I really want to do the right thing and I need help!

[HRCRN]

Hi all,

I’m not even sure if I’m posting in the right thread. I made this account so I could make this post, because I’m so torn up about how to deal with my suspicions of a coworker diverting narcotics.

I am a relatively new RN with 3 years of experience and this nurse has been a mentor to me throughout my career. She is kind, does a wonderful job, has over 20 years of experience and just received a prestigious achievement award at our hospital. I strongly suspect she is stealing opiates from patients.

We work on a busy med-surg unit where 99% of staff works 12 hour shifts. This nurse is one of the few who, because she works part time and has a lot of seniority, has been grandfathered in to 8 hour shifts. So there have been multiple occasions where I take some of her patients at 1500. A few months ago I started to notice something unusual. After getting report from her and going in to see my new patient for meds and assessments, I would ask them about pain and tell them I saw on the chart that they had taken oral opiates earlier In the day, and ask if they needed more. They would swear up and down that they hadn’t been taking anything, or anything stronger than Tylenol, for pain. But there it was in the chart scanned in as administered. I trusted that the patients were with it and telling the truth, and it always made sense what they were saying because they looked great and didn’t have pain. It didn’t happen every time, of course, but it happened 4 or 5 times to the point where I noticed the pattern. Other things that stood out to me were that often the opiates documented as administered would be the ONLY time it looked like the patient received them during their stay-so one would think that the patient would be in extra pain and would remember taking something but instead they are emphatically denying both taking the meds and having any pain. I believe that this nurse is just scanning the meds in as if they are administered while in the room giving AM meds to the patient, but then pocketing the pain meds. The fact that they are always scanned at the same time as the morning med pass fits with this.

Ok so I was feeling like, this is just a strong suspicion, this has no real basis, and this nurse has NEVER been impaired at work so who am I to meddle when I have no real proof? Then a few weeks ago I saw a couple times she did it with IV Dilaudid. I don’t know if she has been taking IV opiates for a long time and I just didn’t see it or if this is new but I saw it twice in a week and for me this just crosses a line and really makes me very concerned. I called the anonymous third party reporting line last week and started to file a report, but halfway through I chickened out because I thought, do I owe it to her to confront her and give her the opportunity to self report? I really like her as a coworker and friend, she has a kid she just sent to college—it just feels so wrong for me to tattle on her! On the other hand, I cannot afford to be retaliated against at work and I have no idea what would happen or where it would go if I just talked to her about it, especially because I have no real evidence. She’s not my superior or anything but working there as long as she has I honestly don’t know who might come to her aid at my expense and I have to protect myself. However, on the phone call they informed me that although it’s technically anonymous my name may come out in the course of an investigation. Which would be horrible but I think it’s unlikely in this case. And that’s truly all I want is for someone to look closely at it and do an investigation. I’m not saying I know exactly what’s going on.

I’ve only told my husband about this and he’s tired of hearing me go back and forth...it’s time to make a decision and stick to it. What do I do?

[Emergent, RN]

I went through this. What I was advised to do was talk to the head of pharmacy. I did this by phone.

Pharmacy can run additional monitoring through the dispensing machines. They watched the fellow I suspected and he was confronted a couple of months later.

From your description, your friend is most likely diverting in my opinion. The fellow I tattled on is doing well, working for another hospital as an IV therapist.

I totally know how you feel, I went through a lot of conflict about it as well!

[Emergent, RN]

Here's a thread I started on this very subject.

[rn1965, ADN]

Talk to your nursing supervisor. Let her know your suspicions and tell her you are concerned for the safety of the nurse.

I can tell you, as an alcoholic, the one way she may get help is because she will fear losing her license.

Once you talk to the supervisor, let them take it from there. It may not seem the wheels are turning, but they are.

Also, you can check with your state BON, or one of the many CE classes, and they will likely tell you the same thing.

Good luck and I am glad you are looking out for a fellow nurse and all the patients.

[amoLucia]

One thing to consider is that the nurse may NOT be using the meds herself, but she may be selling them to others for the money. You comment that she has a college age child - that says tuition costs to me.

I can understand your position and hesitancy. But you are a mandated reporter. It is NOT your responsibility to conduct an investigation, but merely to report your suspicions to an appropriate source. They will followup.

Your employer may just NOT be aware of the discrepancies that you've noted. Sometimes it takes a NEW pair of eyes to see what you have. As long as you're acting 'in good faith' when you proceed.

Personally, I would go thru reporting to a third party Pharmacy as PP Emergent suggests. No emotional familiarity ties to cloud the situation. Your DOH could also investigate as they have Pharmacy on the their team.

Right now, it looks like pts are OK safe, but that could change. And if your coworker has a problem with using herself, you will be helping her in the long run. You title that 'you really want to do the right thing', so reporting is the right thing.

Good luck to you and hopefully for your coworker.

