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Killing them or helping them?

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Fayren Fayren (New) New Nurse

I've always questioned giving morphine to hospice pt. But I've never minded it so much. But lately I feel like I'm pushing comfort meds to pt. I work weekend doubles and when I come in I find that I am the only nurse who has given medication in a week. I was angry at first knowing that the nurse through the week hates hospice and wants to save everyone. I love that about her but at the same time its not always our job to save people. She's been pushing the evening nurse not to give these meds to the 2 pt whom need it most the night nurse will sometimes give it.

A few weekend ago I walked into my pt room he was crying. Asked me to kill him, tried to kill himself by pulling tubes or pulling off O2. I called the Don had him moved to isolation so family could visit when he was unresponsive after having he pulled his O2 off for to long before an aide found him. I asked fm about comfort meds. They said yes. This last weekend again pulled out tubes in pain. Asked hospice to up pain meds. They did. He recently died.

The nurse on morning shift asked me if I liked killing my pt. If it gives me joy? It hurt so much I've started to question myself. I just had another pt. Moved to comfort meds after talking to family hadnt eaten in weeks curled in bed constantly yelling out if an aide so much as touched him refusing anything but sublingual meds. She asked me if he was next.

I've talked to my DON and she says that my choices are good and that I'm helping them pass. She's mad at the other nurse but I don't want her to be, I'm just debating on if I'm helping or if I'm killing. If maybe I'm pushing to hard to let them die. I know my job isn't always to save but by giving them these meds I'm afraid I'm just killing them.

TLDR: giving pt. Morphine pushing comfort medication?

That's tantamount to patient abuse! If a hospice patient has morphine ordered, give it to them. If a patient is crying in pain because the hateful nurse refused to medicate them for her own personal beliefs, write an incident report and report her. You never let people suffer because of your own beliefs. She's failing to satisfy the duties of her job. What type of reverse Kevorkian is this chick?

Yes you do want your DON to be upset, you should be pissed! You're helping them. The purpose of medicating hospice patients is to keep them from suffering until they pass away. For example, cancer patients are usually in terrible pain and have some of the strongest pain meds available ordered. Cancer is painful, so I've been told. They're going to pass soon anyway, why make them suffer in pain until that day comes? It's hateful, cruel, and insensitive.

If she doesn't believe in hospice, why the hell is she there? Hopefully, the DON fires her and get the patients nurses who truly care. Those are potential med errors and definitely dereliction of duty. I've changed my mind, having patients needlessly suffer, especially willingly doing so, IS patient abuse.

Let me also add, trying to shame and control coworkers into failing to provide adequate patient care is creating a hostile working environment. She needs to go!

For the reasons stated in the previous post, the day nurse needs to go. Your DON is not helping matters any by allowing her to treat patients this way.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

Having recently watched my mother go through untreatable metastatic cancer and pass while on hospice, I would say this nurse is in the wrong specialty. Towards the end, you better bet that my siblings and I were giving morphine and haldol regularly to keep Mom as comfortable as possible during what had to be the most painful experience of her life. Failure to give ordered meds when those meds are clearly warranted is, in my opinion, patient neglect.

You are not in any way “killing” your patients. Their disease process is killing them. You are simply making that process more comfortable. Before haldol was added for my mom, she would be incredibly agitated despite the morphine. She was distressed, screaming for this that and the other person to help her (some living, some others already passed, ripping blankets and clothes off. That is not how any person should have to be. The meds stopped that, calmed her to the point she was able to recognize when all of the grandchildren came to say their goodbyes. And she passed peacefully the next afternoon with all of us surrounding her. That is the goal of hospice, not your coworker’s notion of saving these patients. The only saving these patients need is from their treatable adverse effects of the dying process.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

13 hours ago, Fayren said:

I was angry at first knowing that the nurse through the week hates hospice and wants to save everyone. I love that about her but at the same time its not always our job to save people.

No, don't "love that about her." She is wrong. "Saving everyone" is not what it is about -- and it is not what these patients need or want. What the patients need and want is comfort. They want their suffering to be relieved. By forcing the patients to suffer needlessly, she is being cruel. She may even be breaking some laws by refusing to give properly ordered, needed medication.

