HELP! the adon stealing out of the med cart?

[blondnursey]

hi

my friend who is also a lpn, got a new job this week.

its a local nursing ho me with a very bad rep. i told her to be careful...

well she has called me everyday that she has worked freaking out.

seems the adon asked her for lasix 60 out of her cart, he forgot to take his that day. she said no, and he wetn and got it from a different nurse. then the next day he asked for the keys to "audit" the cart &(she was feeding and couldnt get up) then said "oh yeah i gave so and so a vicodin" but the pt showed no sigs of pain relief and vics always make him sleep.

the staff asks her for tylenol and aleve from her cart. the nurse she follows doesnt use the mar and half the pills arent there to give anyway,as she doesnt order. to make things worse, several pts have body lice and they only had expired shampoo to use. i told her to call the state. she said she didnt know the number, it wasnt posted anywhere in the building. and she was afraid if the state came in and followed her, and the meds werent there to give she would get in trouble..

she wants to quit, but doenst want the residents to continue to not get their meds & good care they deserve.

so my question is what a good reply to the adon when he wants to audit? what to do when the state comes and your meds arent there? what if you are pretty sure the adon took the narc? he is in tight with the don & owner so who else is there to complain too?

how do you deal with no meds to give?

i have told her i would ask for help on here, she is anxiously awaiting your advice.

thanks

[FLArn]

If she were my friend, I would advise her to contact a nurse attorney IMMEDIATELY ! Call and give her notice and get out of there AS SOON AS POSSIBLE! The attorney will advise her as to when and how to contact the state and what to do to protect her license. Good luck to her.

[TheCommuter, BSN, RN]

This is a common part of the workplace culture at the various nursing homes where I've been employed. It's certainly illegal, but it's also an accepted part of the culture here.

Coworkers walk up to the med cart with complaints of a headache or back pain, and the nurse will usually give them a Tylenol, Aleve, or Motrin from the OTC supply. If a coworker's blood pressure is sky high, someone will usually hijack a Clonidine or Lopressor to give to the coworker to get his/her BP back under control. It may not be the right thing to do (it is actually fraudulent), but these practices have occurred at every LTC facility where I have ever worked.

Yesterday was a Sunday. Our facility administrator pops into the nursing home on his day off because he has a nasty looking skin tear, and asks nursing staff to dress it. I doubt that he is planning to reimburse the facility for the cost of the wound cleanser, triple antibiotic ointment, dry dressing, and cloth tape that were applied to the skin tear.

The other issues you have mentioned (expired shampoo, Vicodin missing, meds not in the cart) definitely need to be resolved in order to do the right thing for the residents.

[ohmeowzer RN, RN]

call the state , right now and i would call the ombudsman for senior citizens.. right now ..

[MassED, BSN, RN]

report report report that ADON. Right away - don't you have to sign for your narc key? or some accountability for that? That is on you if you don't report it. Keep documentation of dates, times, etc. REPORT it.

[MassED, BSN, RN]

This is a common part of the workplace culture at the various nursing homes where I've been employed. It's certainly illegal, but it's also an accepted part of the culture here.

Coworkers walk up to the med cart with complaints of a headache or back pain, and the nurse will usually give them a Tylenol, Aleve, or Motrin from the OTC supply. If a coworker's blood pressure is sky high, someone will usually hijack a Clonidine or Lopressor to give to the coworker to get his/her BP back under control. It may not be the right thing to do (it is actually fraudulent), but these practices have occurred at every LTC facility where I have ever worked.

Yesterday was a Sunday. Our facility administrator pops into the nursing home on his day off because he has a nasty looking skin tear, and asks nursing staff to dress it. I doubt that he is planning to reimburse the facility for the cost of the wound cleanser, triple antibiotic ointment, dry dressing, and cloth tape that were applied to the skin tear.

The other issues you have mentioned (expired shampoo, Vicodin missing, meds not in the cart) definitely need to be resolved in order to do the right thing for the residents.

