broken narc box.

Published

I work in a LTC/Rehab facility. I go to work Sunday and the dayshift nurse proceeds to tell me that the narc box lock is broken, we can't open the box, well since the box is not attached to the bottom of the drawer, they just took the top of the box off and closed the drawer and left the narcs in the drawer. The dayshift nurse said she called the DON and the Admin and they told her they would get it fixed the next day (Monday) to keep the meds in the med room and pass the meds from the med room...ooooo kkkkk WE HAVE 25 RES to pass med to. So rather than fix the box right away they want to inconvience us in our med pass. The next day I was moved off my regular hall the worst hall in the building with 33 res. on 2 halls. my med pass started at 4pm and I passed meds non stop i know til after midnight. during that time in my med pass. i had a res fall, one with a cbg over 530. so i was on the phone with dr 5 different times, and the dr told me he never had to deal with a blood sugar that high give the regular sliding scale insulin and consult the other dr for the hyperclycemic care, so I did that. and in looking thru this res orders i find tht her am long acting insulin had a hold on it if it was below 150. her cbg at 7am was 96, at noon it was 122 and at 5 pm it was 531. other doc tells me to take the hold off of that long acting and to never hold that. and re check in 2 hrs since i just gave her the 12 units. check it again and it only came down to 500, so i call again, get one time order for 15 units sliding scale, res is alert, oriented, no distress, asymptomatic, ect. so between med pass, the res that fell, the res with elevated blood sugar, i stick myself with a clean insulin syringe with the long acting insulin in it. thankfully i didn't inject any. I tell my DON who was still there and she tells me to check my blood sugar, eat some snacks, and that no paperwork is needs to be done since it was a clean needle. and why weren't those narcs locked up last night ? I told her that cart was like that when I got here. She said they were suppose to be locked up in the narc cabinet in the med room and we were suppose to get them from the med room as we needed them, I told her i didn't know that and the cart was that way when I got there. then she said she was leaving and for me to check on the other nurses because they were all new and off of orientation. BUT THEY WILL NOT ORIENTATE ANY NEW NURSES TO THAT HALL I WAS ON...which is not my normal hall. I was told by the staffing nurse they could not orientate anyone back there with the nurse who normally works back there. So none of these new nurses will ever work back there.I did not leave there til after 2 am and to top it off I had to go in yesterday on my day off and put in that one time order for the 15 units of insulin i gave because I forgot to do it that night. I have been at this place now for 8 months. I am still a new nurse, this is my first nursing job. I told a co worker that I have had it, I'm going to give a 2 wk notice and quit. I get a phone call from the staffing nurse today on my voice mail asking me if i quit, so I call back and the admin aswers the phone and asks me the same thing, I told him I would give a 2 wk notice before I quit, and he said for me to come in tomorrow and talk with him. So I'm gonna write down a list of things that i have a prob with starting with the narc box and how no one would fix it and would rather inconvience the nurses than to fix it right away. I was telling my husband that the money is good but it won't be so good if I lose my lic becuase of some dumb **** management doesn't want to deal with

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Specializes in retired LTC.

Not sure if you know but at some places, the med carts are the property of the pharmacy and are 'loaned' to the facility. Those 'loaned' carts get repaired by the pharmacy so it might just be that there was no possibility for the pharmacy to send out a repairman or send a replacement cart on a Sunday (Father's Day, no less.).

Also, there may be special circumstances if your maint person were to come in. It might be overtime or compensatory time-off for him. And we all know how much Admin looooooves that!!! And he may not have been able to fix it after all that!

What you had was a temporary situation that was inconveniencing you, but was NOT a threat to any person or procedure that couldn't be handled with the temporary (altho nuisance to you) arrangement your DON requested. I'm not clear when you learned about the narc box, what floor it was and how info was or was not communicated, but your DON's directions WERE NOT followed. It is her ultimate accountability to insure that narcs are secured accdg to regulations. And it sounds like they weren't.

