advice on this one, and it's making me NERVOUS.

RNGrammie · Mar 7, 2013

I see this all the time....doing something you know is wrong just because others do it. You got caught, you're under investigation....own it. Next time, do what YOU know is right.

nurseprnRN, BSN, RN · Mar 7, 2013

I see this all the time....doing something you know is wrong just because others do it. You got caught, you're under investigation....own it. Next time, do what YOU know is right.

Alas, I can't expand on this much. You (and the other nurses) must have learned in nursing school that it's unethical to deceive a patient like this; it amounts to administering a placebo, which you can't do without a physician plan of care, and the physician plan of care for placebo cannot be implemented without the patient's awareness and permission. I know this sounds goofy, but the point of a placebo is not deception.

Take your "reeducation" and recognize that the rest of your floor will probably get the message too, one way or the other. And as your mother probably once said, "If your friends were jumping off a cliff, would you do it too?"

catlvr · Mar 7, 2013

OP, I wonder who turned you in or how the pt found out that they were not actually getting the Ativan...you've learned your lesson about honesty and careful documentation, but it sounds as if you have an unsavory character where you work. I absolutely despise this aspect of nursing.

BSNbeauty, BSN, RN · Mar 7, 2013

I've seen this done before. It is not good practice. Learn from this mistake and never do it again.

Keep_Calm · Mar 7, 2013

Wow. That just sucks all around. I know how hard it can be dealing with patients/residents like that, but as GrnTea said, you cannot deceive a patient like that and yes, it's your fault. Valuable lesson learned by all.....BUT--and this is what I HATE about where I work too--why wasn't this problem addressed properly instead of nurses lying to the resident? UGH! Plus the nurse that oriented you did it!?!? The blame goes to others as well. I hope for the best outcome for you.

sherabear · Mar 7, 2013

I don't think the resident every found out. The night nurse must have said something, because I reported off and let her know about the PRN pain meds she had received, but told her no ativan this shift...I have only ever given her ativan once, at her request. The night in question, the resident just asked for 'all her night pills', and then asked about her sleeping pill, which I assumed was the trazodone she gets, and asked to make sure that all her pills were there.

The day nurse and other evening nurse have both OPENLY ADMITTED to not giving the ativan, which is why it mostly just sucks that I am the one on unpaid leave during investigation. I s'pose from now on, I'll just ativan her up.

Rags2Riches RN · Mar 7, 2013

Working in dual diagnosis I have encountered similar situations. When I was orienting one of my preceptors says that if a patient is ordered Ativan and they can have it (i.e. enough time has elapsed and they're not maxing out) then administer it. She always told me that if the doctor didn't want the patient to have it then s/he would discontinue it. That's really been my motto, even though I try to offer alternatives like Vistaril which of course never does anything for them. If the nurses didn't feel the patient needed it then they should have mentioned it to the physician to either discontinue it or increase the frequency. Now as far as what you did, honestly it depends on the exact words that were exchanged. You stated in your original post that your preceptor "will tell her that all her pills are in her med cup and administer away." That might be a true statement, perhaps all of her scheduled meds are in the cup. Now if the patient asked if the Ativan was in there too (when it really was not) and she/you said yes, then that is false and rightfully grounds for some investigation or at the very least a teaching moment for you & your co-workers.

Nurse_ · Mar 7, 2013

Let them risk their license. Protect your own.

My question is why is the patient asking for it? Does she want company? Is she really anxious? What was the Ativan order for?

Depending on your doctor's orders, indication of use can be really specific. Like: Tylenol 325mg PO every six hours for temp of greater or above 100.1. Can you give the tylenol for pain? NO! The order was specifically for what it is indicated. That's why we always have a clarification of order.

So why is she taking the Ativan? Is it for anxiety? Do you think she's anxious? If not, you have to explain to her. That's your job. If she needs a stronger dose, you have to rely that to the physician. The doctor does not know how much ativan she takes, and its your job to follow up on that. Is her anxiety getting worse? If it is, does she need a better medication to manage it?

Just because other nurses openly admit it to you, it doesn't mean they will risk their license to openly admit that in court. You have to protect yourself because, guess what... you are the newbie, it's easier to get rid of you.

Morainey, BSN, RN · Mar 7, 2013

Yeah, unfortunately, "but everyone else does it!" doesn't really leave you with a leg to stand on.

Also just FYI I just had a patient who takes Ativan at bedtime occasionally, it doesn't make him act obviously less anxious, but he does say that it helps his mind quiet so he can relax and sleep.

squatmunkie_RN · Mar 7, 2013

Wow that's kinda harsh punishment. I've told a pt that I'm giving pain medicine when in fact I was just pushing 5cc of NS. But that was because the MD didn't want to order iv pain medicine. It was a last resort and miraculously that solved her problem lol.

sherabear · Mar 7, 2013

[quote=Nurse_;7212422

So why is she taking the Ativan? Is it for anxiety? Do you think she's anxious? If not, you have to explain to her. That's your job. If she needs a stronger dose, you have to rely that to the physician. The doctor does not know how much ativan she takes, and its your job to follow up on that. Is her anxiety getting worse? If it is, does she need a better medication to manage it?

Just because other nurses openly admit it to you, it doesn't mean they will risk their license to openly admit that in court. You have to protect yourself because, guess what... you are the newbie, it's easier to get rid of you.

If things go well for me, I am going to talk to the doctor about possibly scheduling it BID or TID depending on what he thinks; she asks for it like clockwork, regardless of whether or not she actually needs it, which in my honest and professional opinion, she does not. She is a higher needs resident and has her call light on at least 6-8 times per hour, which definitely indicates a need for human contact, and I have stayed in her room on more than one occasion, even making her forget that she requested the ativan, which is why I've only administered it once. I think she relies on the idea of the ativan more than the effects of it...that doesn't excuse the whole not administering it thing, I know. And I've had the last two days to have my heart pound and think about the outcome, and really regret being a lemming. I don't agree that she needs it. But like you say...it's not my call. It's the doc's and her's.