Testing the new nurse?

[papergirlRN]

OK- first day passing meds by myself, and the patient care person (an experienced nurse) comes to me at 0845 and tells me Mr. Whatshisname is constipated and could use some MOM. Fine, I tell her - as soon as I finish with this pt, I'll go there next.

So, I pull up his scheduled meds and he is due miralax, docusate, and sorbitol all at 0900. Using my nursing judgement, I decide not to give the MOM that the patient care person had asked for and instead just gave the scheduled meds. This is a dementia patient, so he can't necessarily tell me that he's constipated. I asked the nurse why she thought he was constipated, and she said he had not had a BM this morning. I pull up his records - moderate BM yesterday at 1300, PRN MOM not given since Jan 20. Assessed his abd: soft and nontender, not distended at all. I made myself a note to check back in with him during my 1300 med pass that day and see how he was. I tried to find her and let her know that I had not given the MOM, but she was nowhere to be found.

1300 med pass, I have to skip him because he's in the bathroom. I come back 15 mins or so later, and the patient care person tells me he had a large BM, so I can chart that the PRN MOM was "definitely effective." I told her I hadn't given the MOM after all, since he was scheduled the other meds.

So anyway, she ends up going to my nurse manager, telling her that I "REFUSED" to give Mr. Whatshisname a PRN med that he needed, and perhaps I was turned loose to pass meds by myself a bit too soon!

What's up with that? What would ya'll have done? Was I wrong?

[onyx77]

Given the information that you gave, I would have done the same thing you did. If he had a BM the day before and was schedule with other meds for his bowels then it was obvious that the PRN MOM wasn't needed. I think you did the right thing. Had you given the MOM just thin of the mess that the pt care person would've had to clean up! Did you talk to your nurse manager about the situation?

[papergirlRN]

Yep, I did go to my nurse manager and she said don't worry about it, that I did what any 'reasonably prudent nurse' would do and no harm was done.

Today, the same nurse told me to give a patient immodium for diarrhea, but he was positive for c.diff, which she did not know.

Now the orders on the unit are to run PRN meds by the charge nurse if this particular nurse requests them for a patient, at least for the time being. Evidently, I'm not the only one that has questioned a request. Which makes me feel better since I am the only new grad on the unit.

[onyx77]

Thank goodness you are able to think further into things than this other nurse. I would hate to have her giving me or any of my family members medications. I would hate to see what she requests for patients with PRN anxiety meds - they must be snowed all the time! I am glad that your nursing supervisor saw the way things were and what a good job you are doing with completely assessing the situation.