MD ordered placebo for pain PRN~would you give it?

[beetlebailey524]

I am an RN student who will graduate in May. I ran across a situation during my clinical the other day that I wanted to seek some experienced advice on. This was my 3rd or 4th day of clinical at this hospital so I was still getting oriented to everything and trying to familiarize myself with all the "policies and procedures."

I do not have an instructor with me but my preceptor is great and always answers my questions but even she seemed to be at a loss of explanation for this one.

The secretary for the floor asked my preceptor to try and decipher an order for a new med scribbled out on the pts chart so it could be ordered. It was determined to read "Placebo for pain PRN" and scanned to the pharmacy. So of course I had to ask my preceptor if this was normally done at this hospital and what exactly would be given to the patient.

She did not seem to surprised by the order and said she had not ever had this ordered for any of her patients so she did not know what would be given. (she was acting as charge nurse so we had to view the chart)

Being new and a student and not knowing the entire situation I did not say anything else to her but I did ask another nurse what her opinion of giving a placebo for pain was. She seemed surprised that this was actually written on an order and scanned to the pharmacy but also said she had never had this ordered for any of her patients before so she really did not know what to tell me.

All I want to know is this something that goes on and nurses are doing? I would not give a placebo pain med to a patient, ordered or not. It is not honest and goes against all I have been taught in school about an RN being a patient advocate, practicing with fidelity and non-maleficence. Am I just being naive?

If the patient were to find out they had been mislead and wanted to press charges against the MD, the hospital and the nurse wouldn't that qualify as an intentional tort on my part-as my instructor always says "a prudent nurse would have known otherwise!"

I do not know if the order was ever carried out but I was told the doctor had discussed this with the patient's nurse. Whatever that meant? I have chosen to use this as an ethical dilemma I encountered during clinical to write a short paper on so any feedback would be appreciated, pro or con.

Thanks.

[blondy2061h, MSN, RN]

I would not give it.

Worst order I saw was to "give narcan until family chooses to make patient a DNR."

[RN1982]

No. I think giving a patient a placebo instead of really treating their pain is unethical.

[Blee O'Myacin, BSN, RN]

I would not give it either as there are many non-narcotic avenues for pain management. If it were my patient, I'd be addressing it with the doc AND kicking it up the nursing chain of command.

[elkpark]

You're not being naive. The AMA and other medical associations established a policy years ago that use of placebos is completely unethical without having the same informed consent from the client that you would obtain for any other procedure/treatment (i.e., without the client having agreed to the use of placebos). In the absence of documentation of such informed consent, I would refuse to give it.

[Elvish, BSN, DNP, RN, NP]

I wouldn't give it. I'm not lying to a patient telling them I'm giving them something for pain when it's nothing.

[Batman24]

I wouldn't give it either. It's unethical. I would make your instructor aware of the situation. The nurse should have called the doctor to clarify and if he stated the order was accurate I would go to my CN, etc.

[CoffeeRTC, BSN, RN]

Wow...I didn't know this happened in the real world. I'd be curious to know more about this pt and the docs reasoning.

Now..I've been known to talk up a tylenol Extra strenght or a motirn that was used before the narc was due or ordered to be given.

[truern]

I absolutely would not give it. :angryfire

And I'd want YOU to be my nurse if ever I were in pain!! :)

[ChristineN, BSN, RN]

I hope your preceptor (or whoever that pt's nurse was) called the doctor up for clarification and a real pain medication order. Even Tylenol would be better than a Placebo!

Good job being a pt advocate!

[beetlebailey524]

She will be aware when I write the paper for her class:) Other students in my class have encountered the same thing. One girl said her preceptor actually gave a saline injection for pain relief to a patient in an ICU! It's amazing how nursing school does not prepare you for the "real world" of nursing. I have seen so many things we are taught not to do-I'm staying true to my beliefs and maintaining my integrity regardless. I have worked to hard!

[ChristineN, BSN, RN]

She will be aware when I write the paper for her class:) Other students in my class have encountered the same thing. One girl said her preceptor actually gave a saline injection for pain relief to a patient in an ICU! It's amazing how nursing school does not prepare you for the "real world" of nursing. I have seen so many things we are taught not to do-I'm staying true to my beliefs and maintaining my integrity regardless. I have worked to hard!

I work in the "real world" of nursing and I would still be shocked if I saw any of my co-workers giving saline or placebos for medications. That's just cruel.