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 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.
I am trying very hard to put this behind me. I have not spoken about it to anybody at work, that is why I posted it here.
I did NOT want to believe this pt. Based on her background and all the other issues she's had on the floor, I really think she is manipulative. But that's just MY opinion.
It's a case of her word against the nurse's word. I didnt want to tell my preceptor the issue, but I knew I had to because the pt was making a big deal out of it. Besides, I attempted to look in the trashcan FIRST for empty wrappers before I even mentioned anything to my preceptor. I atleast wanted to come with some PROOF that my coworker was being accused of something she didnt do. My preceptor got the nurse manager involved because the pt was requesting to speak with a higher up.
This is very hard for me, because it was MY pt, and the coworker was just offering to help out, now she's being thrown under the bus.
But I'm thinking if the nurse is innocent, then nothing will come of it. If she is diverting, hopefully, she'll get the help she needs.
OP, you did everything right. Don't lose a moments sleep over this. You threw no one under a bus and you didn't disrespect your patient. This whole issue is unfortunately a dark side of nursing. Pt's lie, (addict or not) and some nurses divert. We're all human, accept it and move on.
But anyhow, continue being kind and respectful and you'll do well. I hope your next shift is much more uneventful!
Just let the nurse manager deal with it from this point forward. You didnt do anything wrong. Hang in there. However, I wouldnt discuss this with coworkers if at all possible.
I am not sure what to believe here....I can honestly see it going EITHER way. I've dealt with drug seekers that lie, but so many things on the nurse's end seem too convenient. Maybe I missed it, but how did she know the pt was due for OxyContin? And why was the PRN given early? Why were they taken out at the same time, if she hadn't gone in to the patient's room first?
Sounds fishy, from both sides. I would love to know the outcome.
Here is what I learned from this post.....If a coworker is trying to help me out by giving a med that I have another hour to give, I should say 'thanks, but no thanks',
Another thing is that if something like this happens follow the same route as the op.
I've known nurses that were drug addicts that quit their job because they were caught diverting narcs. I've also known addicts that think nothing of taking 12 Vicodin at one time consistently. I may not know a whole lot, but I do know that an addict will try to get over on you every chance they get if they think they can. Giving the med in front of your preceptor was wise.
I am not sure what to believe here....I can honestly see it going EITHER way. I've dealt with drug seekers that lie, but so many things on the nurse's end seem too convenient. Maybe I missed it, but how did she know the pt was due for OxyContin? And why was the PRN given early? Why were they taken out at the same time, if she hadn't gone in to the patient's room first?
Sounds fishy, from both sides. I would love to know the outcome.
What I understood fromt he original post was that the other nurse had been in the room with the OP when she tried to get the Oxycodone out of the Pyxis to begin with (and told the OP that she needed to go to another Pyxis for it), so she knew that it was due.
My question is, why did she also take the Percocet out at the same time? And was she going to take the Percocets at home, so her drug screen at the time would be negative...or was she diverting for someone else, maybe even selling the pills? (Sorry, I know I'm going a bit nuts here, but my inner city nurse is taking over for a few minutes. I'm just saying that a negative drug screen doesn't necessarily prove everything.)
It would be wonderful if no one was lying, but unfortunately, someone is. And I hope, hope, hope it's not the nurse. Or if it is, I pray that she receives help!
What I understood fromt he original post was that the other nurse had been in the room with the OP when she tried to get the Oxycodone out of the Pyxis to begin with (and told the OP that she needed to go to another Pyxis for it), so she knew that it was due.
My question is, why did she also take the Percocet out at the same time? And was she going to take the Percocets at home, so her drug screen at the time would be negative...or was she diverting for someone else, maybe even selling the pills? (Sorry, I know I'm going a bit nuts here, but my inner city nurse is taking over for a few minutes. I'm just saying that a negative drug screen doesn't necessarily prove everything.)
It would be wonderful if no one was lying, but unfortunately, someone is. And I hope, hope, hope it's not the nurse. Or if it is, I pray that she receives help!
Naomi Grace RN
Still strikes me as odd....when I see a coworker who has a crisis with a patient, or is behind in general due to several factors, the question I ask is, "Is there anything I can do for you?" I let THEM decide what would be helpful, but it hanging a med, or whatever. The specifics of it DO make me wonder, although I sincerely hope that I am wrong here.
Specializes in acute rehab, med surg, LTC, peds, home c.
I will give the nurse the benefit of the doubt but this does sound suspicious. Why would she take it upon herself to give the percocet and give it too early. Our pixis has a screen that pops up if you try to give a prn even 5 minutes earlier than it should be that says "It is been less than enough time to give this med" or something to that affect.
On the other hand, I was once framed by an agency nurse for steeling needles (of all things). It was an agency nurse at a ltc facility I worked at. I didn't know her and I had counted by myself that morning b/c she was late. When it came time to count the syringes (believe it or not they count them in some places) we were missing several. We later found them hidden in a pts drawer. I dont know if she wanted them for iv drug use or was just trying to make me look bad. Anybody that knows me knows I am not a drug user so it wasn't that I was in danger of loosing my job but I did get written up for not locking my med cart.
I would be very careful in dealing with this nurse, never leave yourself vulnerable to her again.
Still strikes me as odd....when I see a coworker who has a crisis with a patient, or is behind in general due to several factors, the question I ask is, "Is there anything I can do for you?" I let THEM decide what would be helpful, but it hanging a med, or whatever. The specifics of it DO make me wonder, although I sincerely hope that I am wrong here.
Exactly. I came back to add what you just stated. Thanks for doing it for me! :)
Well, I go in tonight, so we'll see how this all pans out.
I've been checking my email, and so far nothing from the higher ups.
It is still striking me as somewhat odd that the nurse pulled the PRN's on her own accord. I never ASKED her to do that, so still don't understand why she would take it upon herself to do that. Especially if it was not due at the time.
The lesson I've learned here is to pass MY own meds for my own patients. Also, tighting up my time management so I won't be in a situation like this in the future, although, I thought I was ahead of schedule by attempting to pass meds within a hour early.
Another thing that kinda struck me as odd was the nurse was asking about passing the Oxycontin while I was busy with my crashing pt, and I was getting instructions from my preceptor at the same time. I was overwhelmed with information overload, and she found THAT time to ask me about passing a scheduled med. Again, wasnt the priority to me.
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shoegalRN, RN
1,338 Posts
I am trying very hard to put this behind me. I have not spoken about it to anybody at work, that is why I posted it here.
I did NOT want to believe this pt. Based on her background and all the other issues she's had on the floor, I really think she is manipulative. But that's just MY opinion.
It's a case of her word against the nurse's word. I didnt want to tell my preceptor the issue, but I knew I had to because the pt was making a big deal out of it. Besides, I attempted to look in the trashcan FIRST for empty wrappers before I even mentioned anything to my preceptor. I atleast wanted to come with some PROOF that my coworker was being accused of something she didnt do. My preceptor got the nurse manager involved because the pt was requesting to speak with a higher up.
This is very hard for me, because it was MY pt, and the coworker was just offering to help out, now she's being thrown under the bus.
But I'm thinking if the nurse is innocent, then nothing will come of it. If she is diverting, hopefully, she'll get the help she needs.