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

[learnfromthis]

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?

[ontheway2crna]

Next time, by the 2nd request, I would ask the nurse to please explain to the patient why he is not getting it.

[Red Kryptonite]

Next time, by the 2nd request, I would ask the nurse to please explain to the patient why he is not getting it.

And after the third patient request and the nurse refusing to give it, I'd be talking to the charge nurse.

[edmia, BSN, RN]

You were put in a difficult spot. Next time, when a patient requests a medication, just say: Mr. soandso would like to ask you a question about his medications.

You can't answer to his meds, that's her job and she needs to deal with it.

Sent from my iPhone -- blame all errors on spellcheck

[CT Pixie, BSN, RN]

Once you gave the nurse the info the first time, he/she should have gone to talk with the patient.

When any of the PCT/CNAs relay info to me about a patient wanting pain meds or whatever, if I know they can have it, if the tech is going back in that direction I ask them to relay to the patient that I would pull the med and be down to the room shortly. If I know the med isn't due or whatever the case may be that they can't have it at that time, I thank the tech and head to the room myself to talk with the patient directly.

You should not have been put in that position. In the future I'd would suggest asking the nurse to speak with the patient about their request if the nurse states they aren't going to give it to them. Or go back to the patient and let them know you informed the nurse about the request. If they call again and say they didn't get it, I'd go back to the nurse, let them know the patient requested the med again and to please go speak with the patient.

[excited1]

I am a nursing student and we were taught, regardless of personal opinion, if its time and there is an order and the pt's VS are stable for said medication, we give it. Even if we feel they are drug seekers. We arent in the profession to judge why someone wants their meds. There are other branches of nursing/medical that will assist the patient with substance abuse, but as the treating RN/student, we shall pass no judgement. You are doing great!

[nrsang97, BSN, RN]

I do not understand why nurses don't want to give PRN meds to a patient if they are due and they can have them. It is not up to me to decide if they are truly in pain or just want their Ativan or whatever. I will give it if they can have it. It makes my life a lot easier. If the patient can have their dilaudid every 4 hours I will give it every 4 hours as needed.

[Momma1RN, MSN, RN, APRN]

This RNs attitude aside, she went over an hour and a half without even seeing her patients? She knew he wanted a medication and didn't go in to see the patient? Was there something going on with another patient? I can think of one time I wasn't able to give a PRN and it was because another one of my patients was in status epilepticus and I was in a rapid response. Another RN medicated the patient. That sucks you were in that situation. You handled it well.

[KelRN215, BSN, RN]

Honestly? The second time, I'd approach the nurse and say "Mr. X has a question for you" and then let her go in and talk to him about his Ativan.

[blue0714, LVN, RN]

YOU did all the right things. Remember this situation when you become a nurse as well to keep you on the right track to never become like her. Never lose that caring you now hold for your patients. Because it sure sounds as if the colleague your working with sure has. Also unfortunately, this will NOT be the last time you encounter this type of mindset. There will be a lot of situations throughout your career such as this in the same and different ways, same concept though. I had to learn as well that not everyone has the same work ethics as I do. And I wont lie, it still causes me alot of stress when it occurs. The only thing you can do is exactly what you did. Keep on caring and always be an advocate for your patient, report any one that acts in an unprofessional manner towards them no matter who that might be. Unfortunately you cannot change someone, but as long as you know you have done the right thing you can look yourself in the mirror every day after work and be proud of yourself. The general rule I try to follow is: Do the right thing even when no one is looking.

[Julius Seizure]

I am a nursing student and we were taught, regardless of personal opinion, if its time and there is an order and the pt's VS are stable for said medication, we give it. Even if we feel they are drug seekers. We arent in the profession to judge why someone wants their meds. There are other branches of nursing/medical that will assist the patient with substance abuse, but as the treating RN/student, we shall pass no judgement. You are doing great!

I would say that it is somewhat more nuanced than this. If my patient was complaining of pain and asking for their PRN pain med...I MIGHT (depending on the circumstance) offer some non-pharmacologic options before handing them the narcotics. Perhaps I would suggest repositioning, dimming the lights, turning down the television and resting. Maybe getting up to walk and stretch a little.

Basically, my point is that as the RN, it IS my job to assess and address my patients needs to the best of my ability. Sometimes this means giving them a PRN med, and sometimes it means approaching things a different way.

I agree that it is not my job to control their possible substance abuse problem by refusing to medicate. I just wanted to add that the RN assessment is more nuanced than "did he ask for the pill and is it due?" :)

[greenbeanio]

It's not necessarily always a power trip. I work in psych and sometimes there is a good reason to delay a PRN. Sometimes orders are written so that patients can take all their PRNs really quickly in an unspecified amount of time - such as "tid" = 3 times in 24 hours but technically speaking they can take it 3 times in 3 hours because it does not say "every 8 hours". And some patients will take all their PRNs in a couple hours and then fall apart for the rest of the day or on the next shift. So sometimes it can be in their own best interest to try and save the PRN for later.

But as the nurse, I never leave it up to the aide to explain that to the patient. I explain it myself, and I offer to help them reduce there anxiety in some other way. Or if I have already explained that to the patient I let the aide know that and ask if they would be willing to help them through distraction or deep breathing or some other relaxation technique. You can't just never get back to the patient.

I'm sorry you were put in that position. And if you ever are again, like others have said, ask the nurse "What would you like me to tell the patient?" or better still, "Could you please let him know that?" or get the patient over to the nurse so he can ask her himself.

[Angeljho, MSN, NP]

It's not necessarily always a power trip. I work in psych and sometimes there is a good reason to delay a PRN. Sometimes orders are written so that patients can take all their PRNs really quickly in an unspecified amount of time - such as "tid" = 3 times in 24 hours but technically speaking they can take it 3 times and 3 hours because it does not say "every 8 hours". And some patients will take all their PRNs in a couple hours and then fall apart for the rest of the day or on the next shift. So sometimes it can be in their own best interest to try and save the PRN for later.

Then I would confront the doctor about this. A PRN order should have an indication of how far a part we can give a medication. Lorazepam 2mg PO PRN TID, maximum daily dose of 3x/24hrs is NOT a correctly written order. However, lorazepam 2mg PO Q4 hours PRN, maximum daily dose of 3x/24hrs is much better written because it specifies a window. Some medications cannot be given too close together or all at once, and if something happens, the nurse would be the first one responsible.