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?
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.
A patient saying they didn’t take a medication is not proof enough for me to make a report. There are all sorts of reasons why a patient might forget they had medication. Anonymous or not. If she is in fact innocent, then we are not only talking about possibly ruining her career but also her reputation. Once the board is involved they will assume she is guilty. Period! Her name, credentials, years invested, and prestigious awards will carry no weight. And stealing pills is just as bad as stealing IV meds when it comes to this. I have a feeling this is going to come back and bite you in the butt. Nothing is Anonymous when it comes to things like this. If they want to know who filed the complaint, they will find out.
Yeah there are no secrets in the land of nursing. Somebody will find out if you come forward. I agree with Random, a bunch of patients saying they didn't get their meds doesn't really prove anything. Further, she has never been impaired at you that you have seen? Personally, I would let the managers and pharmacists do their jobs and concentrate on taking care of the patients in my care. Know this the mere allegation of this kind of thing is enough to ruin your friend's life. Proof is completely optional in the land of monitoring programs
Multiple patients saying they didnt get pain meds and the fact that they hadnt been getting them before plus them being scanned in with morning meds. Yeah i was diverting and did all that. I would hate to see someone put in monitoring that was innocent too but when someone gets a complaint they usually dont have evidence at that time. Thats why they investigate. Thats a tough call because I can see both sides. But i just know what i did and the red flags are there based off what you described.
I am thinking that with narcotic usage being soooo tightly controlled now (we used to see people getting whomping doses and nothing else when now we see smaller doses matched with other better therapies) one of the things an audit might look for is timing of removal of controlled substances vs time charted/given. If there is a pattern of narcs consistently being given with morning med pass, yes that would be a red flag. I’m not justifying what you might think is questionable behavior but realize that what might just be her work flow (assess then bring PRNs with med pass) but it is also a pattern that is best proven by pharmacy audit as opposed to a general “hunch.” If you feel you must do something, an anonymous report to pharmacy is probably the best. They run their audit. Nothing throws up flags and life goes on. Rather than risk possibly ruining someone’s life, let those who know what to look for do their job. You do that, you’ve done your due diligence and move on. Worry about your patients and your patient care, on your shift.
I wouldn't report it unless you're 100% sure. Like you mention, you could destroy her career, life and so on. It sucks that your patients might not be getting their pain medicine but they'll be okay. I know I am more on top of pain medications than some nurses I work with. It probably looks like I give more. Plus, if they're in therapy during the day, it's probably warranted that they give it frequently in the AM. Plus you mentioned that you haven't seen her impaired. I'd imagine she'd seem impaired if she had an iv med but who knows. Sorry you're in this position.
Specializes in Pharmacy, ADC ( automated dispensing cabinet).
Hello, I am a pyxis manager at a major facility, and manage and monitor 80+ stations and over 3,000 users. I work with the hospitals narcotic investigation team and continually run reports to assess signs of diversion. Your story seems classic to what I see often. Wether it be late charting or no charting at all and no trail of were the pulled meds have disappeared to. I definitely understand the fear of reprisal, but you should consider the harm she could be causing herself or someone else. As a nurse you are responsible for the patients, and if you are having such strong suspicions about this, your assumptions could be true. I conduct audits with the controlled substance board every month and we are constantly finding suspicious activity. If the nurse is doing what she is supposed to, she has nothing to worry about. I guess what I'm getting to is that the percentage of nurse/provider diversion is significant in my experience because it is to easy to do so. I think you have a responsibility to report your suspicions.
Specializes in Pharmacy, ADC ( automated dispensing cabinet).
I'd like to add that her not seeming impaired does not equate to her not taking the meds for personal use. There are functional alcoholics as well as drug users, and they show no signs at all, especially with long term use.
Hello, I am a pyxis manager at a major facility, and manage and monitor 80+ stations and over 3,000 users. I work with the hospitals narcotic investigation team and continually run reports to assess signs of diversion. Your story seems classic to what I see often. Wether it be late charting or no charting at all and no trail of were the pulled meds have disappeared to. I definitely understand the fear of reprisal, but you should consider the harm she could be causing herself or someone else. As a nurse you are responsible for the patients, and if you are having such strong suspicions about this, your assumptions could be true. I conduct audits with the controlled substance board every month and we are constantly finding suspicious activity. If the nurse is doing what she is supposed to, she has nothing to worry about. I guess what I'm getting to is that the percentage of nurse/provider diversion is significant in my experience because it is to easy to do so. I think you have a responsibility to report your suspicions.
