Ok, here's the story. I just need a different set of eyes and point of views regarding this issue.
I work nights and I am a new grad. I am in a new grad residency program and in orientation in the SICU. I was assigned two pts, one of the pts I had the previous night.
This particular pt is something else. First off, she has a hx of IV drug use and was in the ICU d/t a kidney biospy. She was a transfer from the floor. She argued with my preceptor and I most of the night over the "pain management". According to notes from the floor, she will go to the bathroom for about "30 minutes" and then come out with a small bag full of syringes that was not given at the hospital. This pt also has several bruising and needle marks on her lower legs bilaterally that she claims another facility caused by attempting IV starts.
Well, this night I got the pt, I got report from the day nurse who said an order was entered to change her Percocet to 15 mgs PRN q 6 h. He gave her the 15 mg of Percocet at approximately 1600. She was also SCHEDULED for Oxycontin 80 mg at 2100. Well, it was about 2030, and I was getting ready to get her scheduled oxycontin out of the pysis. We have an hour before and after schedule med is due to give the med. I wanted to be somewhat ahead of schedule just in case something happened (ie other pt crashing).
I go to the med room to get the oxycontin. There was another nurse in there at the time. I pulled up my pt's name and her med profile and her oxycontin was grayed out. I asked the other nurse what that meant and she said I would have to go to another pysis to get the oxycontin. I said ok and exited out. As I was on my way to the other pysis, my other patient started crashing. I ran into the room and my preceptor was already there. The other nurse asked me if I wanted her to get the oxycontin for my other patient, I said yes as I'm trying to get oxygen on my crashing patient.
Fastforward to an hour later, I go into my other pt's room and she asked me for her 15 mg of Percocet. I look at the MAR and the nurse who gave her the 80 mg of Oxycontin charted that she also gave her the 15 mg of Percocet AT THE SAME TIME! I advised the patient of this. The pt stated "I never seen that nurse before in my life and she came in her and gave me my 80 mg of Oxycontin, the green pill. She never gave me the 15 mg of Percocet, which are white pills and it would have been 3 of them. She only gave me one pill".
So, I told my preceptor what happened. We checked the pysis and sure enough, the Percocet and Oxycontin were pulled out at the same time under my co-worker's ID. The patient states she knew she couldnt have her Percocet until after 2100, and she would have asked for it. The pt also states the nurse did not have a med cup, she opened the 80 mg of Oxycontin and gave it to her in her hand. My first reaction was to check the trash for open wrappers, but the housekeeping lady had already dumped the trash.
My preceptor went to the other nurse and asked her what happened. It was a totally different story. The other nurse said that she gave all 4 pills to the patient and asked for her pain score which the pt replied it was a 9/10. The preceptor had no choice but to go to the nurse manager because the pt started throwing a fit about the Percocet not being given. The nurse manager interviewed the pt, who told her the same thing she told me.
We had to call the pt's doctor and advise him of what happened, and then override the Percocet and give it to the pt. I gave it and then keep the wrappers for myself. I charted that I gave them and made sure my preceptor was in the room at the time.
I was also interviewed by the nurse manager and I had to send something in writing about this whole incident. So did my preceptor. The nurse involved also had to take a drug test. I don't know who to believe. I feel so bad because it was my patient. What do you all think? I'm only hoping the patient was proven to be a liar. Is that wrong?
I think a few of you are far too judgmental towards drug addicts and need to take a step back. A few of you could also re-educate yourselves about narcotics and pain management.
You can't just pick a side here. You just can't. You were not there. You do not know the nurse's history. You do not know the patient. You don't know anything. Picking sides based on a he said she said story just screams bad judgment.
You are right, I WAS there, and I don't know either one personally. All I know is that it was my pt's word against a nurse's word.
I personally did not ask this nurse to pass my med, she OFFERED, which is something the nurse manager wanted to be clear about. In my opinion, this pt could have waited to get her scheduled pain med. I still had an hour to get her the pain med, it was NOT the priority to me.