You had a bad shift r/t to your diabetic pt (with all the MD calls) and that upset you. You were floated to a different unit, and we all know how disconcerting that is. There was a fall. You poked yourself with a clean needle, but that was no problem other than "ouch". You're mega-frustrated, but...

You'll notice that your 'threat' of quitting has already made the circuit like wildfire at your facility. No employee is indispensable - in fact, "when you're gone, they'll miss you for 2 weeks". That's the time it'll take for the payroll dept to process you out of the system. That piece of wisdom came from my first supervisor in my very first job in non-health, pvt industry business.

Even if you don't leave NOW, you are on their radar. LTC is not easy and many, many times, you have to proceed accdg to Plan B. You need flexibility and that can be difficult. I know - been there, done that, too. Just know that things could have been worse. I cringe and feel it when others have those kind of nites from hell. We all do - so I do understand your vent. Good luck.

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But couldn't that narc box result in disciplinary action on my lic ?? and to give an example of how long nurses stay there...I have the most senority on my shift and I've only been there 8 months.

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Specializes in Care Coordination, MDS, med-surg, Peds.

ok, so the directive from the DON was to put the narcs in the med room/narc box and pass from there and you didn't follow her directive, regardless what the prior shift did, you were in the wrong. i could see you getting disciplined from work, but unless narcs were diverted, stolen, given inapporpriately, etc., I am not thinking you will get BON involvement for your license. BTW.. If I had been the staffing sup, Medical on call, etc., and you threatened to quit, I may well have walked you to the time clock and had you talk to Admin/DON before returning. I would rather do the job myself than have a staff member threaten me with this. Don't mean to sound harsh, but its reality...

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I thought for sure that I posted to this earlier. If that is the arrangement the DON wanted, she should have provided more help. Expecting someone to prepare and administer meds for 20-30 patients by walking each patience's meds from the med room to the patient is asinine. A spare cart would fix this problem, and make weekly cart cleaning easier as well.

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Specializes in Care Coordination, MDS, med-surg, Peds.

For some reason, I thought that JUST the narcs would be inconvienient, NOT all the meds. So while it would be a pain for one or two nights to walk the Narcs a little farther, it wouldn't be the same as ALL the meds. I truly don't know/think that every resident would have narcs at every med pass?

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Specializes in retired LTC.

I thought we were talking narcs only, also. Didn't sound like the med cart was non-functional.

>>>>>>>>>>>>>>>>>

To OP: Med room refrigs usually have locks so you could have put the narc box in there (unless it wouldn't fit). But your medroom door is locked, yes?. You don't lay your keys down anywhere? And your narcotic count still had to be accurate. Who did you think was going to report you? You were working with an unexpected emergency and things do happen.

And I know many of you will find this hard to believe but not so long ago 'in the old days...' there was a time when nurses poured /passed their meds on a tray with little med cards from a med cabinet/closet. NO MED CARTS!!!!!! I am so thankful somethings HAVE changed for the better!!! But think about it - if your home dishwasher breaks, you do dishes by hand for a while. Or you use paper plates. So....

So you were inconvenienced, frustrated, angry and PO'd.... But that's not BON discipline action. But there is a real major possibility for some employer disciplinary action for you. There were several questionable issues in your post.

And the fact that your facility has poor staff retention with high turnover IS a problem with your facility. But that fact is a separate issue - like you're mixing apples with your oranges. YOU balked at lending support/assist to other nurses, newer than you. That's what a lot of newbies here on AN (probably yourself, incl) complain about - staff not helping one another! In a pinch, you all just pull together to help one another.

At times, you have to be able to switch to Plan B and improvise to do the best you can. I said it previously, you had a bad nite and you're venting. I understand. But those kinds of nites will continue to occur and they can be worse. Good luck.

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Are nursing jobs hard to find where you live? Why don't you just quit?

