Being Investigated for Narcotic Diversion

[Nurse Beth, MSN]

Dear Nurse Beth,

I am an agency nurse. It was very busy they gave me the hardest assignment while the other nurses sat and watched me struggling. I could not locate a few pts needing BS and a lot of visitors were there taking the patient outside or out LOA.

The Aides hate agency nurses and offered me no help. The computer system for meds you ask pts if their in pain( Most of them ). So there were 3 pts I asked if they needed pain meds agreed, I did notice they usually did not ask for them. From my 40 years experience as an LPN I notice few pts have narcs ordered so when they are ordered I offer it to them. My last job pts were not allowed pain meds unless hospice so it was not an issue. Later the boss of my agency said she filed a complaint because there were 9 pain meds given during my 4 shifts for pts who usually do not ask for them. I had never met these pts.

She also c/o a nurse observed me doing a BS at 3PM. There are only 2 reasons -pt was out until the afternoon or I was rechecking a high or low. I do not recall a 3 PM BS but there were pts coming back from visits. The DON questioned the 3 pts who did not recall asking for pain meds, I know I asked them and they agreed. So now I am being investigated I do not know by whom or how and I am horrified.

I have been a nurse 40 years and nothing ever happened to me. A few days later the agency sent me somewhere else and I overheard 2 nurses talking about a card of OXY 10 disappeared and the nurse who signed for them was suspended. Well the next day they want me to make a statement- did I get a delivery _NO I would locked them immediately. So the boss at the agency is thinking I had to be involved! even when I overheard the nurse was suspended for sighing the card in.

So the agency put a hold on my account. I can work the shifts in July offered to me with a very far drive as punishment. So while she does not trust me I go to work this AM for a double and they accidentally took me off the 3-11 shift but the scheduler called the agency who told them I could not accept it since I am on hold. First they schedule me a double and when they want to keep both shifts were told no I could not the DON called and asked why.

My boss said I was investigated so she came to me demanded I give the keys back and leave at 11 AM. In a few days I am on schedule to work at the second place with the lost oxy card, why would I risk another false accusation? I have many bills that will only get paid if I keep working but I will go be an aide and cut back everything rather then risk my license. Agency nurses run alot of risk as it is not knowing the pts staff or policy. My agency days are over! I have no clue what the penalty is or what the investigation process entails. I am scared I am proud of my 40 years as a nurse and work hard to do best I can, I am scared and mad. Hope you respond.

Dear Scared,

I'm sorry you are going through this and having your license in jeopardy is every nurse's worst nightmare.

From what I can follow, you offered pain meds to patients because the computer prompted you to. Hence you were under suspicion for giving narcotics to patients who otherwise did not get them. Most facilities run reports of narcotic usage by users and you came up as a high user compared to other nurses. The part I don't understand is then you say you "had never met" the patients.

How can there be confusion as to who administered medication or took a blood sugar? Your name is either electronically or manually in the record. Or not. I would say the same thing about the Oxycontin. Surely there is a chain of custody for narcotics and everyone from Pharmacy to nursing involved in the re-stocking is on record. The agency may actually be trying to proactively defend you since you (therefore they) are already under suspicion.

As far as the 3 patients who you say you did give narcotics to who later denied being asked about their pain, did you document the nature of the pain and intensity of the pain? Did the intensity of their pain meet the criteria for narcotics, such as a level 7 on a scale of 1-10? This is why documentation is so important. Likewise, if a patient had a blood sugar due and they were not available, you would document that the reason why the blood sugar was not done as ordered.

I agree that if there is no supporting documentation and the patients claim you did not ask them about their pain, it is suspicious. Granted they may be forgetful, but if was 3 out 3 patients with no documentation, there is cause for concern.

An investigation could mean just an internal investigation and maybe being terminated, or it could result in being reported to the Board, which is far more serious. I would meet with my my boss and calmly ask about the process. It's better to know than to guess and worry. Ask how long it takes and when you can expect an answer.

If you are being reported to the Board, get an attorney that specializes in representing nurses to the Board. You need someone on your side.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[Nurse SMS, MSN, RN]

In reading this I kept wanting to ask what the documentation says. Documentation eliminates questions the vast majority of the time. I think Nurse Beth is spot on. If you didn't document, unfortunately things may not go so well for you. I hope that isn't the case.