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I'm supposed to be taking my grandfather (who has dementia and Macular Degeneration) to his ophthalmologist in 2 days as he's part of a clinical trial in which he receives injections into his cornea to try to combat MD. In order to keep infection out, he's supposed to get a drop of Tobramycin in each eye for 4 days before and 4 days after his injections. I got a call from him today in which he stated that the nurse is refusing to give him the drops.

I drove over to the ALF to confirm if the nurse on staff is giving him the drops or not and it turns out that she isn't. We ended up getting in a huge argument over this and she stated that she refuses to give the drops as the prescription does not state when she's supposed to get them, so that the prescription is not valid.. I asked to see the prescription that she has on file and it stated 1gt 4D (one drop for 4 days). I tried to go above her head but it turns out that she's the charge nurse of the facility. I ended up having to run to CVS to get a refill prescription so that I could give him the drops myself as she refused to even give me the bottle as I'm not POA. I tried to go to the director of the ALF and he told me that this issue is between the staff nurse and myself / my doctor and that he has no control over the issue! My doctor is telling me(as well as I as a EMT-P) know that this is the correct writing of the prescription.... does anyone have any advice on how I should go about in getting the staff nurse to give him the eyedrops? As a paramedic I'm on shift for 24 hours so I can only get to him every other day to give it to him myself.

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Take it up with the State Board of Nursing in your state. You can find contact information for them on-line with a simple Google search.

It is not legal for her to just refuse to give a medicine if she has a question about dosage or time. It is her responsibility to contact the Dr. and get the details that she doesn't understand straightened out and on record (at the ALF). I know that each facility has its own policies and procedures for medication administration but if they have a licensed nurse on site to give medicines, then she should be giving them. And it is not the facility's policy that dictates her actions related to administering medications but the State Board of Nursing from whom she gets her authority and license to do so. Their rules trump all the other rules except for your father's right to refuse medication on his own.

Don't tell anyone there at the ALF what you are planning to do, if you do follow my suggestion. Just do it as soon as you can and let the State Board take care of it. They are the ones 'above her head' that you need to go to.


Oh yeah...and the prescription seems right to me, too...usually it might say 1gt QD (every day) 4D but that extra QD is implied in omission. Either the nurse is not really a nurse...or is somehow ignorant of things that all nurses should know...or she's got a nefarious reason for acting outside of her authority in regard to your dad.
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Quick solution is to have the Dr. call-in an order to the DON specifying a time (morning...etc.) this way the nurse has no way out. Then, as stated above, take the issue to the Board of Nursing, and to the Facilities Board of Directors...imply you are considering having your father removed since their Administrator obviously has no administrative power of his staff.
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The bit about the nurse knowing this or that about a study is ridiculous. She has no say in that matter and should be able to get clarification from a dr. The only authority She maybe should have is if she thinks a treatment or medicine is harmful or counteracts with another. I agree with going to the board of nursing. Also, what's up with a facilitiy director acting as if they have to override a DON? They should be working as a team to treat their patient with whatever their dr prescribes. It seems to me that there really are too many chiefs in the nursing world. For instance, I had a nurse in our small hometown at a behavioral center tell me repeatedly that "you cannot force a person into a nursing home. Alot of people think you can just drop them off and that is a falsehood."
This caused me no undue amount of stress because my father's wife had died and he was wandering around in the yard at 3am and falling down. Someone called adult protective svcs who intervened and said that he could not be alone, had him evaluated by a dr at THE SAME facility and declared incompetent. They then told me that I was able to then make decisions for him. END of story. The same nurse said no more about it and helped me make the transition to NH. She obviously had interjected her own personal feelings into the situation and this caused me considerable, unnecessary heartache as no one was available to live with my father. My father also went to jail with his dementia from driving. I had a heated argument about getting him evaluated to go to the hospital by some state employed jail nurse who told me that "your father was under the influence and he would not be transported to the hospital because the rules of the jail dictated that prisoners don't get transported, etc. My dad doesn't even drink. He was driving erratically because of dementia. It's ridiculous that this staff nurse could make these calls. it seems to me like there are a lot of power tripping nurses out there.
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I do not believe it is for anyone to comment on what is the best treatment for Newman's grandfather for the exception of the family and the doctor. I believe this because my mother is now in stage 7 Alzheimer and will die soon. The illness robbed me of my mother, but what would have been worse is if she would have been like my grandfather who lost most of his sight, hearing and speech before he died. He was so angry at the world that he struck out at everything including my grandmother. In the three years that my mother has dropped through stages 4 - 7 at least have been peaceful for my mother because she could see, hear and speak. Please focus on the real problem here in that the nurse is not doing what she should be doing not on what the family believes is best for their family member. You just really do not know those details.
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A nurse can refuse to give medication but there has to be a follow up as to WHY she refused. By the way this has to be documented as to why the medication was not given. If the script was unclear you call the doctor. It is not the nurse's business if he is involved in a clinical trial. That is beside the point Ferris - the meat of the matter is the nurse not following the care plan that has been set up for the patient because of her own views. Please save us from the health professionals.
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I agree with freelancewriter, really irresponsible that the Administrative Director chooses to not do his job
!
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I sure am learning a lot about assisted living -- and to be honest, I don't like what people say. This facility is your father's employee. He pays to be there. I find her attitude to be rude. I have had 7 surgeries, and I always had a Satan Nurse, and the rest were wonderful. The POA can have you as a co-POA if they choose. I hope you get this worked out. A nurse refusing to give medication is absolutely unacceptable. You may as well pay another person/facility.
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Nurses have to make judgment calls every day but it is only appropriate if it is concerning patient safety. The other decisions are NONE of our business. Even if asked, it isn't our place to offer suggestions about things that require far more personal knowledge than we could every be privy to (or want to be privy to!)