[Rdsrn]

Unless she is stealing massive amounts of drugs she isnt paying anyones tuition..i doubt shes selling small amount of medications, putting her license at risk to make a few dollars. It sounds like she is taking the medication herself and probably truly has a problem with opiates, in which case she is going to take risks in order to feed her addiction. Pharmacy can see the medications are being scanned it properly but they dont get to talk to the patients to inquire about whether they were given the meds. They can be helpful in picking up on trends such as the fact that her patients only get pain medication when she is there. But even still i would talk to the nurse manager and there are things they can start to look out for..such as purposely giving her patients with certain meds, monitoring her wasting, or they may do an investigation and then bring it to her when they have enough evidence. At that point they can either let her self report, or report her and press charges. I was diverting medications for a short time and i am very thankful that i was caught and able to get clean, even if it means being in monitoring and receiving criminal charges...at least i like the person i see in the mirror today.

[Persephone Paige, ADN]

No good deed goes unpunished... I would drop an anonymous note in the mailbox of the head pharmacist, as someone suggested. Make sure the complaint can't be traced back to you. You would be surprised the things that long term coworkers are willing to overlook, no matter how wrong. And keep yourself safe with documentation...

[Workitinurfava, BSN, RN]

You have no solid proof, but you can report. You could be right but you could be wrong. Be prepared for both outcomes. This type of thing should be completely anonymous so that the nurse doesn't find out that you reported her, especially because if you are wrong idk. I hope the hospital protects your privacy so you aren't targeted, which can happen. From my understanding supervisors and managers are now suppose to be the 2nd to know of this. There should be a direct reporting line.

[Randomnurse3]

I’m going to be the odd ball and say if you don’t have solid proof then I don’t think you should report. You cannot be the only nurse that follows behind this nurse. Why hasn’t anyone else noticed. I get the whole fresh eyes thing but you aren’t positive if she is stealing the medication. What if you are wrong and put her entire career on hold and in jeopardy? Would you really want to do that just based on a hunch or feeling you have? Also you stated you noticed it with oral medication at first and after a while you noticed it with IV medication. You stated that IV meds crossed the line with you. Why are IV narcs more of a concern for you than oral narcs? If you really felt it was wrong why wait until you notice IV narcs being given. I’m not in anyway attacking you. Its just an observation in your post that I thought was odd.

[catsmeow1972, BSN, RN]

2 hours ago, Randomnurse3 said:

I’m going to be the odd ball and say if you don’t have solid proof then I don’t think you should report. You cannot be the only nurse that follows behind this nurse. Why hasn’t anyone else noticed. I get the whole fresh eyes thing but you aren’t positive if she is stealing the medication. What if you are wrong and put her entire career on hold and in jeopardy? Would you really want to do that just based on a hunch or feeling you have? Also you stated you noticed it with oral medication at first and after a while you noticed it with IV medication. You stated that IV meds crossed the line with you. Why are IV narcs more of a concern for you than oral narcs? If you really felt it was wrong why wait until you notice IV narcs being given. I’m not in anyway attacking you. Its just an observation in your post that I thought was odd.

I have been watching this thread and musing about the same thing. In years past, due to some physical health issues, I spent entirely too much time sitting in a hospital bed and got to know some of my nurses quite well. Some were more aggressive with pain control measures than others. With a few, the assessment questions were asked, I’d say, nah, I’m good and that was that. Other times, ehhh...so-So, PT was coming around and that walk down the hall was killing me...and then there were times that I swear Q4, PRN was interpreted as Q4 because with a gut full of staples, I was just fine. My point being, if that nurse is erring on the aggressive side with some of her patients and as you say “this doesn’t happen every time.”? Plus, others also follow behind you? I am not a floor nurse, but I am pretty sure pharmacy runs random audits on people’s PYXIS usage. You report her based on nothing more than a ‘hunch’ , she gets audited, even if they find nothing out of the ordinary, many places work off the ‘better safe than sorry’ angle and she gets reported to whatever your state’s program is and then have to spend a metric ton of money to prove there isn’t a problem.

Coming from the side of having been inappropriately forced into this mess, I promise you, unless I had more concrete evidence or knew that a patient was being harmed, I could not in good conscience do that to a person. Just my opinion.

[HRCRN]

Of course I don’t want to put someone’s career in jeopardy, on the other hand it really upsets me to think about someone possibly stealing from patients. IV medication crosses a line for me because IF this nurse is using these medications that definitely indicates a higher level of abuse. I don’t think anyone would argue that if someone is shooting heroine they have the same level of addiction as someone who takes the occasional hydrocodone for back pain. If you’ve already achieved that level of tolerance you’re going to continue to escalate. I really don’t know what the right thing to do is, that’s why I’m asking for advice. I know that this pattern of behavior is odd, I trust my gut and it doesn’t come from a place of judgment. I want there to be an investigation, but I’m also not naive enough to think that if this nurse is not stealing medication that her career and license would be safe after an investigation. I know that a suspicion alone could ruin her career.

[HRCRN]

Also I want to add, there would be no reason for pharmacy to audit this nurse for her behavior. She withdraws the medication, she scans it into the chart. The only suspicious thing is that the patient says they didn’t take anything.