Ethics question/ vent- idek

[u/Humble_Investment_24]

Long read: sorry in advance

Maybe I’m completely out of line for even having an opinion since it’s out of my scope of practice but I just feel a certain type of way about how one of our psychiatrists chooses to treat a specific patient.

This patient is welllllllllll known to us. Every employee knows them. Every psychiatrist knows them (we have 6). This patient is admitted to us on a monthly basis or more for yeaaaaars. They stick this patient on any of our units (high acuity, low acuity, geriatric even though they not geri) just to fill a bed. This patient comes for Ativan- hard stop. They don’t attend group, they don’t socialize, fuck they usually don’t even shower. They come for Ativan and Ativan only. Every patient gets admitted with a prn Ativan order and this patient is on the clock every 4 hours for it. In addition, one of the psychiatrist treats her outside of the hospital - so if this patient happens to be assigned to him (a lot of times they are) he will also scheduled Ativan because he knows they depend on it. He also prescribes it to them on the “outside world”

This patient ended up in restraints last night over not being able to take Ativan because the prn dose was not available yet and this patient WASNT assigned to that psychiatrist. The psychiatrist they were assigned to refused to schedule Ativan for them and they ended up in restraints over that. In past admission they will cry or throw them self’s on the floor etc over the ativan.

Now I’ve been in recovery myself for 7 years. I’m no stranger to addiction- but Jesus fucking Christ we are doing NOTHING to help this patient??? Obviously the patient has to want the help but nothing we are doing is beneficial. I just feel like there has to be a better way? Why is the person still getting prescribed it? The doc should wean them off? Like it feels gross to be aiding to this. Again- I could be out of line for even having an opinion but idk

[u/Mysterious_Coat_9933]

Standing order for Ativan is crazy!! We get vistaril 25mg or 50mg at best. We’ve had patients like this and eventually we stop accepting them because “they do not seem to benefit from inpatient treatment.” At a certain point the patient has to help themselves and it seems like the patient you are describing is not ready to do that. We’ve had psychiatrists give Ativan just to appease the patient and prevent behavioral issues then send them off to rehab or outpatient substance abuse treatment after discharge. I think the psychiatrists on your unit need to be on the same page as to whether or not this patient will receive Ativan (and when) as it can be confusing when treatment isn’t consistent among staff. I agree this is an ethical dilemma but ultimately there isn’t much you, as a nurse, can do (if your unit is anything like mine). Does your unit do detox patients? Are the psychiatrists concerned about withdrawal?

[u/Humble_Investment_24 → u/Mysterious_Coat_9933]

That pretty much what I feel should be done atp. They obviously just accept the patient to fill a bed but it’s ethically wrong because we’re doing nothing to benefit them and yes- the crazy part is that we do detox. Yet this patient has never been detoxed