Other shifts telling us which PRNs to give...

[Nola009]

So I work 2nd shift at a LTC facility, and the nurses on 3rds supposedly want us to give certain people PRN medications on a nightly basis, irregardless of what MY/OUR assessment findings are. So then, it's as if they are not PRNs. I will give them as needed per resident request or as needed per my assessment findings (let's be honest, they only want us to do this to people who have behaviors and dementia, who can't really say what they want or need themselves much of the time). I feel like, if there are behaviors being exhibited on another shift and not mine, then why would I rely on their judgment/requests?? Can't they give these meds - ativan, norco, zonegran- as needed?! Doesn't this seem weird? Or am I overreacting? Like I said, there for sure ARE times I assess the need for these meds and give them. But when I don't have findings which support me giving them, the 3rd shift complains! I'm not there to snow people for them!

[lifelearningrn, BSN, RN]

They want you to make their job easier by getting them nice and sedated prior to their shift. I've had nurses ask me to do the same, especially with a particular trach patient who apparently on second shift liked to pull out his trach, I never had that issue with him on my shift, and never gave him his PRN haldol and xanax. I don't think I ever handed him off without being asked by the oncoming nurse, "did you sedate him?". "Um, no, he's been an angel for me".. lol

[VivaLasViejas, ASN, RN]

Using PRN psychotropics without an indication for them is considered a chemical restraint. BIG no-no. Good for you for refusing to give them for the convenience of the next shift.

[casi, ASN, RN]

I can see medications like Norco. When I worked nights I've asked that 2nd shift ask/evaluate/offer pain medication before bedtime in patients I find aren't sleeping due to pain or are having a lot of pain at night. If the pain becomes a trend, I then contact the MD for an order for Norco at HS scheduled.

[Blackcat99]

Yes. the other shifts will try to tell you how to do your job. For example, a nurse told me not to give prn pain meds to a certain patient because "she is not really having pain" I just ignore those kind of remarks. This is my shift and I will make all of the medication decisions for my residents, not the other shifts.

[morte, LPN, LVN]

oh please! since I work all three shifts I am here to tell you that sometimes persons need that med at the end of your shift or the next shift is playing catch up all shift! we have a client that like clock work 1/2 hour into shift is off the wall, now we can't anything into her/him, they are a risk to themselves and others, and you don't want to medicate? this is a 24/7 job folks! take the feed back and work it out. and yes, I do as I say!

[lifelearningrn, BSN, RN]

If that is the case, call the doc and get the medication scheduled, OR, medicate at the beginning of YOUR shift.

[Nola009]

oh please! since I work all three shifts I am here to tell you that sometimes persons need that med at the end of your shift or the next shift is playing catch up all shift! we have a client that like clock work 1/2 hour into shift is off the wall, now we can't anything into her/him, they are a risk to themselves and others, and you don't want to medicate? this is a 24/7 job folks! take the feed back and work it out. and yes, I do as I say!

I take what "they" say under advisement. If it's a regular need, it needs to become a scheduled med. At my work there are some nurses who say "How high?" When told to jump, no matter what. Not me. Not trying to be difficult, or not part of the team, but I'm not naive and feel like if people don't like me because I don't follow what they say without question, well... good.

[Nola009]

Thanks for all of the feedback. I was just starting to wonder if I was crazy.

[caliotter3]

In certain cases (not everybody in that "problem" group), I can see making sure they get the med during the PM shift. But if they truly need it, then, as others have said, contact the doctor and get an order for routine administration. While I may take into consideration what I'm being told by others, I also am one for making my own decisions when it comes to meds or other matters.

[kiszi, RN]

A little off-topic, but how about when the CNA says "can you give him something" when pleasantly confused resident is trying to stand up from the wheelchair. No, sorry, The MAR says Xanax prn for agitation. I don't see it listed here "prn to make staff's job easier"

[charnsuka, ADN]

Funny you mention this. The other day while receiving report, I had the nurse from first shift tell me that she was mad at another nurse from third shift for not giving a PRN med because she had to "deal with her behaviors all day", then went on to suggest that I SHOULD give a PRN to this particular resident also.

All I could do was give a blank stare and think "just like you trust your OWN nursing judgement, I will trust mine as well." If it isn't indicated that it's needed from my assessments, I'm not giving it just to make your shift a convenience.