leigh.anne

I'm feeling affirmed by some of you and downright attacked by some others. If I paint a typical picture for you, what would you do? A patient presents at the window precisely 4 hours after last request for Ativan. Pt. states, "can I have my Ativan?" Prn order either states "for mild to moderate anxiety or agitation" or "for moderate to severe anxiety or agitation." Pt. was last seen sitting in lobby laughing and joking with peers. Current presentation could be described as neutral. In report I learn that this is the patients common practice. Do I hand over Ativan w/o even a question? This is in a short-term psychiatric department. Our typical census consists of the standard 30-50% co-occurring disorder patients (sub abuse and psych disorder), a handful of genuinely mentally ill patients, and a whole lot of borderline or other personality disorders. I'm willing to look at other points of view, but so far I'm not convinced that passing benzodiazapines so freely is the right thing to do. I also would like to point out that I'm pretty mild-mannered and not the type to withhold a medication just because I can (as some have implied). Please reply. This is of utmost interest.

Good point. Thanks.

Did I mention I work in a psychiatric unit? If I was a cardiac nurse, the approach would be entirely different. And btw, I do have more than one semester of psych training. Thank you for taking time to reply.

Thanks for all of your responses. Did I mention I work in a psychiatric unit? As such, I'm attempting to be therapeutic with patients by helping them to look at prospective causes of their anxiety. I'm not anti-benzo. I give it freely if the need is there. But around here it seems we do hand it out like candy. The patient isn't even encouraged to do the necessary work toward their own self-care. Granted, I do prefer a more holistic approach than throwing meds at every problem. For example, I know if I have feelings of anxiety, I try to identify the cause. I don't just pop a pill. Is there a psych forum I should have addressed this to?

How often do you give Ativan or another med for anxiety? We have it as a standing order for most patients. It seems that many patients, once they discover it's available, request it regularly. Since Ativan is for anxiety and anxiety is a response to a real or imagined threat, I try to assess my patient's need by asking, "what is your anxiety about?" My motive is also to get them to address the nature of their anxiety -- if they are truly having anxiety. Many times they are not. They just like the Ativan effects. (I'm not including patients with obvious anxiety disorders or who are in etoh withdrawal). My question often angers the patient. One even reported me to the rights advisor. They think if it's ordered, they're entitled. Many of the other nurses don't ask any questions. They just hand it over. Granted, that might be easier. Is that the right thing to do? I could probably do that if I detach myself and behave as a robotic-type nurse. Any insights?

Where do we draw the line in requiring people to wear helmets? Should joggers wear helmets? How about people walking their dogs? Kids playing kickball in the street? I'd much rather see the safety police put energy into encouraging proper driving of cars. Rather than nag their friends about wearing helmets, they could nag their friends about courteous driving. :nono:Tell your friends to slow down and not be in such a hurry, don't tailgate, give the right of way, don't apply makeup while driving and please hang up the phone. A safe driving campaign would go a long way in preventing nasty car-motorcycle accidents, helmet or no helmet.

I am 44 and on my second career since 8/06. I also work on an oncology/medical floor. I too am overwhelmed and scared. I ask for divine help each day I work and thank the nursing gods when I go home each night. I'm trying to learn priorities. I simply cannot do everything that is expected in a day. To me, important tasks are assessments & documentation, meds, orders, checking labs/tele strips, and admissions/discharges. If that was all there was to do, I think I'd be okay. Add things like I&O's, calorie counts, daily weights, pain assessments/interventions/outcomes, nurse report sheets, specimens, fresh water, toileting, finding help, repositioning, answering calls, talking to family members (do they really think I know anything?!?), etc... I don't feel good about my patient care and I don't feel safe. I feel like I'm too busy to practice any critical thinking...I'm just doing the tasks. I realize the PCT's are responsible for many of these tasks, but quite frankly, they are also spread thin. Sometimes they just don't care. Last week, I recieved report about an elderly alzheimer's patient who wasn't eating. I fed her that day and she ate quite well. I think she wasn't eating because nobody was taking the time to feed her! I feel like I'm on a treadmill balancing plates on a stick. As the day wears on I'm trying to balance more and more plates. The cheering section is great. They smile and say, "you can do it" as they toss me another plate. I really don't like my job and I don't even like to talk about it. It's depressing.