We had a very demented gentleman, very childlike, who is a one assist since he's rather unsteady. Because we can't get him to sit still the charge nurse care planned a geri chair with a tray (for those in the UK, the big, padded recliners on wheels).
He's had a lot of back pain for which he has Tylenol 3 Q6H PRN, and for his agitation Ativan 0.25 mg Q6H PRN. He also has IM Haldol. And, of course, no one ever uses these meds because they're controlled substances and if you actually use them you get a reputation for overusing PRESCRIBED meds.
Well. I work with "perfect nurse." You have one. She writes up everyone for everything and does everything according to the very rigid book. SHE asked me this mornig if he had an order for anything injectable. I told her I was giving him an Ativan. I also gave him a T3 for his back pain - hardly an obtunding combo.
It immediately calmed him down. Pleasant all AM.
After lunch things were hectic, as always. Perfect Nurse was floating TX between 2 units. I TOLD her I'd take care of our PM tx's - they are three neds, a cath, and an inhaler. She insisted on doing it all. I had kiddingly told her at lunch that I would chemically restrain demented wanderer with Ativan and T3 at 2. I did plan on repeating the dosages, but geeze Louise, hear the sarcasm, no?
Well. He won' sit still. We're busy. I have 5 minutes until being done with my med pass. They want him in the geri-chair. I knowm how badly this distresses him so I say, "give me 5 minutes and I'll take him over." They insist that there aren't 5 minutes. An aide grabs the chair, Perfect Nurse grabs him, and they indicate the tray and say, "Sue? Well?" I got to grab him and he's flailing and striking and yelling, "NO!"
I let him go. I said, "Okay, buddy. It's okay." The aides are yelling at me that they'll get into trouble if he falls. I told them that I had obviously accepted responsibility for him. Gave him his meds. Within 5 minutes he was calm and smiling again.
This affectionate childlike man now flinches when anyone goes to touch him.
Perfect Nurse goes to the charge nurse, repeats what I said about chemically restraining him, and explains that I refused to follow the care plan. I told her to fire me on the spot because a care plan wasn't carved in granite and I was not going to in effect chain the nut to the radiator because he was inconvenient. I then burst into tears - I feel very passionately about this issue. Talk about indignity!
