Is this a matter for the State Board?

Nurses Professionalism

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Sadly, I work with a liar. Everyone knows this coworker is a liar. At least that is what I am told. I have taken the matter to our DON in the past, after watching him/her tell a patient's family member that she did a procedure that, in fact, I had done. She proceeded to answer the family member's questions, as if she really had done the procedure. Of course, she made up those answers, too....and they didn't match up with what really happened.

More recently I watched this coworker tell the doctors lies about how patients are doing with their medications. I witnessed him/her telling the doctor that the patient needed a medication increased because the q4h prn amount ordered wasn't enough. Fact was, the patient was using the q4h prn med approximately q6-8hrs. I even brought this up when we were discussing this with the Doc, but she said, "Oh, no! She's asking for it more than that!" Well, the Doc increase the dosage and changed it to q6h. Two daya later I returned to find the order was back to the lower dosage and q4h. I asked why and was told, by another nurse, that the increased dosage had been too strong for the patient. No surprise to me!!

Now a new scenerio has emerged. The other day I admitted a patient. The following morning the nurse I question told me, "She's really confused!" Now, I know that confusion can come and go, and this person did have a UTI, but there was absolutely no confusion noted upon admission. And she was 10 days into a 14-day course of antibiotics. What with my coworker's track record, I'm having a very difficult time trusting her assessment report. It's almost as if he/she is creating pathologies to rescue, so he/she can be the hero. Unfortunately, I didn't have an opportunity to follow-up and do my own assessment on this patient. I only have a gut feeling that I should beware.

My question is this: if a nurse is telling fictitious information about patients, and those stories involve patient care outcomes, is it a matter that should be reported to the State Board of Nursing? Perhaps there's not enough concrete evidence to go to State....unless a q4h admin record counts. I really don't like confrontations, but I'm concerned.

It may be best to compassionately approach this coworker in my DON's presence just to address these issues, first. Bring it out in the open and see if he/she wants to change ways on his/her own. But, I feel unable to sit and watch this continue. This person even has even been promoted to a Leadership position. It's beyond my understanding that a person in Leadership should behave in these ways. Shouldn't that person be leading by example and possess a quality of character that is admired and respected?

What I have reported here was what I alone have witnessed. What's to say there's more? It's rather scary!! Sadly, I have to work with this person frequently, sharing the same patients. I'm not feeling very good about it, and haven't for quite some time. Anybody have some thoughts on this? Thank you.

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If her comments are specifically related to pain or other controlled substances, I might wonder if she is diverting. look at all the S/S listed to detect a person who is diverting and see how many this person has. here is one such chart Signs and Behaviors of Impaired Colleagues or from Allnurses https://allnurses.com/general-nursing-discussion/this-is-quot-29438.html

If you can check off a lot of them, you might be able to share your concern that way.

If you don't think this is the case, cross your T-s and dot your I's. keep a record of his/her actions and actual statements and try and have wittness available that hears the comments. note the time and who else was within earshot. I not big on sticking my nose in other people's business but if I was uncomfortable with a situation I would be building a CYA notebook if they ever tried to blame anything on me.

I would confront them privately first if I felt comfortable with doing so and her actions were directly causing or risking patient harm. If she was just taking credit for my work or in front of a patient etc I would just ignore it and also do my own assessment if I did not trust his/hers. That is what we are supposed to do anyway.

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southpaw, I'll go right ahead and reject the document in your first link, and I care not who published it.

There is nothing scientific about such a document as far as it's usefulness nor its ability to be used as a reliable tool. It doesn't take even the most basic scientific approach, such as what an evidence-based scoring model would require. It doesn't specify whether these items can be taken individually or should be used collectively. The majority of those "associations" aren't even REMOTELY specific to drug diversion. In fact, "Drugs, syringes, needles improperly stored" - on another thread I delineated EXACTLY how poor staffing and other lack of resources controlled by the employer can and does contribute to such a situation.

So, just NO.

Jimminy effin Christmas. Don't they teach people the general concept of how to make appropriate associations in about 4th grade? At least by junior high?

I'd love to know the specificity. This propaganda is so non-specific that it is nearly useless, and IT IS HURTING PEOPLE. Look around this site.

Yes this makes me "angry". Because I am about as likely to divert drugs as murder someone [slight exaggeration but it conveys my point]. I don't want to be swept up in this crap.

