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

[Cleona11]

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?

[thevez]

I dislike this type of nurses. They need to atleast relay the information on why they are not giving it.

[MunoRN, RN]

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.

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.

That's not what "TID" means, at least based on how regulatory agencies allow it to be defined which is probably the most practical definition to use.

"TID" and q 8 hours both mean that a medication can be given 3 times per 24 hour period. The difference between TID and q8hr is that TID refers to specified administration times as defined by the facility. "TID" might mean the patient receives the med at 0800, 1400, and 2000, for instance. This is why scheduled meds are typically ordered "BID", "TID", etc and prn meds are often ordered as q x hours.

[jadelpn, LPN, EMT-B]

Forgive me, I have not read all the responses, however:

You are not playing telephone. There is no need to do a he said/she said. That puts you in a tough spot, and the patient the ability to use your words against you.

I would simply say "the patient in room 333 is increasing in agitation. He is asking to speak with you." If the nurse does not, I would again say "the patient in room 333 continues being agitated, and is now at the door of the room. If you can not go speak with him, should I get the charge nurse to?"

Don't get involved in specific requests for meds, getting tangled in weird dynamics....just ask the nurse to go in and have discussion with the patient in question.

[Nurse SMS, MSN, RN]

You had every right in this situation to ask the nurse to go see the patient, because he was obviously agitated and still requesting his Ativan. You were put in a terrible place, having to answer for something in which you have no control over whether or not it is resolved. You handled it just fine. That nurse, however, did not.

[Jules A, MSN]

Unless I missed it we still aren't sure it was even due yet, right? The nurse definitely should have given you an explanation regardless of what it was and also gone to see the patient herself. As a provider in cases where I am not ordering a requested medication such as benzos or narcotics that I know will result in grief for my nurses I go see the patient myself and tell them.

As nurses I would think we might have a bit of empathy for the nurse in this scenario who although it sounds like she could have handled it better she might have been stressed out over people who were actively in medical crisis and this patient's c/o of anxiety might have taken a lower priority. Not saying it was correct just that it happens at times and I can picture this patient being a round the clock full time job in which case as others have noted it is easier to just give the ordered medication and avoid the strife.

This is an excellent learning experience for the OP.

[hppygr8ful, ASN, RN, EMT-I]

While we may disagree with how they are treated anxiety disorders are very real and if the medication is ordered and within the time frame of up to 1 hour before it should be given. If you have ever had a patient go off on your unit and I mean "Go OFF" you'll never forget it. If the patient has a an addiction or dependence issue and is being tapered/detoxed the Dr should have explained that to the patient and care team. Even then the nurse involved did not tell the OP that it wasn't time for the medicine she said she wasn't going to give it! Period! I don't care how busy a nurse is they have an equal duty to all patients under their care and it did appear that the nurse in question was involved in a critical situation at that moment. She was engaged in a power struggle with both the OP and the patient.

Like it or not medical care is a consumer driven business and we as nurses have a duty to provide the same level of care to all the individuals we serve. That is until of course we go single payer when patient outcomes and satisfaction will no longer matter.

Hppy

[Julius Seizure]

I would simply say "the patient in room 333 is increasing in agitation. He is asking to speak with you." If the nurse does not, I would again say "the patient in room 333 continues being agitated, and is now at the door of the room. If you can not go speak with him, should I get the charge nurse to?"

To avoid the nurse possibly saying something like, "no, dont get the charge nurse and Im not going to speak to him either." I suggest choosing your wording carefully. Only provide the options that are acceptable to you, in order to facilitate getting a satisfactory response.

For example, maybe say this:

"The patient is still agitated and now he is at the door of his room looking for a nurse. Do you have time to speak to him now, or should I ask the charge nurse to help him?"

That puts the ball in her court and gives her the options of deal with it or you are getting the charge nurse, but without forcing you to be that aggressive. At this point she would have to go out of her way to refuse to allow a nurse to address the patients concerns.

[Red Kryptonite]

After three refusals to take care of her patient, I kinda don't care of she sees me as aggressive and doesn't like it.

[caliotter3]

This thread sure makes me wonder why the nurse wouldn't give the medication.

[Jules A, MSN]

This thread sure makes me wonder why the nurse wouldn't give the medication.

I agree because there is plenty of speculation and yet no clear explanation. There are many assuming the Ativan was due and the nurse refused to give it but I'm not sure that is accurate.

I definitely would have asked in a non-confrontational way when she was no longer busy. Something I used successfully with Docs in the past was "sorry if I'm being dense but I'd really like to learn more. Can you tell me what you meant by xyz?". Most times if someone doesn't feel as if you are challenging them they will be happy to share their rationale. I personally just do it up front because not only can it be a learning experience for staff but it can also be a learning experience for me if the staff person has additional information that I might not be considering. Its sort of like thinking out loud and I have found that helpful for both team relations as well as quality of patient care.

[toomuchbaloney]

This thread sure makes me wonder why the nurse wouldn't give the medication.

I agree, especially because it seems from the OP that the nurse did not speak to or assess the patient after the first or second request for an important portion of his medication POC.

If the nurse doesn't assess the patient or situation personally, by what mechanism is she deciding to hold the requested medication? Sounds like negligence to me.

[Jules A, MSN]

If the nurse doesn't assess the patient or situation personally, by what mechanism is she deciding to hold the requested medication? Sounds like negligence to me.

But what if it simply wasn't due for several hours?????