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Narc count question

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by tybutler74 tybutler74 (New) New

I am a new LPN @ 5 months working for an agency (did home care for 1 year before the agency)- I worked last Friday and I had 2 carts, both with narcs- I counted off each cart w/ a different nurse and they both accepted the count and signed and took the keys. Well, when one of the nurses was getting off and counted w/ the next nurse, there was a narc missing. She told the office that I was in a big hurry to leave work Friday, and that I shoved the narc book in her hand and I counted the cards. She is trying to imply that I was acting shady and took this med and tried to speed up the narc count so she wouldn't notice. Now they are trying to say my narc count was invalid because I should have counted the sheets and the oncoming nurse should have counted the meds. I go out of my way to be extra polite to other nurses because 1) I am a new nurse and respect those w/ more experience than me and 2) I am a visitor in their facility, they know the policies and regulations better than me. I always ask the oncoming nurse "Do you want the book or the cart?" because I didn't know it had to be counted a certain way, because to me, each nurse should look at both the book and the pills to ensure a correct count. I am ESPICALLY careful w my narcs because I am agency, and I know how easy it is for nurses to blame the agency nurse for mistakes. I have a meeting at 10 am tomorrow @ this. I am livid. Does it matter who counts what? And isn't this out of my hands because she accepted the count?

Also is this slanderous? I can prove that I wasn't rushing out of there. After I handed both keys over I went to the central station because the oncoming nurse needed a med that was kept in central supply. I picked it up for her and dropped it off to her to help her out. This is not the med in question, it was a med that was in our cart. But this proves I was in no hurry to leave! Plus, I believe I placed a call to my home from the nurses station so if it comes to it and I have to hire an attorney I can hopefully get phone records pulled proving I was there about for about 15 min after I was off the cart. Please, any advice would be great.

peacefulpeach

Specializes in PACU & NICU.

Hi,

I hope your meeting today went well. I have only worked for one place of employment in my time as a nurse. But I do know that it is always important to see in writing for yourself what the policy is concerning what ever nursing procedure we have to complete as nurses.

I know what you mean about being new and attempting to fit in with staff. What sort of orientation did you have and certainly the manager covered issues like this (smile)?

I think that the nurses that accepted the count are at fault if there was a mix up with the count. Did both of you sign the count? How does the unit handle signing off? What does your agency representatives think about this situation?

And in reference to the notation of slander.......unfortunately, I think that some people in nursing are quick to make statements that can not be backed by factual events. Many nurses seem to make this mistake and I do think that sometimes slander is a good word to describe the conversations.

Well, I hope your today was better than yesterday.

In my history it has never mattered which nurse did which task, as long as the count was done by one on-coming and one off-going nurse. If she accepted the keys, then that means she verified the count, no matter which of the two roles she took on during the count. You might want to point this out during the meeting. Also mention the phone call, that's easily verified.

most of the places i worked at the oncoming nurse counted the meds and the offgoing did the book..

however she did accept the count and the keys and therefore the mistake was on her watch

first lesson that a newbie learns..everyone covers their behind n matter who they have to hang out to dry

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

?????? You know, I keep seeing threads like this about people getting blamed for narcotic discrepancies AFTER the nurse following them counted with them and signed off on the count. Seems to me that once the following nurse signs off on the narc count, it becomes *COMPLETELY* out of the hands of the nurse that they followed and counted with!

Geez....

Thank you all for your responces..I am never oriented to any facility I go to, it's pretty much wing it once you get there. I am so angry about this!!! