"He wants his Ativan? Well I'm not giving it to him"

[learnfromthis, BSN, RN]

Currently I'm a student nurse. I took a job as a nursing assistant at a local hospital to gain patient care experience. It's been great and I highly recommend this route for current students. Many of the nurse I work with were once Nursing Assistants as well. They are helpful, informative and even offer me opportunities to learn and try new skils - ...

But as a nurse's assistant you are dead-center in the middle of the nurse-patient relationship. You are the one that answers the call light and keeps the nurse informed of changes with the patient, if they've voided, eaten, or if they want medication. Tonight I was put in the middle of a very uncomfortable situation. My patient rang the call bell and appeared very agitated when I arrived at his bedside. He asked if I woukd ask his nurse for his Ativan. I replied with a "yes, I will let her know you are asking." I made my way down the hall to the nurse and relayed the message. Her reply surprised me but I thought - "she must have her reasons" and I continued with my work. She had responded with a dramatic eye roll and stated, "he wants Ativan? Well I'm not giving it to him."

Thirty minutes later this gentlemen was ringing the light again, and this time he was at the doorway of the room looking out into the hallway, and still appearing agitated. I asked him how I could help and he said that he still had not gotten his Ativan. I apologized and told him I would tell his nurse. And as I had before, I approached her with the same information, stating that again he was asking for his Ativan. The nurse again, refused. By now I was concerned that at two separate times a patient requested medication and two separate times the nurse refused to give it. Not because it wasn't due or it couldn't be given--it was because she didn't want to. As far as I know... It is possible it wasn't due but typically the nurse would report this information and I in turn could report back to the patient - "I'm sorry your nurse says it's too soon after your last dose." This is not what happened.

I continued attend to my other patients trying to remain neutral -- and then the man rang his call bell again another 30min later. When I answered and he told me he still had not gotten his med I felt terrible. I thought "he must think the nurse is blowing him off or he thinks that I'm a liar." I apologized again and told him I would tell her -- he then asked me "well what did she say the last time you asked her?!" I froze! Of course I couldn't tell him what she actually said. I just looked blankly at him and said, "I don't know what she said" obviously lying while trying not to lie. I felt really crappy to be put in this position and because I wasn't sure how to handle it I pulled the charge nurse aside and without mentioning names I asked he a hypothetical "what should I do ...if this happens?" She asked which patient, pulled up the emar, asked which nurse and said she'll talk to her -- but now I feel like a rat. I like this nurse a lot, I enjoy working with her but this was something that really upset me.. I thought @its not her call to with hold a bed -- just because she wants to?" ---right?

[anh06005, MSN, APRN, NP]

To hold a medication you need a good reason. I don't know why she wouldn't give you the reason if she had one or at least tell you something to tell the patient. Obviously he wasn't too sedated so unless it wasn't time or the med wasn't available I can't think of many other reasons to not give it.

Even drug seeking patients...I can't make the call to not give something just because I don't want to. If it's ordered, it's time, and their status doesn't contraindicate giving the med I give it.

Hopefully she was having a bad day (which isn't an excuse) or there was a reason she didn't mention to you. Hopefully.

And I agree working as an aide is great. I think it helps you appreciate your aides more when you become the nurse.

[Libby1987]

She handled that poorly on several accounts.

[Gooselady, BSN, RN]

That sucks. You really did get put in the middle, by the nurse. You are learning one of those terribly valuable lessons, I'm afraid, but it will only benefit you in the long run.

You did nothing whatsoever 'wrong', in anything you said you did or said.

I haven't worked with a nurse with that horrendous of an attitude in a loooong time. Thankfully it's not that common.

But if a similar situation pops up in the future, and the patient is ambulatory, help them put on a robe and suggest they take a walk around the unit, perhaps his nurse just needs to assess him more directly before she gives him an Ativan

Just cuz you are a 'student intern' or acting-CNA doesn't mean you have to be a sitting duck for a nurse with a crappy attitude. You don't have to 'put up with' that kind of unprofessional, immature behavior. You have super powerz, too. You can advocate for that patient just fine, and you just may need to find more creative ways to do it. I can think of about TWENTY right off the top of my head .

