No Narc count????

Nurses General Nursing

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I just started orienting at a SNF. Today was my first day there. The nurse I was orienting with showed up a little later and jumped right in to get report and then we were off passing meds etc. At first I thought maybe someone just counted her cart for her but when I asked her later about how they do the narc count there she said they don't, they trust each other!!! I am surprised to say the least. I sat there for a minute speechless but then said...I hope no one is going to be offended when I don't accept the cart until I count the narcs. She said they'll be count with you but they might think your a *****!!!!:eek:

Has anyone ever heard of such a thing?? I mean I am a fairly new nurse but.....is this the norm????!!

I would definitely do the count.

I worked with a nurse that we all just "trusted" and we found out much later that he was stealing narcotics. He seemed to have it together but it was all a show. Thankfully, he was not stealing in a way that threatened anyone else's license. However, if someone had not counted a drawer and he stole something... that could be bad news bears. The guy eventually died, partly as a result of his addiction. I can't imagine what I would have felt like if I had the chance to hold him accountable with a narcotics count and I decided not to based on preferences.

Specializes in ICU.

agree with all the others, don't jeopardize your career, do what you KNOW is right

Specializes in ICU.

agree with all the others, don't jeopardize your career, do what you KNOW is right

Specializes in Certified Med/Surg tele, and other stuff.

What about DOH? How do they explain that one?

Specializes in Hospital Education Coordinator.

there should be a policy about this. Even if someone else gets in trouble over diversion, and you were following the crowd, you would still be liable for your role in not following policy. Insist that it be done. Tell DON.

In my 25 years as a nurse, I have worked in a variety of settings, and have seen a variety of practices-by the book, or otherwise. One place I worked, a drug rehab no less, used to put scotch tape around the top of bottles and pronounce them "sealed" so they wouldn't be opened every change of shift to be counted. Of course when they were finally checked, there were pills missing, and all of the staff since the last real count had to get urine tests.

Some places I worked the people just "trusted" each other, because the oncoming shift was so late coming in, and it took so long to give report, that the 1 off-going licensed person didn't have time to count within the half-hout overlap of shifts.

Then there was the giant state hospital, where they had huge, 500 count bottles of phenobarbital and other countables, that they expected to be counted at change of shift, besides giving report on 60 or so patients, all in a half-hour, with walking rounds.

Obviously, the people that make the standards don't take staffing, acuity, and management frugality into account.

PS: It really used to **** me off when people would leave half a pill taped into a blister pack, or a half used single-use vial, and write 0.5 on the count--oh, really? you can see that well that it is not .35 or .6??? It would have made me tear my hair out if I weren't already follicularly challenged!

I would say "Well, I'm funning like that...talk all you want, but just give me a few minutes for a count." Don't take the keys until it is counted.

Even if you trust each other 110%, mistakes can be made. That is why we count!

In LTC...we give a ton of narcs, sleeping pills, psych meds.

Specializes in Plastics. General Surgery. ITU. Oncology.

That's interesting. In the UK narcotics are never kept in the general medicine trolleys (with the exception of Oramorph which my ward allows to be given by a single nurse, no contersignature required) but in a locked seperate cabinet. The "CD's" as we call them (controlled drugs)are checked every night by the night staff.

Today was my second day of orientation. I was with a different nurse but I told her about my wanting to count the narcs so she counted with me but it still wasn't an official count with the off going nurse. There is no real official handing off of the keys either they are just kind of left laying on the cart all day. I really like this place and don't want to mess things up but I just think they aren't as on top of some things as they should be. Like I said, the keys are just on top of the cart, the med carts are never locked, neither is the med room door. I hate to go in there trying to change things I know people will start to really hate me. I am just a prn nurse there. There is another nurse who is orienting and she is a brand new nurse and she being trained the way they do things I have a little bit of experience so I know it's not right but this poor girl has no clue. I did see them counting their cart today but again she was counting with the nurse who was orienting her not the nurse who was on before her and they didn't count with anyone after shift either. If I say something they will all know it was me.....jeez, why can't anything ever be simple.....?

Thanks for all of your previous responses. At this point once I'm done orientation I will insist on counting but as far as anything else I don't know what to do.

Specializes in Geriatrics.

All I can say is "no narc count? - no taking the keys - no taking the floor" Always insist on counting, it will save your behind (and your licence)!

Specializes in Psych, Chem Dependency, Occ. Health.

Carts need to be locked. The med room needs to be locked. I have worked with nurses who abused and stole everything from methadone to seroquel to benadryl...Do not trust anyone. Always count your narcs, always. NEVER give your keys to another nurse, ever. Addiction nursing is my speciality and I can't emphasize strongly enough that you need to do these things all the time.

To be honest, I would quit, like yesterday. Even if they trust each other(Which is no excuse!!!), they are hiring in new people and not counting? Are they ALL crazy?? You need to talk to whoever is in charge of staff education. This facility and these nurses are in desperate need of an inservice on how prevalent diversion and drug abuse is among nurses. Crazy.

Sue

I would stick to your guns and training on this one. Count, each and every time you take responsibility for the cart. Who cares what everyone thinks of you. The truth is, you're there to make a living not friends! I agree that it is illegal and against best practice to just take over a cart without knowing if its contents are correct. You knew that right away. I wish you luck!

:up: Thank you! I'm glad to see everyone agrees with me. I just hope the response I get from the other nurses when God forbid I ask them to take a minute to count with me isn't too harsh. And actually hopefully some of the other nurses follow suit. A girl can dream can't she??!;)

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