This is precisely my point. Let the pharmacy folks do their jobs. They know what to look for and if they choose to take action, it’s because they have enough reasonable suspicion, beyond a ‘hunch.’
If this person is diverting then it will hopefully get her the help she needs and if not, there will be ample evidence to protect her from accusations made by people who don’t realize how badly this can ruin a person.
My suggestion is to Make an anonymous report to pharmacy and go back to concentrating on your patients.
If you make an anonymous report make sure it can’t be traced to you. Don’t use company email or tell anybody face to face. I don’t know about your hospital but there is no such thing as anonymous where I work. Print it using a common font and mail it would be my suggestion from a mailbox away from your home. Most importantly tell nobody and don’t get drawn into any discussions when the allegations start as nobody really trusts someone who tells on another coworker. I guess this is an unfortunate fact but from what I’ve seen a fact nonetheless
I can talk from being on the receiving end of things, being falsely accused of using and then also having diverted in a different period where I was not caught. This actually really does sound like diverting behavior and there are absolutely ways pharmacy and administration can investigate this. Easiest way to report anonymously is to either hand write a note for the person in charge of the pharmacy and send it intercompany mail. You could also create a burner email account and email them.
They can look into the records retrospectively. They can monitor records moving forward. They can even drug test the patients who denied EVER taking anything to see if they have any of the drug they are denying in their system. They can do a for cause drug screen on the nurse; if she has scripts for the specific oral and IV narcs in question, she could get away with it, but if she is taking a variety of narcs, this would be unlikely for her to fudge.
When I was falsely accused, I was taken to employee health and had to immediately pee while observed. That screen was fully negative, because I was not taking anything at all, diverted or otherwise. Also, a peer of mine was accused of smelling of alcohol and had to immediately drop and test; her screen was negative too including alcohol, and she returned to work as soon as the results showed negative. Now, if one can still be fired if your behavior is off or your work is suffering, like I was, because I was having a mental health issue that affected my work, and while drugs and alcohol were nor the cause, I was still fired. My peer was neither fired nor disciplined, because her behavior and work were fine, someone just thought she smelled wrong.
But having diverted in the past and was ironically never caught for that, I can say this is diverting behavior. Reporting alone won't get her fired; it will get her an investigation by the hospital. The results of the investigation will determine if she gets fired. It sounds like her behavior at work is fine, so if she is cleared, she will likely be fine employment-wise. Perhaps one patient saying they did not get a med would be one thing, but if multiple people are saying this, an investigation will likely show that this is a pattern...that she is frequently the only nurse giving narcs to patients who otherwise do not take narcs.
I think reporting is a good idea. Again. A report alone won't get her fired if the investigation shows nothing amuck. I've been falsely accused and cleared of it, and I've seen others falsely accused and cleared of it.
Specializes in Psych, Addictions, SOL (Student of Life).
I differ somewhat from other's here because I was an impaired nurse. Now I never stole meds from the hospital but I was a functional alcoholic (at least I thought I was functional) until a fellow nurse confronted me for "seeming off" I went home that night after almost 30 years of drinking (Started in my early teens) and attempted to take my life. Someone/thing was watching over me however and my husband found me in time to save my life. I went through the whole impaired nurse program for five years cost me close to $50,000.00 not including lost wages for that time, but today I am happy sober and free.
I am thankful for the nurse that confronted me (She later died from an opiate overdose so I guess it takes one to know one) . Bottom line is that even though and accusation can have lethal consequences we have a duty to our profession to make these things known. I support talking to the nurse directly/privately and if that doesn't work go to management. You might not see the results you want right away but the wheels will be turning.
Randomnurse3
169 Posts
A patient saying they didn’t take a medication is not proof enough for me to make a report. There are all sorts of reasons why a patient might forget they had medication. Anonymous or not. If she is in fact innocent, then we are not only talking about possibly ruining her career but also her reputation. Once the board is involved they will assume she is guilty. Period! Her name, credentials, years invested, and prestigious awards will carry no weight. And stealing pills is just as bad as stealing IV meds when it comes to this. I have a feeling this is going to come back and bite you in the butt. Nothing is Anonymous when it comes to things like this. If they want to know who filed the complaint, they will find out.