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

[sherabear]

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!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

For sherabear......

We've all played the fall guy in this career at one time or another......some of us, maybe a few times until we mastered the concept of a thick skin with still a heart of gold. I sympathize with you in that respect. So just as a friendly FYI, some of these old folks are left with nothing but memories of times gone by and the only family that they have is the nurse that will take them under his/her wing and show them that someone cares. In your particular situation, the Ativan may be the key to freeing the resident from those thoughts and times soooooooo longed for that is probably causing a lot of emotional discomfort. My family will tell you thatim the last person to condone frequent narcotic use. Hell,I've never even taken a drink in my life and my oldest child is 32. (I'm saving my experience for later years in the nursing hime, too!) But when I encounter elderly patients in the hospital, my heart goes out to them and I just can't help but to wonder what they are missing at this point that they so thoroughly enjoyed during younger years.

I know we deal so much with science and numbers that we forget that 205-B actually has a first, middle, and last name. And think about it, some of these folks have been on this stuff since before you realized that nursing school was not a place to teach new others how to breast-feed. So you're not going to be the one to detox them.

Some of the posts here were rather 'unkind'. But what I will say to you, not to undermine you in any way because I have to say this to myself A LOT OF TIMES as a med/surg nurse, integrity is doing the right thing even when you KNOW no one is looking. Im not saying create a hostile or awkward working environment. I'm saying, pay attention to your trainers but do what you knowin your heart of hearts is right. I would say TRUST NO ONE but you will find out quickly who to trust in your co-workers and who to avoid after extending a quick smile while keeping it moving.

Good luck and always keep side job so that there wil be no break in employment......

[GLORIAmunchkin72]

"Since when does "PRN" = "If the nurse thinks she needs it"?"

Does not the nurse need to 'assess' before giving a PRN?

[KRSLPN, LPN]

I have read through all 4 pages of responses to this post.

The bottom line, as I see it is this, IF the patient has the med ordered prn and they ask for it, WHAT seems to be the problem? Give it to them as ordered, now see, that would take approximately 10 seconds to remove the med from the narc drawer put it in the med cup, give it to them and sign it off, now that wasn't too hard, now was it?

[Bortaz, MSN, RN]

"Since when does "PRN" = "If the nurse thinks she needs it"?"

Does not the nurse need to 'assess' before giving a PRN?

Yes. And with anxiety meds, that assessment is fulfilled by "did pt say she has anxiety and needs the med?"

[morte, LPN, LVN]

hmm...not really. could be, wants to be numb. That said, in LTC, as some one said "up" post. It is the end of life as they know it. Give what ever, just don't kill'em.

Yes. And with anxiety meds, that assessment is fulfilled by "did pt say she has anxiety and needs the med?"