Had it been me, I would have OFFERED to take a drug test right there on the spot, and then demanded an apology from management and the pt herself. Maybe the pt took advantage of the situation of a different nurse passing her med and saw it as an opportunity to get more meds, or maybe the nurse took advantage of a drug addict's pain because she knew nobody would believe her, I don't know.
All I know is that this is a serious accusation, and someone license could be on the line.
Sorry OP, I didn't mean YOU made her take a drug test. My point was it was insulting that she was made to take a drug test, after a druggie said she hadn't gotten her fix.
Honestly, i'm pretty much positive the patient took all 4 pills, and then when you came back in, said she didn't get the PRNs, and she ultimately got you to give her a double dose of it. The fact that you made the float nurse take a drug test is insulting. To make it worse, she had to take a drug test because a drug addict said so. Drug addicts will tell you ANYTHING to get more than what they can have, and in thise case, the patient won. I can't believe anyone, including the Nurse Manager of all people, would think that the patient had any credibility at all. Giving a scheduled narc and a prn narc at the same time to a drug addict isn't going to do much, unless the doses of each were insanely high. So the part of giving them together really isn't of concern. It WOULD be a concern if you giving them to an 80 year old nun that has chocolate milk in her system as the most toxic substance.
And who cares that a drug addict knows exactly what pills she gets - the woman is a drug addict and drug addicts will LIE and get anyone in trouble in order to get their fix.
How on earth can you be positive of ANYTHING in this situation, you were not even there. You dont know the patient nor do you know the nurse. Its insane to always accuse the addict just because they are an addict. Thats just wrong. Some nurses are addicts too, and determining WHO is an addict is tricky. I would put money on it that there is a huge possibility that you work with at least one addict and dont even know it. The odds are there.
Yes addicts will lie to get what they want....including addict nurses. Im not assuming the nurse in this situation is an addict, but it IS a possibility. And if it had been me being accused of it, I would go to any length to prove my innocence, including a drug screen. However, who is to say that this nurse isnt diverting to SELL it, rather than consume it. There is no way to know. A drug test will only prove her innocence from CONSUMING the drug. It will NOT prove she didnt take it from the patient to sell it.
Drug addicts do tell the truth as well as lie.
And its a matter of opinion as to if the two drugs should be given together or not, it depends on the pain rating and circumstance and diagnosis, etc. And if it wasnt time to give it, then they should NOT have been given together regardless.
And it is the nurse manager's responsibility to follow up on any complaint from a patient, including an addict, especially when it involves narcs.
Your post really concerns me. I hope you dont treat your addict patients with the attitude you just exhibited on here. They do have pain too, and it takes more meds for them because of the tolerance they have built from consuming so many drugs. They do lie, but you still have to treat them with respect, just as your other patients.
Honestly, i'm pretty much positive the patient took all 4 pills, and then when you came back in, said she didn't get the PRNs, and she ultimately got you to give her a double dose of it. The fact that you made the float nurse take a drug test is insulting. To make it worse, she had to take a drug test because a drug addict said so. Drug addicts will tell you ANYTHING to get more than what they can have, and in thise case, the patient won. I can't believe anyone, including the Nurse Manager of all people, would think that the patient had any credibility at all. Giving a scheduled narc and a prn narc at the same time to a drug addict isn't going to do much, unless the doses of each were insanely high. So the part of giving them together really isn't of concern. It WOULD be a concern if you giving them to an 80 year old nun that has chocolate milk in her system as the most toxic substance.
And who cares that a drug addict knows exactly what pills she gets - the woman is a drug addict and drug addicts will LIE and get anyone in trouble in order to get their fix.
I hope pt's with addictions are never subjected to your judgmental attitude.
Specializes in psych, addictions, hospice, education.
I'm going to be devil's advocate here. Let's pretend both the patient and the nurse in question are addicts. Would you prefer to believe the nurse over the patient? Or, let's pretend neither is an addict. Would you choose to believe the nurse over the addict? What about patient advocacy?
Sorry, but I don't believe a word an active drug addict says. If you want to believe them, then fine, you go do that and see how fast they screw you over. I also love the "I hope youre never MY nurse" responses. Pathetic. Maybe in your land of faires and unicorns a drug addict is trustworthy, but not in my world. I side on the side of the nurse UNLESS it is proven otherwise. This particular case seems so easy: an active druggie exhibiting bizarre behavior. The patient lied. It's as clear as my butt is fat.
