Signing out medications for my manager.

[OlaHospiceRNBSN]

Hello Nurses-

After several years as a home health nurse, I've just returned to hospital nursing. The manager on my med-surg-tele unit regularly asks nurses to sign dilaudid out of the Accudose for him to administer to patients on the floor. As a brand new employee still on orientation I was afraid to argue with him about whether this practice is right/legal. He contends that it is absolutely okay to have nurses sign out meds to give to him (the manager) to administer and that he "is required to give a certain number of meds each month." I asked him why he doesn't have his own access to the Accudose and he said that it's because he's responsible for reconciling the medications so it would be a conflict for him to have access. I haven't been able to find ANY literature on the internet about policies regarding signing out medications for other nurses and I want to be able to back-up my contention that this can't be okay. Any advice or references to legal or professional sources would be greatly appreciated.

[KelRN215, BSN, RN]

Definitely sketchy. If I'm signing out dilaudid or any other controlled substances, I'm giving it. How is your manager going about this? He's seeking out a patient who needs dilaudid and then following that patient's nurse to ask them to allow him to give them med? And sign it out for him? Are 2 nurses involved in signing out the med? Has anyone witnessed him administer it or waste the remainder of the vial?

When I worked in the hospital, my manager did not have access to the Pyxis. I always found this stupid and it became an excuse when we were short-staffed about why she couldn't help out on the floor but that's a different issue entirely.

Why is med administration the only nursing task this person has to complete every month? Why is it only Dilaudid that he can administer? Why not the Colace or the Metformin? Those drugs he can probably administer without involving another nurse... I've never seen a unit that locks those in a Pyxis.

[FlyingScot, RN]

Get a lawyer first and then make the notification. What he has done is create a paper trail WITH YOUR NAME ON IT!!!!!! If this comes up he's going to pin it on you. Get a lawyer, get a lawyer, get a lawyer!!!!!!! Get an independent tox screen on your hair too. Oh, and did I mention. Get a lawyer!!!

[joanna73, BSN, RN]

Never sign narcotics or any other medications for anyone to administer. That's bad practise. The person who signs for the med and pulls it should be administering that med.

[dutchesskaura]

Hello Nurses-

After several years as a home health nurse, I've just returned to hospital nursing. The manager on my med-surg-tele unit regularly asks nurses to sign dilaudid out of the Accudose for him to administer to patients on the floor. As a brand new employee still on orientation I was afraid to argue with him about whether this practice is right/legal. He contends that it is absolutely okay to have nurses sign out meds to give to him (the manager) to administer and that he "is required to give a certain number of meds each month." I asked him why he doesn't have his own access to the Accudose and he said that it's because he's responsible for reconciling the medications so it would be a conflict for him to have access. I haven't been able to find ANY literature on the internet about policies regarding signing out medications for other nurses and I want to be able to back-up my contention that this can't be okay. Any advice or references to legal or professional sources would be greatly appreciated.

Sounds "FISHY" to me

[jadelpn, LPN, EMT-B]

First off, we all have to take our turn counting narcotics, so this business about "responsible for reconciling therefore can't have access" is incorrect. (and not sure how someone can reconcile meds that they don't have access to is questionable). It is also interesting that he is asking you, the new nurse on orientation. That is abuse of power. I can see that I would also be afraid that if you said no you could lose your job, especially if you are still on orientation. Is he into the charts to see which patient needs which narcotics at which time? In other words, if patient in room 567 is not due for pain medication, and you pull it, that could also get you in hot water. If there is not another choice, I would say something along the lines of "is this a test of new orientees? I was taught that unless I am giving pain medication myself after assessment, that I can not pull meds for a patient that someone else is going to assess and give and reassess." Are all these patients who need pain meds your patients to begin with? There are so many unanswered questions. And I feel for you and your situation. I would bring it to the compliance hotline, I would do a safety report, I would bring it to the DON, or to HR. I would not speak about it to the other nurses, as you don't want to start gossip, just protect your license. Oh, and something else I just thought of--a lot of places require orientees to have witnesses to pull narcotics and all places need a witness to waste. And with dilaudid, 9 times out of 10 there's a waste involved. Perhaps this is some strange policy loophole and you can in your facility do this. Know that this is WAY out of the norm, and I would suggest that perhaps to protect all involved that a witness is needed for narcotics one of which needs to be the care nurse. Let us know what happens with this.