co-worker stealing narcotics

[starbin]

I work in a nursing home. I have a patient who is prescribed percocet 1 tab every 6 hours PRN for pain. She generally takes one tab at 9AM and the other at 9PM. One of my collegues, who is a floater and occasionally works on my floor signed 4 percocet in her 8 hours (11PM to 7AM) shift. She was very clever to make the order look like 2 tabs(it was a handwritten order in the MAR, she channged it by adding I to the order which then looked like II tab), however, even if the patient was supposed to get 2 tabs she had her last dose at 9PM and the nurse who worked 11PM to 7AM can not give more than one dose during her shift. The same night she signed for 6 percocets on another patient who was supposed to get 2tabs every 6 hours, and had her last dose at 10PM. The nurse does not sign the the MAR for the PRN medicine but just signs the narcotics sheet.

We complained to the supervisor and it was even relayed to the DON but no action was taken............

After a week, a whole pack of percocet (20 Tabs) was lost along with its paper during her shift from my floor again. Everybody knew about it including the DON but she is still hanging in the building. Today, she was again on my floor....Eventhough I counted the narcotics with her,,,,, i was very much scared to give my keys to her..i have just ordered percocet for my patient, it will be delivered tonight. I don't wanna loose that but i wonder if I will see it in the narcotics box tommorow. To keep myself in the safer side, i had all the narcotic sheets copied for myself.....

[MS._Jen_RN, ASN, RN]

From the Admin's side (I know, not a popular one)- They are not legally allowed to tell you what they have done in response to your report. For all you know they are gathering evidence and/or have already called the BON. You made the report. You did the right thing, give your DON a chance to do their job. If, after some time, nothing has happened I'd consider calling the BON.

~Jen

[Lacie, BSN, RN]

That RN would have had no problem letting me get fired. What really upsets me, that you can't fire someone for this, they get to have counselling, and get their job back. Wow, if I ever missed giving drugs to my patients, and say sold them, instead of ingested them, I would be fired, and lose my liscense.

Where else can you steal, and hurt people, and get away with it? Could you see the judge saying to a person who ran over someone while on drugs, oh thats ok, your just addicted, go in peace and use no more, heres your keys back.

Wow do you not have the correct info here. Check your state BON site and inquire of thier IPN programs if they are offered. Granted it's wrong and I'm not defending diverters in any such way. But to state they just "get away with thier jobs intact" is very very false. Once caught they most likely will have to endure a legal arrest by law enforcement, jail time, court hearings, then presenting before the BON. Hearings after hearings. Most IPN programs require up to 5 years or more of continous monitoring to include daily AA/NA meetings, peer support group meetings, in-patient addictionologist workups, up to 7 randomly ua's a week if they want etc. Dont forget the very flawed ETG. Many of these nurses jump through hoops to get thier license re-instated then have to fight to even find a job after they get that license back. So please dont stereotype them as some crack head in the street as thats just not how it works. Not to mention all this is out of that nurses pocket while they have no job to pay for it. Sometimes the stress of all the hoops is enough to make on consider relapse due to the stress. These nurses fight hard to get back and when they do take a lesson from them and I bet they have some great advice when you find these type situations. Most of these nurses arent doing it just because it's fun.

Now as far as the admin ignoring? Again they cant and usually wont tell you what they are doing regarding the monitoring of the situation. But you can bet sooner or later this person will be caught. When she does get caught she will suffer the consequences and rightfully so. Document, document, document. Dont make assumptions but have concrete statements. It's not your job to investigate but to report it. If you feel at anytime this nurse is working while in an "impaired" state then you report it right then and hope they jump to drug test her immediately. It could be the facility wants to be sure they have all thier ducks in a row if diversion is an issue. If you arent satisfied with that most every bon has an anonymous reporting area on thier websites. This happens more than you realize.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Wow,..I'm sooooo glad I've never had to be personally involved in something like this,...it's stories like this (and nurses like this) that make it very hard for us to be loyal team players,.....I agree w/some of the previous posts,.give the DON some time to do her/his job,.document all the facts and follow up prn....Good luck to you!

[SCRN1]

Last year, there was a nurse who was working on our floor who had previously been convicted of stealing narcotics. We learned this from a nurse who'd worked with her in the past and knew about what happened. Come to find out, she was not only caught at one places, but TWO! Our NM hired her anyway knowing all this. Being an orthopedic floor, she had access to many narcotics in all forms available.