I think a few of you are far too judgmental towards drug addicts and need to take a step back. A few of you could also re-educate yourselves about narcotics and pain management.
You can't just pick a side here. You just can't. You were not there. You do not know the nurse's history. You do not know the patient. You don't know anything. Picking sides based on a he said she said story just screams bad judgment.
As far as I am cncerned one of the biggest problems I have encountered in nursing is other nurses' willingness to throw one another under the bus.
I don't know if you were addressing me, but no matter. I know plenty about junkies and addiction.
Unless it is proven that the nurse in question is lying I believe her over the patient. I certainly may pick a side. It's the other nurse.
I think you did everything that you need to, and yes, the nurse manager gets paid the big bucks to get to the bottom of this. But, like someone else said, I believe that a nurse can be an addict, and I also believe that patient's with a known history of drug abuse, do tell the truth at times, and they are not as hairy-scary as some might have you believe.
Also, I just want to caution you about making too much of this. As you said, you are new. You are still on a straight upwards learning curve. New nurses want to do the right thing and earn the respect of their more experienced coworkers. I would say, do your best to put this behind you. If this nurse, is in fact, diverting, her truth will come out in its time. And, the patient, if she was lying, it was probably not the first time. If any more comes of this, I might wonder if anyone looked into the patient's past issues and how much she has demonstrated drug seeking, running out of scripts too soon, involvement with the law regarding drugs, etc.
Sorry, but I don't believe a word an active drug addict says. If you want to believe them, then fine, you go do that and see how fast they screw you over. I also love the "I hope youre never MY nurse" responses. Pathetic. Maybe in your land of faires and unicorns a drug addict is trustworthy, but not in my world. I side on the side of the nurse UNLESS it is proven otherwise. This particular case seems so easy: an active druggie exhibiting bizarre behavior. The patient lied. It's as clear as my butt is fat.
I never said an addict is trustworthy, but just because someone has a history of not telling the truth doesn't mean that they are ALWAYS lying. Yes, even when it comes to narcotics they claim they didn't receive. In this case I think it's probably more likely that the pt saw and took an opportunity to get a double-dose. But to bang the gavel without proof--on an online forum no less--shows a limited point of view. One of the most difficult things to wrap your head around as a health care provider is the strength of an addict's preoccupation and compulsion to get their drug. It is not a personal offense against the provider (or anyone the addict lies to), and addicts do not inherently have malicious intentions. They don't consider consequences, which is a major part of their disease. Often to get from point A (no drug) to point B (drug acquisition) they screw people over--friends and strangers alike. If it was possible to prove that the OP's pt was a scammer (which, unfortunately, it's not), I think the best course would be to level with her. Even without proof, you might get somewhere with a conversation. For example, straight up telling the patient that a nurse's livelihood is at stake due to this incident might appeal to the person, and not the addict. Any action an addict can take that reveals her inner-person is an action that can provide hope for recovery.
Last I checked, fairies and unicorns were mythological creatures. People with good hearts and minds who also happen to be addicted to drugs are real, however.
Oh, and there is nothing pathetic about any nurse on this board hoping that you keep your distance from patients with substance abuse disorders.
shoegalRN, RN
1,338 Posts
You are right, I WAS there, and I don't know either one personally. All I know is that it was my pt's word against a nurse's word.
I personally did not ask this nurse to pass my med, she OFFERED, which is something the nurse manager wanted to be clear about. In my opinion, this pt could have waited to get her scheduled pain med. I still had an hour to get her the pain med, it was NOT the priority to me.
Had it been me, I would have OFFERED to take a drug test right there on the spot, and then demanded an apology from management and the pt herself. Maybe the pt took advantage of the situation of a different nurse passing her med and saw it as an opportunity to get more meds, or maybe the nurse took advantage of a drug addict's pain because she knew nobody would believe her, I don't know.
All I know is that this is a serious accusation, and someone license could be on the line.