ladynischeraRN

I've found that alot of the things I learned in school in regards to med administration and contraindications are virtually ignored on this floor. Ativan, Xanax, Haldol, Remeron and Seroquel are given out like candy. I guess I need to work harder on the 'ignore' part, instead of trying to be understanding and compassionate...because that was just not working last night!

Sorry that my first post had to be a rant...but I'm so frustrated and angry and really need to vent. I work on a geri med-surg unit at a local hospital...and I don't know if it's the community surrounding the hospital, but lately I have found my head on the chopping block on numerous occasions with families of patients, more often than not, ones whose family members are nurses. A brilliant example? Last night, I had an elderly patient with moderate Alzheimer's with a high fall risk, who remained agitated and combative despite many non pharmaceutical interventions which included : (1) numerous unsuccessful attempts at re-orientation (2) being given diversional activities - such as folding towels and magazines to read (3) being ambulated around the unit and off the floor with a contact guard (4) being seated at the nurse's station in a geri-chair (5) getting an order for a tray to be placed on the geri-chair (played limbo and slipped under the darn thing) (6) expressing to her how important it is not to get up by herself, please call if you need anything. ...still insisted on running off the floor with poor 8 and a 1/2 month pregnant S.O.B. me in hot pursuit. She may be elderly, but she sure is fast! After escorting her back to her geri chair for the 13th time, while missing being punched and scratched only by a hair, I am at my wit's end. It's almost 5:00, I haven't seen any of my other patients (one who wants a pain medication, another whose family member wants to speak to me regarding plan of care, a respiratory therapist who wants to clarify a medication on another,) and of course there are no sitters available because the hospital has cut the safety sitter budget. Great. Glorious. I call a family member and ask if there was anyone available to come sit with the patient, and hopefully help calm her down. "Absolutely!" they say. "It'll be another hour though." Another hour. Another hour for her to run circles around my CNAs and to avoid a black eye. Driven to desperation, I go to the resource nurse and plead my case. Call the doctor she says. Maybe a dose of Ativan or Haldol is just what she needs. I call the doctor - give her Ativan 1 mg p.o. he says. "No can do doctor, the lady is so combative she won't take p.o. meds. Any chance to give it IV?" I get a flat out no. He gives me Haldol 0.5 mg IM q4h prn instead. I give her the Haldol, which might as well have been a lollipop for all the effect it had, the lady's still going. Her daughter finally shows up, and not only does she rub me the wrong way she feels it her God given duty to inform me and throw in my face on a repeated basis that she is a 37 year old clinician nurse in the field, that the hopsital is a dump, and that her brother is a captain in the navy who doesn't take **** from anyone. (Her words, not mine.) I take each insult with a nod and a smile. On the inside I feel like crying. She wants to know why her mother is on this medication, am I watching for side effects of another, why does her mother have a saline lock if she's not getting any IV meds? On her way out she instructs 'not suggests' that her mother get some Ativan to help calm her down. I inform her that she got a dose of Haldol. Oops. Wrong word. Her eyes enlarge, her face reddens. "YOU GAVE THAT %$# to my mother? YOU HAVE NO SENSE OF NURSING PRACTICE!! DON'T YOU KNOW ANYTHING ABOUT GERIATRICS? DON'T YOU KNOW HALDOL IS CONTRAINDICATED IN THE ELDERLY?" I've reached the limits of my patience. I let her know that I tried almost every non pharmaceutical intervention available (except for tying the woman down, which I'm definitely sure neither of them would have appreciated! ) I AM ONLY ONE PERSON! My God, how much do they expect me to do? That's not sufficient. She wants to speak to the nursing supervisor. STAT. It turns out that the supervisor takes too long for her liking so she leaves with a huff and a puff before she blows the house down. I proceed to let the resource nurse know my side of the story and write the longest documentation note ever to cover my back and my license. I love nursing, both the ups and downs of it, but I'm really starting to feel like geriatrics is maybe not the field for me...not day in and day out, feeling pinned in the corner when it comes to my practice, especially with the high number of dementia patients and fall risk patients that we have. I've only been at this job for five months but I'm already itching for a transfer....