I'm a night-shift inpatient Psych RN for eleven months, and this situation happened two nights ago. It was a very chaotic unit, with multiple emergency meds given to several patients already.
One of my patients comes up to the medication room for his meds. I see on his MAR that his psychiatrist has gone up on his Seroquel dose from 400 to 500 today. Show him the Seroquel 500 and he starts flipping out, going off about how the doctor really upped his dose too much without telling him, and saying he'll only take 400 but not 500. He ends up on the phone threatening to act out on the unit.
I've paged the resident on-call telling him the situation. Resident calls back and says "No, either he takes the 500 [the orders] or he refuses. If he ends up needing a shot, we'll give him a shot".
However, the house supervisor RN is on my unit, and she's telling me, "Just give him the 400! This is psych, we can give them a lower dose if that's all they'll take!" I told her that I can't just give a different dose without the doctor's orders, and moreover the resident already said no. She calls up the incoming night-shift supervisor and is trying to get him to agree with her. I'm angry at this point and say, "You can give it if you want to, I'm not giving it". She ends up giving it and charting it under her name. She told me to make sure to put in my nursing progress note he got 400 instead of 500, which I did.
Who was right here? Me or this nursing supervisor?