13 hours ago, Fayren said:

I've talked to my DON and she says that my choices are good and that I'm helping them pass. She's mad at the other nurse but I don't want her to be,

She should be mad at the other nurse -- and you should want her to be mad. In fact, she should correct this other nurses's thinking and/or fire that other nurse. She should even consider reporting this nurse to legal authorities! That other nurse is extremely dangerous -- purposely harming the patients by not following the prescribed plan and providing them with the comfort measures ordered. You and your manager should be the patients advocate. Your patients don't want to experience agony as they die. If you can't see that, maybe you shouldn't be caring for hospice patience either.

All of your patients are going to die on your service. Get used to it. That's what hospice services are all about. They provide care for patients who are dying. You don't "save" anyone: you help them die. Hopefully, you can keep them comfortable throughout the death process and can help them die in peace, comfort and dignity.

1 hour ago, llg said:

I think I need to clear some things up. I'm not personally a hospice nurse. I work LTC so does she.

The meds that only I seem to give are PRN. I've only seen her hold the routine a few times.

Honestly I came here to vent because she had pointed out that 5 people in the last month either died on the weekend or right after I had left on Monday.

I always am the one whom calls family about comfort meds. Because hospice isn't allowed in. And I've heard the rumors from different aides telling me that they call me the angel of death during the week and it killed me to hear that I don't want my pt. To hurt so I do give PRN. But I don't like people thinking I've killed them.. I've been giving them their meds. I've been putting them on comfort meds. I've been asking hospice for routine instead of PRN because prns haven't been given. I just felt like if I'm the only one doing these things maybe I was wrong. Shes been a nurse longer than me. She's an RN. She's worked in hospitals while all I've ever done is work LTC. While we were working on morning shift together short handed I asked her if she thought a pt. Needed comfort med cause they hadn't eating and were half way non responsive except to pain needed suctioned continued. she had said, "don't you wanna find out whats wrong with them before killing them." Very blut. I just froze I thought it was time for comfort meds turns out she had aspirations pneumonia. She still ended up dying anyway without comfort meds. That stuck with me.

I think after writing all of this I know that the problem is some what through we need to have an inservice with pain meds and hospice pt. normally I am not the one to ask for comfort meds none of us are normally hospice does it on their own and gives us the order but without hospice allowed in they just do phone visits throughout the week with the morning shift nurse. I speak to on call on the weekend. Hospice can't do their job properly they can't see their pt. So it feels like I'm the only one doing it because maybe other nurses aren't use to. I just always work weekends so I'm use to bothering hospice by asking for new orders or seeing it before being a nurse. Now it just seems worse normally hospice will nip nurses like her quickly like speaking like you guys.

I'm sorry that this other nurse said that to you, I would also be distressed. Like the other posters said, she is not doing her job. It isn't our job to impose our values on how people should die, we are assessing and responding based on that assessment: you are seeing your patients in pain and advocating for pain management. This other nurse is simply turning a blind eye. What good is that? no one lives forever so why shouldn't we advocate for our patients to have a comfortable death when they can? Keep being the nurse you are, You sound like a true advocate.

Imessedup

Specializes in LPN. Has 19 years experience.

I would ask her if she liked neglecting pain that the pt might be having and failing to follow orders on making him comfortable? WOW! tho, she has the nerve!!

On 6/18/2020 at 1:23 AM, Fayren said:

The nurse on morning shift asked me if I liked killing my pt.

On 6/18/2020 at 5:22 PM, Fayren said:

Honestly I came here to vent because she had pointed out that 5 people in the last month either died on the weekend or right after I had left on Monday. 

On 6/18/2020 at 1:23 AM, Fayren said:

I've talked to my DON and she says that my choices are good

Your DON needs to hear pleasantly but directly that you expect the other nurse's commentary to stop immediately.

The other nurse is wrong. And at the same time, people who run their mouth like this generally can convince another person or two (or more) there's something to be suspicious about--just because that's the way people are.

This is not the time to "love that about her" or to be all empathetic with ridiculous views. Loud people end up convincing others, no matter how stupid their message is. Therefore, tell your DON you don't find this acceptable at all and that despite having provided nursing care that is standard, compassionate, and both medically and ethically appropriate, this person is accusing you of killing people. Tell your DON that this is slander of a serious nature and you need it to stop immediately.

Further support of my previous comment:

On 6/18/2020 at 1:23 AM, Fayren said:

I work weekend doubles and when I come in I find that I am the only nurse who has given medication in a week.

There are a lot of people not doing their job. You have a loudmouth trying to deflect away from this rampant NEGLIGENCE by putting the spotlight on you and suggesting that there is something nefarious about what you're doing. You look like an outlier by the mere fact that you're the only one doing your job.