Well, it all started again for her shortly after being hired. Patient's who didn't complain of much pain and barely asked for anything were all of a sudden documented being given as many pain meds as could be. That threw up one red flag. Then she started having accidents with Morphine & Demerol syringes for PCAs. She would claim she dropped them on the floor after taking them from the pyxis and have someone co-sign a waste with her. Finally, a tech reported seeing her withdrawing the drug from the syringe and putting in a container she had in her pocket. Then she dropped the syringe on the floor and poured some water on it. That threw up a really big flag and no one would co-sign for her and just tell her she'd have to report it to the NM because they didn't see it happen (since everyone by this time was already aware of her history and what was apparently happening again). One night, I had a patient who was complaining of pain and said he hadn't had anything all day to relieve it. The nurse I'm talking about had been assigned to him the previous shift. I went to the pyxis and printed out the patient history. Between the MAR and the pyxis, it was a complete mess! To keep it short, let's just say she was withdrawing narcs and then found someone to witness a return or waste here and there throughout the shift. However, the drug count in the pyxis showed much less than what should've been there. But the # was right with what she had actually taken out before the returns/wastes. If that patient had actually been given all she took out on him, he would've been dead.

She was reported several times by several nurses when these type things occurred. We thought at first it was falling on deaf ears. Come to find out, during all that time she was still allowed to work, they were actually letting her have enough rope to hang herself so that their accusations on her would stick. They just had to have the proof. That print out I did on the pyxis? I gave it to my NM and apparently, it was a long enough "rope".

[CoffeeRTC, BSN, RN]

Yah...you never know what management is doing to take care of the problem, but how long does it have to go on until things change?

We've had similar issues at my facility. After people "caught on" to what this nurses drug of choice to "give" (often demented residents who only had occasional pain and needed the prns) ....that med was d/c's and changed to an OTC pain med. I think that they thought remove the temptation...remove the stealing? My concern was that the pts really did need the occasional narcotic meds and couldn't get it. When other nurses reordered it...it was soon dc'd.

[starbin, BSN, RN]

I have no idea if the management is doing anything at all. I had asked why this girl is still here and the supervisor said they don't have enough proof to fire her. I have no clue of what more they need as a proof.

the DON had told that if they report such issues to the BON, the representatives from BON and the state department of health will come to the facility everyday,,and sometimes they even continue to do it for six months...u can imagine how much of stress it is for the administration...surveyors in the building for six months.....I think this is the main reason they are turning their deaf ear to this issue....I told mysef, mind your business.... shut my mouth up. These days..whenever i see her name in my floor..i just make copy of my narcotic sheets ...........

[starbin, BSN, RN]

the orders on the mar cannot be changed....they need to coincide with the md's original order.

can you not trace back to the order?

once you see the md wrote for 1 percocet and the mar states 2, the whole order needs to be rewritten to its' original intent.

if you feel that certain, and your DON isn't doing anything, you can make an anonymous report to the BON.

leslie

You are absolutely right. there was difference in the MD's order and the MAR after this girl changed it...but still....they said they don't have enough proof to write this girl up for med error.....I had even made copies of that MAR and narcotics sheets and the physician's order..and gave it to DON,,she said she will personally investigate it.....

[Lacie, BSN, RN]

Well I dont believe that's true regarding surveyors etc. Yes someone from the BON and possible the state would come to investigate and review records. Part of any investigation would involve this but that they stay is incorrect. I've had to report staff to the BON when working in administration and as a NCM. Hated to do but there was significant evidence to show cause. Possibly the facility itself has something to hide and doesnt want someone snooping around. If you feel nothing is being done then you can anomynously report the information to the BON yourself. Every state I believe has a system in place for this. The investigators want to get thier info and move on as they have so many other complaints to deal with they dont have the time to spend months over one complaint in one single institution.

[tddowney]

the DON had told that if they report such issues to the BON, the representatives from BON and the state department of health will come to the facility everyday,,and sometimes they even continue to do it for six months...u can imagine how much of stress it is for the administration...surveyors in the building for six months.....I think this is the main reason they are turning their deaf ear to this issue....I told mysef, mind your business.... shut my mouth up. These days..whenever i see her name in my floor..i just make copy of my narcotic sheets ...........

This doesn't smell right. Most state BONs don't have the kind of staffing to be able to commit people for six months to one facility and one investigation.

As others have noted, this is not a rare problem.

Someone is trying to pull the wool over your eyes, methinks.

[nurseangel47]

I would very rapidly document everything you've just typed in your post to us. Detailed accuracy with dates, times, witnesses, everything. And then make copies for your own records. Then call the board of nursing for your state. Do not even worry so much about the D.O.N. at the facility. If she wants to cover up something like diversion, or favor someone and sweep potential drug use/abuse under the carpet, it's her orifice that's also on the line. Do not get swept up into this potential pile of dynamite. Hold onto your license and integrity. If you're onto the game, you're just as guilty as the wrongdoer and pill popper that the person in question obviously is.

Call the state posthaste. Good luck and keep us posted.

[TazziRN, RN]

BONs do not investigate facilities when a complaint is filed against a nurse for things like diverting. They investigate the nurse. The investigator might come and interview someone at the facility, but only in relation to the nurse accused, not about the facility itself.

[27YearRN]

At one of my state nurses association meetings a few years ago I learned that there are persons hired by BON's to be "fake patients", they occupy a hospital bed and the nurse presumed to be diverting takes care of them. WOW. I'd be a little nervous if I was diverting...