Like I said before, these are valuable lessons to learn as you progress toward being a nurse. The experience you are getting is not just 'patient care experience'. It is experience working with the other nurses, too, and sometimes that can be tough. It is working with families, doctors, therapists, managers, administrators, the stock boy from Medical Supplies, the Blood Bank, valet parking . . . you get my drift :) Healthcare is its own little world, and has a language and culture of it's own, which all of us have had to find ways to adjust to and work within. Your attitude is fine, I think all you 'need' is to continue with your experience and give yourself credit for noticing bad examples of nursing when you see them. Best of luck in your ongoing experiences :)

[Cricket183, BSN, RN]

That's a tough situation to be put in but I think you handled it well. If you are ever in that situation again the only suggestion I would make is perhaps asking the nurse (in a non confrontational way), "What would you like me to tell Mr. Patient?" That way the patient knows you relayed the information to his nurse and hopefully it brings to the nurse's attention the awkward position she is placing you in.

[llg, PhD, RN]

I strongly agree with Cricket 183 RN. You should not have left the patient "hanging" without any explanation. After telling the nurse and finding out that she was not going to give the medication, you should have asked her "What should I tell the patient?" The RN has an obligation to you and to the patient to address the request -- and not just blow it off. You need to speak up to make sure you get YOUR needs met (as well as the patient's needs.)

Particularly after the 2nd time, when the patient had gotten up ... you should have reported that the patient was getting increasingly agitated and needed an explanation as to why he was not getting his medication. By not addressing the patient's legitimate need for an explanation, you let it get worse. If the RN was not responding to your request for assistance/explanation/guidance ... you should have gone to the Charge Nurse right away -- not waited until after the 3rd time it happened.

[MidLifeRN2012]

The nurse herself should have gone to the patient to state why she wasn't giving it. You should not have to be the one to tell the patient anything about the nurses response

I work in psych so I wouldn't give any hesitation to give a requested Ativan to a patient if it is due and the BP/LOC were in order. Makes for a quieter shift when one doesn't have an acting out patient to document on restraints for.

[maxthecat]

The nurse herself should have gone to the patient to state why she wasn't giving it. You should not have to be the one to tell the patient anything about the nurses response

Totally agree. If you as a nurse are deciding to withhold a med, you owe it to the patient to inform him why in person. Who knows--when you actually see the patient yourself, your decision may change. Using an aide as a go-between to give a possibly unpopular response to a patient is poor practice, as well as cowardly.

OP: Yes, you could have pressed the nurse to tell you what you were to tell the patient or suggested that she should talk to the patient herself. But you'll get better at that with time. I think I know the type of nurse you were working with and, as a student who is just learning the ropes, that type of nurse can be quite intimidating. Chalk it up to a learning experience and don't beat yourself up too badly over not being the perfect pt advocate yet.

[Cricket183, BSN, RN]

I'm rethinking my previous response. I didn't mean to imply that it was the OP's responsibility to tell the patient why the medication was being held that is clearly the nurse's responsibility. I re read my post and it did come across that way. I apologize. I was trying to think of a diplomatic way for the OP to communicate with both the patient, who was clearly getting frustrated, and the nurse, who was refusing to medicate or communicate with the patient. The OP was put in an extremely difficult situation and as I said before she handled it well.

[SassyTachyRN]

Or maybe tell the RN, "Mr. X is requesting to speak with you regarding the status of his Ativan." That forces the RN to have to clarify the situation with the patient as he/she should and removes you from the awkward situation.

[MunoRN, RN]

Consider this a good learning opportunity for you as you become a nurse. Unfortunately, there are some nurses out there who for whatever reason see their role as establishing a position of power over someone else, so giving a patient something because they want it is seen as relinquishing some degree of power.

The indication for ativan is often anxiety and agitation, which from your description the patient was clearly experiencing, so there shouldn't have been any reason not to give it based on your description, other than for a power trip.

[iluvivt, BSN, RN]

Yes! Total power trip. There is what I think..the unpolished me. Well! you need to get your butt in there and tell your patient your rational because that is between you and him" and the professional me.. Mr so and so has requested his prn Ativan". If she said she was not going to give it I would then state, That is your responsibility to communicate that to your patient. Yes... that is a direct assertive approach but NOT aggressive and your delivery must not be sarcastic or condescending. At that point if she did not resolve it would have went up the chain of command. Some nurses can be a very judgmental, she was out of line unless there was a justifiable reason for withholding the medication and it does sound like it was needed.