New nurse here. Questions about PRN intervals and "HIPAA spooking"

roser13, ASN, RN · Jan 22, 2017

Be careful what you believe. Nursing instructors are not above a bit of exaggeration to get their point across.

Having said that, I would have asked the educator to pull up the patient herself, given the restraints upon you as a nursing student not currently giving care to the patient. If she doesn't understand that, then you need to have a conversation with your instructor as to what you may or may not access.

RNKPCE · Jan 22, 2017

Part of our workflow is to look up patients before we receive them whether from the ER, OR or another inpatient unit. Sometimes those patient's are discharged from the ER, go to a higher level of care or become unstable and can't transfer. I'd have been fired 50+ times if I was fired for every patient I looked up that didn't materialize on my unit or ended up being assigned to a different co-worker on my unit.

Your instructor is putting very illogical ideas in your head in this regard.

Editorial Team / Admin · Jan 22, 2017

I'm a bit confused about policy vs. reality and as a new nurse, I'm in "nursing school" mode constantly fearing losing my license over technicalities.

Take a look at your BON's disciplinary actions- they're public record. What you'll find is that the vast majority of infractions involve drugs, alcohol, or criminal offenses, not technicalities. It is actually very difficult to lose a license.

Part of our workflow is to look up patients before we receive them whether from the ER, OR or another inpatient unit. Sometimes those patient's are discharged from the ER, go to a higher level of care or become unstable and can't transfer. I'd have been fired 50+ times if I was fired for every patient I looked up that didn't materialize on my unit or ended up being assigned to a different co-worker on my unit.

This. As an OR nurse, it is not uncommon for me to begin looking up information on my next patient when I have a moment during the case before. However, there have been many times where things prevent me from being the nurse on that case: the patient gets cancelled, the case is moved to another room, the current case takes an unexpected turn and goes beyond the end of my shift, etc. I was questioned about a patient once (patient happened to be a relative of an employee and was flagged for audit), but once I explained (and had the electronic audit trail showing the case as having been in my assigned room) that was it.

oceanblue52 · Jan 22, 2017

With PRN meds, you just need to count forwards and make sure an adequate amount of time has lapsed...in that case I would probably be cautious about giving say a q 6hr med 5 hours and 45 minutes instead of at 6 hour mark. And generally my understanding is at education is okay for looking up patients, maybe keep a log of such instances at work so you can justify it if asked.

MunoRN, RN · Jan 22, 2017

It's not unheard of for nursing school faculty to teach things that are absurdly false, this isn't completely without value in nursing school since one of the main things it needs to teach students is how to think critically, and the ability to recognize when your teacher is full of crap is one way to learn critical thinking.

There are no universal regulatory requirements on how PRN orders are interpreted, the general rule is that how they are going to be interpreted is understood in the same way by those writing the orders and those interpreting and implementing the orders. For instance, if a facility allows no wiggle room, the providers need to be aware that patients will typically be getting their prns less frequently than what they order, so they may need to adjust the time frames accordingly.

KatieMI, BSN, MSN, RN · Jan 22, 2017

It's not unheard of for nursing school faculty to teach things that are absurdly false, this isn't completely without value in nursing school since one of the main things it needs to teach students is how to think critically, and the ability to recognize when your teacher is full of crap is one way to learn critical thinking.

Or they just enjoy making fun of students and scaring them out of their minds.

Julius Seizure · Jan 23, 2017

Check your hospital policy about PRNs. Some places differ, but in general, you have to wait the full 4 (or whatever) hours.

The computer chart thing is untrue. Accessing a chart for educational purposes is covered.

Horseshoe, BSN, RN · Jan 23, 2017

Having said that, I would have asked the educator to pull up the patient herself, given the restraints upon you as a nursing student not currently giving care to the patient.

The OP states she is a new nurse, not a nursing student.

OP, why don't you just ask what the policy is regarding PRNs? You have a nurse educator working with you; her job is to answer questions.

Meriwhen, ASN, BSN, MSN, RN · Jan 23, 2017

Agree with the other posters: it doesn't matter what we tell you about our facilities' policies. What matters is YOUR facility's policy. So ask your charge nurse or manager about it.

That being said, in my facility, the practice is that we are allowed a little wiggle room (up to 15 minutes) for most PRNs. For controlled substances, we are stricter about it.

However, we can go outside of that if nursing judgment deems it necessary. For example, if my patient has clonidine q4h PRN, her blood pressure is in the 190s and it's 3.5 hours after her last dose...she's getting the clonidine PRN early. The MD is also getting a request to tweak her scheduled BP meds so we can avoid this in the future.

Extra Pickles · Jan 23, 2017

, in nursing school the instructor one time told a horror story where a nurse was told she was getting a patient from a different unit so looked up the patient to be prepared to receive the patient, and was fired because the patient never actually ended up being given to the nurse.

good lord if this actually happened, which I don't believe, the nurse who got fired was fired for something else entirely. the story is good enough to share around a Nursing Student Campfire, lol, as an urban legend designed to keep unruly campers aka students in line!