There ARE a lot of power-tripping nurses out there...I've worked for and with several. A lot of them, I noticed, oddly enough, were married to cops.

Sure, I have opinions. Everyone does. I just keep them to myself when they aren't directly related to me.

It seems to me that 'autonomy' was way high up on the list of what patients (and human beings in general) need to stay as healthy as possible, both in their body and mind. But then again, it has been over 20 years since I got out of nursing school so that might not be what they teach these days. Maybe they never did...it might be something I learned along the way in these past 2 decades.

Regardless, I know it is true. Minding one's own business ought to be one of the ten commandments, IMO.
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When my mother was in a nursing home/rehab type place, before she came home, it was true, they were not allowed to give anything that was brought in. If we had any 'scripts, they had to be turned over to the nursing staff, who then ordered the medication, themselves. That wasn't always a handy thing, either, because they had to be ordered from whatever program they were in, and the meds had to be curried in... which was not ever on the same day. That said, it's a shame the nurse wasn't kind enough, or efficient enough, to follow through in some kind of way, to remedy that situation. It would seem irresponsible to not at least let you know what needed to be done to make sure he gets the drops. I just wanna say, too, from my family's own experience, you do have to always continue being an advocate for your loved one. They probably all hated having to deal with us, but we knew our mother better than anyone, therefore we had to make requests, over and over again, in every place that she landed, in her recovery. We were always civil in our communications, although some of them were not, and often didn't listen. We almost lost her three times as a result of them not listening. Doctors and nurses are greatly needed, and we appreciate them, in many ways... but they are not Gods, only human beings. And there are sometimes things which they, in their busy tasks, are either not aware of, or perceptive of.
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Just as in many places in life, The actions of a few give the rest a bad reputation. There are 15 nurses right now that I could HUG and KISS. I love them and they are the kindest and most attentive to their jobs. I do not pretend to be able to do what they do and I greatly respect most of them. Just like firemen, they do no harm usually. I just feel that some get a little too drunk on power especially in this day of health insurance companies cutting costs every way they can think of. Seriously, my father has not seen a dr since he has been in the nursing home that he is in. He sees a Nurse practitioner. She is nice and works hard to help him. She consults with a Doctor but I have never met him.
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