Suspecting Co-worker of taking drugs

Nurses General Nursing

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ZASHAGALKA, RN

3,322 Posts

Specializes in Critical Care.

You have a legal obligation to report such suspicions to the board. If you work in a bigger hospital, you can accomplish the same by reporting it to your peer review committee. They are considered local 'agents' for the board, for purposes of well, peer review.

If your boss doesn't take you seriously, that DOES NOT relieve you of your obligation to report. She is merely the FIRST link in a CHAIN OF COMMAND.

Also, you might report it to the ethics committee.

With the advent of pyxis, etc., there is no reason for hospitals not to be on top of this. It's merely a matter of two statistical reviews: 1. How many total narcs a nurse gives in relationship to other nurses on similar units. 2. The percentage of total narcs an individual's group of pts is allowed to have compared to how many are actually being signed out, and a comparison of THAT relationship to other nurses and THEIR group of pts on similar units.

Even the most conscientious pain control nurse should fall within the standard deviations for sign outs.

Any nurse that falls significantly outside the standard deviation (say more then 1.5 standard deviations) should be subject to a drug test EVERYTIME for EVERY shift they fall outside the standard deviation. On the other side, a nurse that signs out signficantly LESS then the standard deviation should be counselled on effective pain control management. With their push for adequate pain control, I'm surprised JCAHO doesn't already mandate this.

That might not solve drug diversion for uses other then personal, but it WOULD significantly reduce the number of 'impaired' nurses due to diversion.

I don't think hospitals do this because 1. they subscribe to the 'any warm body' philosophy, and 2. they don't want to know about such liabilities (See no evil . . .)

But, I think this WILL ultimately become a standard. And, when it does, those hospitals will almost certainly backdate their analysis for the entire employment history of nurses (really, it's just a matter of pushing a few more buttons). You ARE being monitored in this as we speak, even if it's nothing more then a passive collection of records for later analysis at this point.

And let me say this, one of the things I do BEFORE I leave any shift is to check my diebold reports on my pts to see to it that EVERY narc signed out on my pts were either signed out by me, or at my request. If not, that is an incident report. The TWO times I've filed such an incident report: 1 was a diverter that was fired that night (but, he had diverter narcs on 9 pts not his that night), one signed out a xanax on my patient accidentally as his pt was right next to mine on the list AND had the same med ordered, and he had charted he had given it earlier in his shift and there was no record it was signed out on his pt: a simple and correctable accounting error.

~faith,

Timothy.

Midwest4me

1,007 Posts

Specializes in A myriad of specialties.

NOW I would confront the nurse and/or talk with the nurse manager.

I wish I'd spoken up/confronted someone about such a suspicion. Years ago a friend of mine( I'll call her XXXX) and I worked LTC together; she floated among different floors; we did 16-hr shifts on weekends and relieved each other. A narcotic count turned out suspicious(some narcs on several cards were punched out then taped back in); she gave some wierd explanation and I believed her. She left the shift and went home. After finding a narce in the med drawer in a paper cup and re-thinking all those cards with taped-in narcs, I called another RN down to do a re-count....(kicking myself all the while in my mind for not having addressed this while XXXX was still in the building.) The other RN and I made a report to the DON. I later learned that XXXX had an accident years before and been addicted to narcs and was on a nurse-monitoring program. About a year later her obituary was in the paper; she'd committed suicide!!!! It seems that XXXX was being faced with her RN license being suspended (over narc diversion)and she couldn't imagine what else she would do with her life so suicide was the answer. WHAT A SHOCK to all of us who thought we knew her.

KellieNurse06

503 Posts

Good question, but can you clarify something for me? You said taking narcotics...do you mean you think they're stealing them or do you think they're consuming them on the job? Do they have any physical signs of being under the influence of narcotics?

If they're stealing...can't that be verified with Pyxis? Can an RN obtain verification from the pharmacy? If so, you can take that to the NM, right? (Still a student...feel free to correct me.)

If they're consuming on the job....I would go to that person with an approach like, "Your eyes have been blah, blah, your speech blah, blah. It appears that you're under the influence of something and I'm concerned for the safety of your patients. If you are willing to stop, I will be willing to let this be an issue for you to handle on your own. But, I can't ignore the compromise of patient safety."

No direct threats, but a strong message that you know something's going on.

True but the Pyxis only tracks the drugs when they are removed......after they are taken out of the machine.....that's a whole other ballgame you can do whatever you want with them............they can be marked off as given on the med sheets so no one would really know if the patient had it or not unless the patient complained of unresolving pain after meds.........and also how frequently narcs are dispensed when ever one specific person is working....as opposed to other people on different shifts...................I don't get it how a nurse...well anyone for that matter.....could do that to a patient........thats pretty twisted in my opinion.......but I have never been in that position as one who uses drugs so I will not judge others.....:uhoh3:

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