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yes that night was a bad night and I was venting, but it's nights like these that become the norm, there are a lot of frustrated nurses at this facility, the management there does not care about it's nurses. rumor has it that if our census drops below 102 the admin, DON, and the admissions coordinator will lose their jobs. And our census right now is 120. several nurses as well as myself were told by an RN unit manager to chart all skilled residents as 2 person max assist, because the facility will get paid more. I told her no. If they are not a 2 person max assist I will not chart that they are.The MDS coordinator heard this and went to the DON over it, and the DON said that that never happened. Our DON had me do an admit, KNOWING I had never done an admit before, she was gonna give me 2 admits, but I told the staffing nurse I had never done 1 admit let alone 2, I had no idea what to do. So the DON gave the other admit to the other nurse and told me to have the other nurse show me how to do it.I told her I have no idea what I'm doing. She told me medical records had already got the orders in all I had to do was the initial assessment, body audit, and UDA's and I would be fine and then left for the day. I got my admit a few hrs later. I did all that I was suppose to do, but they never showed up on my MAR, and since Medical Records did all the orders, they were suppose to call have pharm deliver meds, they never called, so I never had any meds. I guess somewhere in the admitting process I was suppose to assign her a room number, I didn't know and furthermore I didn't know how. So when i came in the next day. Dayshift nurse proceeded to tell me what she had to fix, that she had to assign the res a room number so they would show on the MAR and call the Pharm to deliver the meds. But she did tell me not to worry because none of that was my fault and the DON or one of the other RN's should have stayed and done that admit knowing I had never done one before. I made it thru it though. and regarding the narc box and the amt of narcs I have to give with each pass. Considering that half my hall is the Rehab overflow,they get routine pain meds q4h and the other half is dementia/alzheimer so I'm giving routine atvian . so yeah I am passing a lot of narcs with each med pass. Not to mention the PRN narcs. It's a very very busy hall that I'm on.

Yes nursing jobs are hard to find here, atleast for LPN's, there are 2 hosp but they dont hire lpns. very few nursing homes and the clinics in this area start there lpns out at $10/hr. So even tho, I vent alot about it, I feel that I am stuck. I can't afford the pay cut and from what the other nurses say, it's the same way at the other nursing homes. I haven't been at this facility a yr yet and in the last 9 months, they have fired 3 RN's and one DON and none of them had been there 6 months. The DON that they fired was the only RN who would actually come out on the floor and help us. She would always make rounds on each hall and ask us if we needed anything. I needed an RN to flush a central line for me and my Unit Manager said she would do it, but she left and never flushed it. So I asked the DON if she would flush it and she asked where the UM was I told her she left for the day, so the DON flushed my central line. She was there 3 months and coorporate fired her. This DON started in Nov, and she was fired in Feb. She never had a chance to do anything . They gave my UM the DON position, and she still won't flush a central line for ya.

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If I had been the staffing sup, Medical on call, etc., and you threatened to quit, I may well have walked you to the time clock and had you talk to Admin/DON before returning. I would rather do the job myself than have a staff member threaten me with this. Don't mean to sound harsh, but its reality...

I didn't tell them that I quit, someone else told him that. I told the admin that I would give a 2 wk notice and work out my notice before i quit. I would not do what the last 5 or 6 nurses have done in the last few months and either just not show up or call in saying they quit. I would give a 2 week notice and work it out. I never threatened them...I had every intention on giving my 2 wk notice. The staffing coordinator talked me out of it. All that we are asking, is that they give us back another nurse, like we used to have, we had 6 nurses on days and 6 on evenings, they are trying to get approval from corporate to get us back to having 6 nurses again. I don't know why they did away with the 6th nurse. But they are trying to get us that 6th nurse again. which would be the difference between working 11-12 days a pay period and working your reg 10 days a pay period. I can't make plans with my family because I don't know if I'm gonna get a day off that week or not, there haave been plenty of weeks were I have worked 10-11 days straight and be off for 1 day and come back for a 10 day stretch. then we get in trouble about all the overtime that we are getting. There was one pay period where I had 90+ hrs OT. my 8 hr shift turns into a 10 hr shift. I usually get 2 hrs OT a night. dayshift nurses don't leave til 4 30 or 5. When they had 6 nurses, everyone got out on time. But corporate does not want to hire another nurse. But they don't want to pay the OT either.

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