WHAT TO DO...Nurse is refusing to give PRN medication

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I work in long term care. I have a patient that is chronically nausea. The patient asks for his prn nausea medications Q6H on the dot. The day nurse is refusing to give the medications because she feels it in the patient head and he is not really nausea. Myself and the other nurse give the medication if he asks for it because who are we to say he doesn't feel nausea. I have reported this to management multiple time and nothing is being do. I did confront the nurse and ask why she not giving it. She said its a matter of her option he does not need it. What right doe she have to with hold his PRN medication? IS there someone else I should be contacting>

Specializes in Psych.

If the MD does not want the med scheduled, perhaps call the MD who is on call for the regular MD and explain the situation, that the nurse refuses to administer the prn nausea med when the pt requests it, although no vomiting, you are concerned perhaps about reflux aspiration in your elderly pt and feel it would be safer if the med were routine. Be honest, of course.

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It's not up to her to decide if it's real or not, it's available to them she's needs to give it.....

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Does she chart witheld due to ________? If yes, I think you're stuck.

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You work in a long term care facility. What does the Pharmacy Consultant have to say about the prn meds not being given? Have you looked up the Federal Reg at CMS to see if the facility is out of compliance? The consultant should be monitoring the meds and making recommendations based on how often them are used. It has been a long time but I can remember something about a prn being used daily after 30 days should be changed to a routine medication. Just a thought.

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You said he eats it just fine? Zofran is a sublingual tab and swallowed pills are not helpful. Might that be a possibility that the resident isn't allowing the med to go the right route?

I might consider holding Zofran if the patient isn't able to take it correctly. Also if they had long QT syndrome, or if they had a lot of meds that also prolong QT and I have reason to think over my timing.

I'm with you when you say that the other nurse's reasoning isn't really good enough. They might need an attitude adjustment.

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This is why I hate PRN meds for a chronic issue. Who is that nurse to determine what the pt feels. It is what the patient says it is. You can report her to administration. If they do nothing call HR and if that doesn't work the ombudsmen.

If you can't be there for the patient get out of nursing. I'm sure someone else would love your/their job! This is one of my biggest pet peeves!!

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Specializes in Corrections Health Care, OB-Gyn, Psych,.

Since this is happening on a regular basis and the nurse involved does not give the medication even after she has been questioned about it, the BON should be made aware. She can go in front of the Board and explain why she thinks this patient doesn't deserve to be free of nausea. Even though you've made every effort to make the management aware and they are as obtuse and ethically bankrupt as she is, you are now obligated to take it a step further. Hold your ground and the best to you! If that was my parent, I would be furious and believe me, I would do everything in my power to make sure that nurse no longer practices in this manner.

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I agree with the thought of getting it scheduled. The concern that I have is giving zofran long-term can prolong the PRI and now you have a heart problem created by you. I would like to know about adding zyprexa. There have been studies showing success in treating nausea in cancer patients and if he has anxiety issues then why not try it? I also wonder if there are medications that are upsetting his stomach like metformin or wellbutrin that could be changed? I feel as though there are parts of the story that are being left out. If not then this person should not be a nurse if they aren't going to treat their patient appropriately!

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Specializes in Quality, Cardiac Stepdown, MICU.

If i were that pt, I'd "fire" that particular nurse. Have them tell the charge they don't want that particular person caring for them again. Problem solved.

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Specializes in Quality, Cardiac Stepdown, MICU.
If the MD does not want the med scheduled, perhaps call the MD who is on call for the regular MD and explain the situation, that the nurse refuses to administer the prn nausea med when the pt requests it, although no vomiting, you are concerned perhaps about reflux aspiration in your elderly pt and feel it would be safer if the med were routine. Be honest, of course.

Be very careful going around one doctor by calling a covering doctor who doesn't know the first person was asked and explicitly said no. It's one thing to be a patient advocate but that's sneaky and dishonest. You do still have to work with these people. The only exception is going to an attending when you have a problem with a resident (md rssident) bc they are learning.

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Specializes in Gerontology, Med surg, Home Health.

Why are people so quick to report another nurse to the BON? Call the on call doctor to go around the PCP? Talk to the DON and the PCP to get this solved.

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You could speak to the doctor as there might be other issues . However ,even a PRN medication should not be held if a patient is complaining of nausea or whatever. This is not the Nurses decision . If she feels this way then I would suggest have a family / staff meeting (including the patient) after all labs have performed by her physician

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