Vent: dealing with nursing home nurses who refuse to provide comfort medication to patient

[stacyRN11]

I work PRN for a local hospice. Recently I had a actively dying patient in a nursing home that was having terminal agitation. I increased his ativan and his agitation decreased. the chaplain stayed with the family to comfort them. I went to another call, the chaplain called stating he was now having pain but the nurse refused to give medication because he was having apnea and she wasn't going to kill him with morphine. When I arrived she told me that giving morphine with a patient respiration rate below 12 is assisted suicide. I calmly tried to explain how patients with pain, the morphine will decrease pain and not decrease respirations. She started telling me that she has been a nurse for 35 years and she knows the patient better than I do. I told her I have been a nurse for 8 years, and board certified in geriatrics and hospice, so I am qualified and understand how the dying process works. I stayed for a couple house to give the morphine. The next day that nurse complained that I belittled her. The family was satisfied with my care, i was just advocating for my patient. Have anyone dealt with nursing home nurses like this and would you handle it differently? Any advice is appreciated.

[TriciaJ, RN]

Actually, there should be some policies and procedures in place about what constitutes comfort care and what is considered to be assisted suicide. Also, some very clear MD orders would be helpful. It's normal for us all to be cautious and not want to hasten anyone's demise. That's where policies, procedures and MD orders would give the nurse a clear framework and maintain more consistency and collaboration between agencies and shifts.

OP, is there any way you can advocate for this so you don't have to go head-to-head with other nurses?

[nursejoy1, ASN, RN]

As a supervisor in LTC and a big Hospice supporter, I am very pro pallative care. My dad died last year while on Hospice an I am very grateful for all they did for him. On my job, when we have a patient actively dying, and I know the LPN has some trepidation about giving pain medication d/t low respirations, etc, I will usually let them know to call me. I will come and give the medication myself if they are uncomfortable with it. I also check on the resident frequently to ensure they are as comfortable as possible. I usually educate as to why I am willing to give the meds and why they SHOULD be willing, but will not push them to do so if they are clearly uncomfortable with it.

[BuckyBadgerRN, ASN, RN]

Maybe that was the law 35 years ago Quite frankly, someone who is going to argue with you about this while the hospice patient suffers, is not someone I see staying current on legislation OR how we know morphine works. Not belittling her, but calling it as I see it.

I didn't say morphine can't decrease respiration, because it does. I told her when a patient is in pain and shows physiological symptoms of pain that the morphine's would decrease pain level. She kept saying that it is state law in OK that giving morphine when respiration is below 12 is assisted suicide.

[canigraduate]

It's not assisted suicide unless they're giving themselves the morphine that you drew up and provided, BTW.

[Stcroix, ASN, PhD, RN]

Ok OP, here is a suggestion for dealing with stubborn set in their way people.

Use a 'presumptive statement'- "I really appreciate your years of experience and I know you are an open-minded person, so you might be as surprised as I was when I heard newer research that has shown...." After a statement like that the person is not going to contradict you because if they do they will be saying that they are stubborn. Has worked many times for me. As a previous poster said, you can't win by butting heads, so you need other tactics.

[LindaRossmanWilliams]

It is what it is. Educating is not belittling. She was threatened. She will recover. If pt is not kept comfy, it's our duty to educate. If she's been a nurse for 35yrs she can pull up her big girl panties and learn from her misconceptions.

[nutella, MSN, RN]

It is what it is. Educating is not belittling. She was threatened. She will recover. If pt is not kept comfy, it's our duty to educate. If she's been a nurse for 35yrs she can pull up her big girl panties and learn from her misconceptions.

While I appreciate your enthusiasm regarding end-of-life education, I think the problem is that her teaching was not well received and ultimately she will find herself with the short straw (so to speak).