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

anotherone, BSN, RN · Mar 8, 2013

I do not understamd why nurses were not giving it when it was ordered. I can not stand that . unless pt seems too unstable for sedating meds than what is the point of this?

anotherone, BSN, RN · Mar 8, 2013

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.

I would suggest no such thing to the dr . frankly this seems offensive to me. You have no idea how she is feeling . mayb e she is a benzo drug seeker or maybe she is very anxious and could bennifit from ativan as the prescribing provider thought. wow. some people can hide their anxiety, depression, delusions and hallucinations (to an extent) very well.

SleeepyRN · Mar 8, 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.

I immediately thought this too, about who turned you in. Did you tell someone you did this? This sounds like a good learning lesson. I HOPE you learned a few things from this. I'm also wondering, wasn't the controlled drug count off?

beeker · Mar 8, 2013

Why would you hold her Ativan? If the doc says she can have it q6 as needed, and he said he needs it, why not give it to her? Why are you withholding meds she is allowed? Because others have? Poor judgement on your part. Perhaps she will use the call light less if she gets her available meds.

Mommy&RN, BSN, RN · Mar 8, 2013

So she's on the call-light all the time...did you ever think that maybe THAT was a sign of, oh, I don't know, ANXIETY??? She seems pretty ANXIOUS to get her Ativan, doesn't she? As a chronic anxiety sufferer, I take offense that anyone would think that because someone doesn't "look anxious," then she must really not need her medication. Do you know what I'm able to do with my medication? The stuff I need to get done during the day: cleaning, cooking, working, caring for my family and myself. Do you know what I do when I'm not on my medication? Lay on the couch in front of the TV, desperately trying to "relax" and calm myself down. Sounds backwards, I know, but you'd understand if you thought about it a little. You don't know what's going on in my head, and you have no idea what's going on in your resident's head.
I hope you learned your lesson.

This is what I wanted to say. If you saw me, you may not think I'm anxious on the inside. I've dealt with anxiety for so long, that I can appear calm, but you have no clue what's going on inside of my body.

Also, if she has been on Ativan for awhile, she may experience withdrawal. Being on the call light all of the time could show her outward signs of anxiety.

Not to mention lying to the patient is wrong. Would it not be easier to just give her her prescribed medication?

SleeepyRN · Mar 8, 2013

I would suggest no such thing to the dr . frankly this seems offensive to me. You have no idea how she is feeling . mayb e she is a benzo drug seeker or maybe she is very anxious and could bennifit from ativan as the prescribing provider thought. wow. some people can hide their anxiety, depression, delusions and hallucinations (to an extent) very well.

I agree. Plus her constantly being on the call light can be one of her symptoms of anxiety. And if she is given her Ativan and still behaving this way at onset and peak. then she may have developed a tolerance and that dosage simply isn't working anymore. Either way, just like pain, anxiety is subjective and is what the patient says it is. I take xanax, and you could not differentiate my behavior from before or after I took it. I sure FEEL a hell of a lot better though.

SleeepyRN · Mar 8, 2013

I am a new grad LPN. I started my very first nursing job last week, and have been orentating since last Wednesday. On the wing that I will be working on, I have 1 resident in particular that asks for PRN Ativan at least four times per day, and other nurses have openly admitted to not giving it to her but telling her that they have. This resident does not exhibit any overt signs of increased anxiety at all, and her behavior doesn't change whether she receives the medication or doesn't. The nurse I was orientating with did the same thing; she will tell her that all her pills are in her med cup and administer away. Like I said, there are no changes in behavior; she believes she got her ativan, so she doesn't ask for another one for 6 hours (she gets it every 6 hours PRN). I did the same thing last night, but suddenly I'm under investigation, despite the fact that it's been going on far longer than I've been there. I'm suspended without pay pending investigation, and I'm just wondering if anyone knows what typical outcomes are. My nurse manager just said that re-education would likely be the result, but that doesn't make me any less nervous!

The more I think about this, the more concerned I get. You have expressed no remorse. You're initial post was asking how much trouble you'll be in. While it's a legitimate concern, you should spend some time thinking hard about all the comments left here to you.

Mks123 · Mar 8, 2013

Wow Bad situation for sure

1. Judgmental and dishonest nurses.

2. Wrong decision on your part Always do the right thing . There us NO room for dishonesty in nursing!

3. Sounds like you are working with some nurses with major personality problems and it probably starts at the top!

4. Work hard be honest pray for good result

Good Luck!

Vespertinas · Mar 8, 2013

As a chronic anxiety sufferer, I take offense that anyone would think that because someone doesn't "look anxious," then she must really not need her medication.

That's what I wanted to say. Someone close to me takes ativan multiple times a day for anxiety. Others may not recognize the differences in how this person feels between doses but this person sure does.

allnurses Guide · Mar 8, 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.

This really disgusts me and makes me feel rather sick inside, both that it was done and that it is now talked about so casually.

It is our position to be a patient advocate. Not judge trial and jury.

OP, I hope you learned your lesson. The only sympathy I have is that you are a new nurse and need guidance. What your coworkers failed to provide we are giving you here. Don't ever ever ever do that again.

martymoose, BSN, RN · Mar 8, 2013

What was wrong with giving them the ativan?I'd rather have my pts sleeping !

kakamegamama · Mar 8, 2013

Wow. Just wow......I'm thinking more and more that I don't ever want to leave a loved one alone in a hospital/longterm care facility/fill in the blank location...... I KNOW there are still good, safe practitioners of nursing care out there, but goodness.....