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?

[Big Blondie, ASN, BSN, MSN, APRN]

MYOB.

[JKL33]

On 6/8/2019 at 6:26 PM, rx3500 said:

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 ridiculous.

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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.

Yes, well none of that is what the OP has posted about.

This discussion is about timely charting and proper trails. But it's good to know that you are able to sleuth out those who might not have all their ducks in a row on paper (or electronically, as the case may be), whether they are diverting or not. ?

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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.

As far as the various estimates that have been published, nurses are affected by SA problems at a rate very similar to or less than the general population. I don't even know what the above quote of yours means. It sounds like random pontificating. It's easy for middle-schoolers and well, practically everyone to get their hands on drugs. As far as I'm concerned I have at least as much (or more) reason not to as anyone, too.

You don't seem to have any concept of the idea that the grand majority (??? I don't know - - 90+ percent?) of nurses don't have anything to do with this [and yes, that is an estimate based on various published figures of approx 10% problem with SA].

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I conduct audits with the controlled substance board every month and we are constantly finding suspicious activity.

Well obviously that is to be expected that when you are reviewing the activity of 3K people - - but I still have to ask: What is meant by "suspicious activity?" Is all of this activity that is subsequently proven to be diversion?

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As a nurse you are responsible for the patients, and if you are having such strong suspicions about this, your assumptions could be true.

Come on. This is not okay. What kind of knowledgeable statement is that? "Your assumptions could be true"....??? The people who investigate everyone else could be diverting, too - - "it's always the ones you don't suspect!" - - right? I'm sorry, IMHO it is not okay for you to come here and talk this way. You sound like someone whose knowledge of one particular tool is contributing to tunnel vision.

Beliefs like those reinforce my personal decision to maintain a very low index of suspicion with regard to my coworkers. As in, I will never report anyone without hard/significant proof or clearly alarming behavior (which may be medical in nature, for all I would know/"assume" at the time). I have no moral obligation to suspect everyone around me, because here is my observation/"experience": There are usually ***FAR*** more likely reasons than diversion that your reports don't look perfect. (Namely staffing and people running their as*es off).

There's a current thread elsewhere with yet another new grad in an unfortunate situation: S/he has forgotten a controlled substance in a patient's locked drawer and didn't remember to take proper care of it before leaving work and having days off. Why. Because the day got "hectic." Chances are, s/he's not going to return to work days later and find that medication in the locked drawer. >>>> "Suspicious activity." S/he took out a controlled substance and never documented giving it and never returned or wasted it and now it's (likely) gone.

People can say that if someone has done nothing wrong then s/he has nothing to worry about - - but you don't get to decide that. Besides, it isn't even true to begin with.

**

To the OP. I get why you have taken note of this. But, since I know patients sometimes or even frequently do things like a) say they haven't seen the doctor when the doctor just walked out of their room after fully interviewing and assessing them b) add more allergies to their list right after you've just administered a medication c) tell the nurse one problem/complaint/reason for visit and then almost immediately tell the doctor either a completely different version of the same or something just totally different d) say "no one has checked on me for 2 hours" when I myself have stuck my head in the room or even walked in to check on them half a dozen times or more....

....I would need more time to make observations in order to decide what to do about this. I'm not saying your patients were lying, but if even a couple of them were wrong about what they thought had gone on, your "problem" instantly doesn't appear the way it does right now.

[NurseBlaq]

On 6/6/2019 at 10:20 AM, HRCRN said:

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.

Is it one patient or multiple patients? I ask because I've seen patients get pain meds and say they didn't to get more or because they didn't like the nurse and wanted to create conflict for her. Crazy but true.

Nevertheless, you know this person and how your unit works. If it bothers you that much, call the report line. Just be sure your suspicions are valid because you could ruin that person's livelihood.

[FeliciaRNCPN]

I was accused on diverting due to some erratic behavior and one inappropriate phone call made during my time off to my manager. It was absolutely warranted.

I had some issues with alcohol at the time. I was aware but scared and it was getting out of control.

I was confronted only days later by my manager and HR. They had run all my pharmacy records full of things not scanned in and the like. They found alcohol and my own prescription medication (which was a controlled substance) in my system. My work was sloppy at best at the time because I was constantly hungover. I was cleared for any concerns regarding diversion and given pay for the time it took to have the results of the screen back. The screen was considered negative because I had an up to date prescription for xanax.

They had me get help for my issues with alcohol and I was able to return to work after a period of sobriety.

I don't like to share this because it was a very shameful experience.

The moral of my story is that I needed help desperately and without this happening in my life I would be in the same place (probably worse).

If this nurse is diverting, yes, it may destroy her career but diverting narcotics can lead you to a worse fate.

Today I'm not drinking or taking xanax and finally gotten control of my anxiety and depression issues.

[rx3500]

Pharmacy per say doesn't run audits, it's done by the PSM or persons allocated to do so. It is fact that not every transaction will be audited, and in this case unless they talk to the patient nothing will show proof of anything because the med scan to the chart shows the narcotic trail. But believe me when I say, processes of verifying patient administration are in the works, including witness verification of administered narcotics to patients. Especially because of the opioid problem . It is to easy for nursing/providers to divert pain meds and chart them accordingly, and assume because they are charted they were given. In the end the person will be caught. I found a nurse whom was stealing antidepressants, a med that is not generally on any radar, but was found and the nurse reprimanded nonetheless. Never assume anything.

[JKL33]

21 hours ago, rx3500 said:

But believe me when I say, processes of verifying patient administration are in the works, including witness verification of administered narcotics to patients.

Make sure you advocate that this is a second RN, and that this RN needs to be present for the entire process of removing the medication from the ADC, all the way to physically administering it to the patient and properly documenting it.

That way we won't end up with another inane process that proves absolutely zero nothing, like our current electronic waste documentation where nurses can summon passer-by coworkers to witness the waste of an unknown substance. Any hospital narcotic police worth their salt would recommend that all medication processes involving controlled substances should be attended and witnessed by a second RN.

??