EricaRN2015

10 mins prior to the end of my shift, the patient asked for his rtn early. I offered tylenol. Refused. He allowed staff to reposition him. Shift over. Oncoming shift starts meds first thing. The pt would revive the rtn within the hour. That was my thinking. I did not think I should run down and give him a prn, on top of the rtn.

I felt stuck, last 5 mins of shift, not sure what the other nurse would feel about that anyways. I feel like he should have accepted the tylenol. I didn't have time to assess after, I was off at that point and the next shift was on

Also, I was the charge nurse.

Heather, when you become a nurse, you will see that you don't always jump to the prn meds, they are usually set up for mild to moderate pain and so forth. You should always offer non pharmacological means prior to meds. Repositioning can work wonders. I do not feel I was wrong in avoiding a potential double dosing. He wanted a ultram, at 0600, the first shift nurse administers this med rtn, due 0800, most give it by 0630 or 0700. If my gut tells me not to do something, I wont. I have never been in this situation before. Most of the time a patient wants a prn after a rtn administration, not right before. I have only been in this facility on wkend for a month. I offered tylenol, it was refused. I reported off to the next nurse to give him the Ultram asap, their policy is 1 hr instead of 30 mins. I ask you heather, would you just give a med, because they ask, without looking at the whole picture?

I repositioned him, offered tylenol, as nurses we always go from less to more. The tylenol may work. He specifically asked for his rtn Ultram early.

He didn't want the Norco. He wanted "The pill he gets in the morning early" which is the ultram.

Thanks. I am going to call them. No idea how it was reported though...

To be honest, being the last 10 mind of the shift, I passed it on in report. I didn't give anything to sign out, and they have a problem if we stay late. After I told the pt that the next nurse could give his rtn around 7 he said ok, that's good, and I finished up and left.

The other day, I was working night shift until 0600. I check on my residents regularly. I had last seen this reservation at 0400. At 0550 he called, stating he wanted his morning pain pill early. He gets tramadol at 0800, but the nurses usually start med pretty early. I offered him tylenol, which he refused. He also has a norco order, but being that early with no food and lethargic, knowing he would get the tramadol at at least 0630 or 0700, I once again offered tylenol in the meantime and repositioned him. His norco order is q 6 hrs prn and Ultram q 4 hrs prn. I have always been taught (8 years) to use non pharmacological means first, and never give a prn that close to a rtn. I followed my gut. Now they are saying I neglected the pt! I was only trying to be safe. They have put me on leave, and it's up to regional if I even get to keep my job. I dont feel I was wrong. The next nurse stated that he always gives this reservation his med btw 0630 and 0700, which proves a prn at 0600 is too close. Am I wrong? Please help.