SNF/LTC nurses not giving PRN morphine
I’m a newer nurse with a little over a year of experience, but I worked as a CNA for 12 years in long-term care. I recently experienced a situation that has been weighing heavily on me, and I’m looking for insight from others in the field. This was not my resident.
We had a 92-year-old resident who was clearly declining and was prescribed morphine and Ativan every two hours PRN for comfort measures. Despite obvious signs of discomfort and active dying, these medications were never initiated. The primary nurse on days reportedly chose not to start them, and the other nurses followed that lead.
The resident appeared visibly uncomfortable during care, especially with repositioning, and had progressed to mouth breathing. Still, no comfort medications were administered.
On the day she passed, she was transferred into a wheelchair and brought to the dining room for breakfast despite actively declining. The CNAs expressed concern multiple times and requested that she be returned to bed for comfort, but those requests were denied. As her condition worsened and signs of imminent passing became more apparent, staff again voiced concerns. Unfortunately, she ultimately passed away in her wheelchair without ever receiving comfort medication.
I understand that every nurse has different clinical judgment and experiences surrounding end-of-life care, but I’m struggling to understand the hesitation to provide ordered PRN comfort medications to a resident who appeared to be actively dying and uncomfortable.
I think I’m partly venting, but I’m also genuinely looking for advice on how others would navigate a situation like this, especially in a small facility where one nurse strongly influences the culture and decision-making of the team. This experience was deeply upsetting to witness, and I can’t stop thinking about whether more could have been done to provide this resident with dignity and comfort in her final hours.
ETA: I should have added this facility has no hospice care just the facility doctor putting orders in. And this patient unfortunately had no family