This is a credible threat.

kp2016

Has 20 years experience.

A couple of things.

"the nurse hates hospice and wants to save everyone" Short of a miracle cure these patients CAN'T be saved! That is why they are on hospice! The only thing we can do for them is help them pass in comfort (as much as possible) as opposed to leaving them crying, pulling their 02 off, refusing to eat and begging for someone to kill them.

"I love that about her but at the same time it's not always our job to save people. She's been pushing the evening nurse not to give these meds to the 2 pt whom need it most" This is not anything to admire in a nurse. Just because medications are PRN doesn't mean you don't need to give them or they can be constantly withheld. It means you should assess the patient and give them as needed to keep the patient comfortable and avoid having them crying in pain and begging to die.

"The nurse on morning shift asked me if I liked killing my pt. If it gives me joy?" Again you are not killing your patient's you are treating their pain. I would ask her why she enjoys withholding a dying persons pain relief and if she enjoys watching her patients suffer?

A pain inservice is a very good idea but I'm not sure how effective it will be against nurses who can routinely withhold pain medication from patients who are suffering in the way you have described. I never thought I would say this but I would seriously consider reporting these nurses to the BON for patient neglect and cruelty.

Best of luck to you and your patients. I sincerely hope your fellow RN loses her job very soon.

As for the pain inservice, while it would be expected and required of such an entity, it will not help those who are not doing their jobs by refusing to administer medications. Even the most naive and uneducated individual is aware of the basics of hospice when they enter that area. I knew that when I took my first hospice case. We actually discussed hospice in nursing school. Needed education on the underlying concepts does not fly as a reason for noncompliance in this instance. Defensive attack is almost always used to cover down to earth just plain LAZINESS. Hospice = sit in a chair and play on your phone, in or out of, sight of family, to many LAZY nurses.

Hello, @Fayren - I hope you have been able to put a stop to this since your last post.

nursemarion, BSN

Has 36 years experience.

I think you would be great as a hospice nurse. In hospice, they often give meds that are shocking to inpatient or LTC nurses. You have to remember, people build a tolerance to narcotics. That bit of morphine is a lot if you are narcotic naive, not so much if you have been on it for a month.

Not a whole lot is given PRN in situations where they are not under constant care. In inpatient hospice meds are every hour or so quite often while getting symptoms under control and during the dying process.

Mostly they want to prevent pain in hospice, so long-actings are only supplemented with breakthrough meds for home or LTC care administration. She should never be holding long-actings or scheduled pain meds without a darn good reason. That ruins what you have achieved in the way of pain and symptom control.

Sometimes I think nurses who withhold meds in this way either have a fear of death or a slight need for patients to suffer because they were taught to be brave in the face of suffering. But when you are talking death, there is no point in suffering. It is already known to be terminal. Acute pain sometimes serves a purpose either diagnostically, or to prevent the patient from overdoing it during recovery. Terminal pain and restlessness are symptoms of suffering that have no purpose. She needs educated. But you, I think you are a hospice nurse at heart.

And death comes when it comes. In hospice, it is thought that sometimes when a patient is finally comfortable they can relax and let go. If you are making that possible because others are not, then you are helping them to pass, not making them pass. I have seen nurses hold meds before the next shift was due to come because they were afraid the patient would relax and die before that shift change. That is wrong too.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

I don’t throw around “BON” lightly... but I would seriously consider reporting this nurse. Her practice is so egregiously abusive, I think the public needs to be protected from her.

Qwerty3

Has 5 years experience.

I once had a similar situation. I’d given morphine as ordered, the patient died through the night, and the oncoming nurse said something along the lines of me being the angel of death and killing them.

I talked to my mom who has been a nurse for almost 20 years because I was beside myself.

she said “would you want to live like that? Would you want help and comfort? Or would you like to go slowly, painfully, and wishing you had a way to help you?”

put everything in perspective and I’ve never thought twice about morphine orders since.

You love her about that? You love seeing or knowing that a patient suffered in pain and agony because the uneducated, irrational, naive nurse refused to give comfort meds per ordered? Just the thought is pissing me off. There is a reason why there’s a doctors order for this patient to be on hospice, not never mind the family/pt agreed to Hospice. What you coworker did was neglectful and unacceptable and she should be be reported, If not, fired. You can even say what she did was abuse, not just neglect and inattentiveness.