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southpaw, I'll go right ahead and reject the document in your first link, and I care not who published it.

There is nothing scientific about such a document as far as it's usefulness nor its ability to be used as a reliable tool. It doesn't take even the most basic scientific approach, such as what an evidence-based scoring model would require. It doesn't specify whether these items can be taken individually or should be used collectively. The majority of those "associations" aren't even REMOTELY specific to drug diversion. In fact, "Drugs, syringes, needles improperly stored" - on another thread I delineated EXACTLY how poor staffing and other lack of resources controlled by the employer can and does contribute to such a situation.

So, just NO.

Jimminy effin Christmas. Don't they teach people the general concept of how to make appropriate associations in about 4th grade? At least by junior high?

I'd love to know the specificity. This propaganda is so non-specific that it is nearly useless, and IT IS HURTING PEOPLE. Look around this site.

Yes this makes me "angry". Because I am about as likely to divert drugs as murder someone [slight exaggeration but it conveys my point]. I don't want to be swept up in this crap.

Sorry it offended you, was just throwing out an idea and I just did the training module at my work that was entirely dedicated to identifying and reporting deversion. It had a similar list. So obviously its a possibility no matter how remote. The hospital 800+ bed thinks its a big enough deal to require every new hire to complete a module on it. I did look for data on deversion/addiction and found an article that said it affects 20% of practicing nurses. this totally blew me away, but explained why there are so many threads here at AN about people with addiction related BON actions/programs

If I had not just read that module, I probably would not have even mentioned it.

I think the second part of my comment is more likely. I would just keep doing my job and not worry about other people unless they were endangering patients

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It's not a matter of me being offended. It's unscientific BS that I am asking my colleagues to look at more critically.

I too have recently been "educated" about this and while I will not disclose any specifics about my situation I might say that I'm familiar with the size of hospital you mention.

I too did a bit of searching just like you did, after the "education" we received. What I found was BS. I found a lot of statements such as "as many as __%" and "up to __%". That doesn't even BEGIN to address the idea that the big places are starting to conflate "mishandling" with "diversion". So that if an RN is running for 12 hours and forgets to waste a medication, s/he may now be accused of "improper medication handling" or "diversion" or whatever they feel like calling it. You know what, even THAT would be fine, if there was an above-board and ethical/just chain of events by which an innocent RN could be proven innocent of traditional "diversion", and just get back to Nursing without enduring some sort of hellish nightmare.

Therefore, encouraging us to be suspicious of each other and using propaganda to make us think the problem is rampant, is unethical. The fact that this agenda is so unscientific at this point and is being pushed forward anyway, makes me ashamed to be a nurse.

I'm just asking every "thinker" to actually think it through.

And yes, I agree with your last statement. I wouldn't do jack without hard proof.

PS - if you can't think of I reason (other than concern for patients and concern for nurses) that big orgs are addressing this in this manner, I CAN. It's just easier and more financially expeditious for them to scare everybody and call everything diversion and fire everyone who doesn't "handle" a med according to policy FOR WHATEVER REASON, including poor staffing. It's an excellent way to avoid responsibility and let the RN deal with it all alone. Voila. Fire and report to BON. Done.

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.

Back to the OP's question - It sounds as if your coworker is exaggerating and fabricating patients' symptoms. You can inquire of your BON and see if this is a reportable offense. IMO a doctor has written medication orders based upon fabricated information on your colleague's part, so it could certainly be reportable even if no harm was done. I agree with your assessment that this colleague is creating things in his/her mind so that he/she can be the hero. Sounds like some serious psychiatric issues going on, in all honesty.

I am interested in seeing how this turns out.

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I realize this post is close to a month old, but figured I'd thrown my two cents in anyways.

Personally, I would go through the chain of command at the facility before contacting the board. This person could be innocent and you've sicked the board on them for nothing. Talk to this person's supervisors first about your concerns and if they don't investigate, then go to the person above them, and so on and so forth. They may drug test her first.

I'm going to play the devil's advocate and say the "confused patient" could have really been confused because you said you didn't see them, so you don't know for sure. However, you do know that she took credit for your work, but that in itself didn't really harm anyone, even though it is really bizarre.

I would assume you are not the only one to have noticed. Maybe some of your coworkers have witnessed strange behavior as well?

I know all of this puts you in an uncomfortable position. Hopefully this matter will get resolved or has already been resolved.

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