I take more issue with the Vicodin - certainly Lopressor is dangerous - giving out Tylenol or Aleve is not as bad, and most places I've ever worked you can even get those from the pharmacy, but the issue is the Narc. Report it. Don't tolerate it - or you could find yourself, or your friend, could go down with that ADON for not reporting it.

[systoly]

Sounds like your friend might greatly benefit from all the threads about LTC on AN, so why not refer her?

[blondnursey]

Sounds like your friend might greatly benefit from all the threads about LTC on AN, so why not refer her?

i did! i sent her a link right to this page..told her how helpfull everyone is here!! thanks for all the advice so far!

[Katie5]

You need to call someone. But remember document...document...document. Sure you may raise suspicion without documentation but you actually mean to nail them, do you not.DOCUMENT and have evidence.

[Vito Andolini]

Tell her to never, never, never release her narc keys or med cart keys at all , for that matter, to anyone, including her bosses. She is responsible for all meds on that cart, including the narcs.

Never mind "tight" relationships. Do you think the owner and DON want to be part of this illegal behavior on the part of the ADON? What makes you think they know about it? She should screw up her courage and speak directly to the perpetrator first, telling him that she can no longer give him any meds from her cart at all and she cannot allow anyone on her cart because she is accountable for the narcotics. Absent changed behavior on his part, she needs to go to the DON. Wrong response? Administrator, then Owner. Then:

She needs to call the Nursing Board if she can't somehow dig up the number to the state or federal licensing folks. CMS = Medicare, which lots of the patients are probably on = 1-800-447-8477 or 1-800-633-4227. If not right, they can direct her.

Whatever state she's in, tell her to call her state senator's or congressman's office for help contacting the right agency, be it Senior Services, Health Department, Social Services, or even the state police. She might want to do this anonymously, if at all possible.

The Admin's boo boo - well, it's pretty hard to say no to the big boss. What a jerk he is to put staff in this position. With all the money he's likely making, he can't go to a drug store and buy some stuff or get treated by a doctor?

But tell her she is practicing medicine without a license to hand out prescription meds - and maybe even the OTC's - I'm not sure.

OTC's are dangerous because people can be allergic to these, too. Then, if they ask you for it and you give it and they react badly, well, guess what - lawsuit time, loss of licensure, criminal prosecution for practicing medicine without a license, etc.

Tell her to just tell the staff she is sorry but she would be risking her license and her livelihood and she'd be stealing if she gave them something that did not belong to her.

She knows all of this and just needs to say no. It's not easy, she wants to fit in, be liked, keep the crew on duty. But she should protect herself before any of that.

I hope she has the good sense and courage to stand up for herself - quietly but firmly, nicely but finally.

[Vito Andolini]

You need to call someone. But remember document...document...document. Sure you may raise suspicion without documentation but you actually mean to nail them, do you not.DOCUMENT and have evidence.

Document what? That she gave out prescription meds to people other than the persons for whom they were ordered? That she "stole" OTC's and handed them out to staff?

That she didn't order meds when she found them missing, even if it's someone else's job to order? That she didn't call Pharmacy and get the meds delivered in a timely manner? That she didn't notify the doc and get alternate orders? Where would she document these things? Maybe in incident reports, sent to the owner, but to bypass her chain of command would be bad.

Maybe her best bet is to play dumb and just start calling the doctor every time there's a problem. The doctor will soon c/o to the boss, who will know he's been found out and maybe put a stop to the practice. This could backfire.

And the nurses who are stealing meds from the patients, especially the nurse who's hooked on the narcotic, need to be reported to the Board of Nursing and to the bosses, in writing, all of them at once, and keep a copy. She need only report her suspicion and then let them sort it out.

What a pathetic and angering mess.

[AngelfireRN, MSN, RN, APRN]

GET OUT! Get out, get out, get out. I applaud her for trying to do what's right for the residents, but she's fighting a losing game. If she refuses to give the NM the keys, and he gets mad, he could very well blame the missing meds on her, get her fired, and have her license examined. Just out of petty spite.

No, she just needs to get out of there. THEN call state. A surprise visit should be in order, methinks.