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!
When I worked LTC I worked all three shifts/PRN. I understand the pressure you can receive from other shifts to leave your patients sedated.
I agree with the way you handle it. Always go off YOUR assessment and nursing judgement. Never administer a PRN medication JUST because someone else told you to.
Now, If the next shift thinks Mrs. Brown sleeps through the night better after having Ativan before 21:00, then as the 2pm-10pm nurse I would assess the situation.
First off, can Mrs. Brown ask for Ativan? Is she verbal? If not, what are her symptoms during my shift? Let's say she is calm without any s/sx agitation. If the 3rd shift nurse says Mrs. Brown gets agitated at 23:00 and does not sleep well, did she/he document this? Is this benefit and behavior after Mrs. Brown relieves Ativan well documented? If Mrs. Brown is nonverbal and her behavior is well documented, I might give the Ativan based off it's documented benefits in this patient. I would also strongly consider leaving a note for the MD explaining the situation and the possible benefits of scheduling the medication for that purpose.
I would NOT sedate a patient for staff convenience, especially if I see no indication of a need for the medication on my shift. If there is well documented benefit for the patient in the nurses notes, I would consider administering the medication.
The next time you get attitude from the oncoming shift, explain to them your liability and responsibility for administering PRN medications as appropriate during your shift based off your assessment. Ask them to document Mrs. Browns behavior and suggest that they leave a note for the MD about scheduling this medication. Explain that if they document Mrs. Brown's behavior then the MD might have the evidence he needs to schedule med. Documentation will be essential.
I admire you for sticking to your guns. Always advocate for your patient and use your nursing judgement in these situations,
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 know there are patients and situations like this. Can you contact the MD to get this medication scheduled? That way you aren't putting the off going nurse in the uncomfortable situation of giving a PRN med with the rationale of "so the patient doesn't have behavior issues on the next shift". If this patient becomes at risk for harming themselves/others then it sounds like the MD needs to be very involved.
If I were the nurse during the shift that the behavior issues occur on, and I knew the patient benefited from a specific PRN medication that was not given on the previous shift, then I would make sure first thing that I assessed them and they received this medication at the very beginning of my shift.
Karou
700 Posts
When I worked LTC I worked all three shifts/PRN. I understand the pressure you can receive from other shifts to leave your patients sedated.
I agree with the way you handle it. Always go off YOUR assessment and nursing judgement. Never administer a PRN medication JUST because someone else told you to.
Now, If the next shift thinks Mrs. Brown sleeps through the night better after having Ativan before 21:00, then as the 2pm-10pm nurse I would assess the situation.
First off, can Mrs. Brown ask for Ativan? Is she verbal? If not, what are her symptoms during my shift? Let's say she is calm without any s/sx agitation. If the 3rd shift nurse says Mrs. Brown gets agitated at 23:00 and does not sleep well, did she/he document this? Is this benefit and behavior after Mrs. Brown relieves Ativan well documented? If Mrs. Brown is nonverbal and her behavior is well documented, I might give the Ativan based off it's documented benefits in this patient. I would also strongly consider leaving a note for the MD explaining the situation and the possible benefits of scheduling the medication for that purpose.
I would NOT sedate a patient for staff convenience, especially if I see no indication of a need for the medication on my shift. If there is well documented benefit for the patient in the nurses notes, I would consider administering the medication.
The next time you get attitude from the oncoming shift, explain to them your liability and responsibility for administering PRN medications as appropriate during your shift based off your assessment. Ask them to document Mrs. Browns behavior and suggest that they leave a note for the MD about scheduling this medication. Explain that if they document Mrs. Brown's behavior then the MD might have the evidence he needs to schedule med. Documentation will be essential.
I admire you for sticking to your guns. Always advocate for your patient and use your nursing judgement in these situations,