"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?

[Red Kryptonite]

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

Doesn't seem that was the case.

She had responded with a dramatic eye roll and stated, "he wants Ativan? Well I'm not giving it to him."

..................

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.

My nurses will always let me know if it's too soon for another dose so I can communicate that to the patient. That way they know we aren't blowing them off. If the med just wasn't due, then why not communicate that?

[Momma1RN, MSN, RN, APRN]

Doesn't seem that was the case.

My nurses will always let me know if it's too soon for another dose so I can communicate that to the patient. That way they know we aren't blowing them off. If the med just wasn't due, then why not communicate that?

I agree. Sometimes people are looking for meds that aren't due. It certainly sounds like he was agitated. Even if it wasn't due, she should have assessed the patient. If the patient remained agitated knowing the medication wasn't due for a couple more hours (for example), then she should have contacted the MD for a one time order or for permission to give the scheduled med early. As nurses, we don't know the patients whole story. Maybe he DOES abuse benzos, maybe she feels like she's enabling that. That isn't our business.

[Jules A, MSN]

Doesn't seem that was the case.

My nurses will always let me know if it's too soon for another dose so I can communicate that to the patient. That way they know we aren't blowing them off. If the med just wasn't due, then why not communicate that?

Doesn't seem doesn't mean isn't. I agree 100% it would be better if the RN clarified why to her tech however the information given does not give enough for us to make the judgement call that she just didn't feel like giving him the Ativan. Maybe the eye roll was directed at the OP and not the patient? I'm not saying the theory that she didn't want to give the Ativan because this patient was a PITA is out of the question, just that we actually don't know and to attack a fellow nurse without all the facts or her side of the story is silly. It definitely makes for an interesting conversation here though and gives us all something to think about.

[Red Kryptonite]

Well since the OP seems to have completely checked out, I guess we'll never know.

[LovelyBlue]

I'm sorry to hear about this situation. Sometimes patients can come across as drug seeking. During a busy shift, the drug seeking behavior can be felt as an irksome thing, but for the sake of professionalism, nurses cannot just roll eyes and say, "no". A nurse must make herself available to commandeer the situation. If she is refusing to give the medication to the patient, she needs to tell the patient why. Also, a nurse should never refuse to give a med because she believes a patient is drug-seeking. Even though, she may be right, it is judgmental and totally shuts down the nurse-client relationship. Although it can be extremely challenging, the nurse must use patience and firmness in working with this type of client. Actually, it borders as unlawful to make the aide the go-between in this situation. The nurse is in charge of administering medications and the assessment/explanations that go with it.

[hppygr8ful, ASN, RN, EMT-I]

Even if it wasn't due for several hours - the patient still needs to be assessed by his nurse to determine what the cause of his issue is. Sudden agitation, anxiety , or sense of impending doom, can be early signs of very real medical decompensation. Even if the medication was not due and the patient is clearly agitated and unable to be coached through self calming techniques it may be time to call the physician for new orders. This is the basis of compassionate nursing. I have said it before and will continue to say that I am saddened by how mean nurses have become. There is no excuse for being unkind. I work in a very busy LTC environment with far more patients ( charge or 37 and personally have 15 to 16 of those) than the average Acute Hospital nurse, but no matter how harried I am or bad my shift is going it all goes away when I walk into a patient's room. The patient has a right to your 100% focus when you are with them. I may be cursing and pulling my hair out in the med room but my colleagues and patient's don't see that.

It has taken me many years to develop this level of calm and compassion and it's certainly not easy but so worth it in the end.

Peace and Namaste

Hppy

[RN6274]

No matter what I always gave a medication if it was ordered and within scheduled time . It's not right to hold the med without dr order or something serious like hypotension etc then still you need to notify dr .

[Jules A, MSN]

Even if it wasn't due for several hours - the patient still needs to be assessed by his nurse to determine what the cause of his issue is. Sudden agitation, anxiety , or sense of impending doom, can be early signs of very real medical decompensation. Even if the medication was not due and the patient is clearly agitated and unable to be coached through self calming techniques it may be time to call the physician for new orders. This is the basis of compassionate nursing. I have said it before and will continue to say that I am saddened by how mean nurses have become. There is no excuse for being unkind. I work in a very busy LTC environment with far more patients ( charge or 37 and personally have 15 to 16 of those) than the average Acute Hospital nurse, but no matter how harried I am or bad my shift is going it all goes away when I walk into a patient's room. The patient has a right to your 100% focus when you are with them. I may be cursing and pulling my hair out in the med room but my colleagues and patient's don't see that.

It has taken me many years to develop this level of calm and compassion and it's certainly not easy but so worth it in the end.

Peace and Namaste

Hppy

You sound like a really good nurse. I can only hope someone with your maturity and compassion is at my or my family member's bedside if we are ever in need.

[hppygr8ful, ASN, RN, EMT-I]

Thank You

[lumbarpain, ADN, RN]

Some patients are persistant pains in the As....and we all know this..even when they had just got a dose of Ativan or a pain pill some patients think they have an endless barrel of meds just for their asking. Its not so...and the nurse should explain this over and over again to these types of patients...sometimes pain killers and Ativan and sleeping pills put them all in that DrUg fog...and they cant remember if they asked or not or they may have something else going on that the nurse should be asking them about...dementia coming on? Stroke? other reasons? An explanation should be given to the patient on why he isn't getting it, afterall THEY ARE PAYING foR IT.....and you shouldn't be put in that position concerning a med....that's the nurses job.

[kanzi monkey]

It's a good lesson because this kind of thing is going to happen ALL THE TIME. On every level. When you are a nurse, you will have similar interactions with providers, who may have similar interactions with their attendings, or with the PCP or specialist, etc, etc, etc.

Communication is a constant flow. Some people are great at it, some people struggle, most of us are in between--and we all vary in our own abilities depending on the day. In the hospital, everything that happens to patients from admission to discharge (and beyond) depends on communication and collaboration.

My approach is to try to start my day with the assumption that everyone I encounter has a predictable, if not similar, goal. Every time I interact with a patient or colleague, I try to make sure I am understanding where they are coming from (because I will act on those impressions, so I don't want to be wrong). Sometimes I might not get that clarity very easily--for example, in my role as hospitalist NP, I sometimes find myself between multiple consultants who aren't in agreement about something, and my job is to sort through that information and come up with a plan for a patient. When I am feeling challenged by this I need to take a step back and re-work the problem. (there are clues that I need to re-direct myself--if I find myself, for example, asking a question more than once or twice, I am "clued in" that I need to approach something differently)

In your case, you absolutely have the ability to take ownership in your situation--when you are talking to the patient for the second time, for example, that is a clue that you are missing necessary data and you need to take a step back, look at the information that you have (a patient is asking for something, the nurse isn't providing it), and the information that you DON'T have (why isn't the nurse giving the patient what he is asking for).

Then you have your question. You ask the nurse--if she doesn't think that you need to know, then you can tell her that she needs to speak with the patient. If she tells you and you feel comfortable relaying it to the patient, then you can solve it that way. If you don't feel comfortable telling the patient, you make a plan with the nurse so that you can tell the patient that his nurse will explain shortly.

The most unpleasant experience is when you feel you are not on the same page as the team you are working with, and you are confronted with questions that you can't answer without making someone look bad. If you get to that point again (we all do even when we try to avoid it), apologize, sincerely, to the patient "I just don't know the answer right now, I think you need to speak with your nurse, I will go get her for you, please understand of it takes a few minutes". Or something. Then tell the nurse "please speak with Mr. Patient as soon as you can, as I can't help him with his current request"

Or something. Keep the flow, ask questions, take control.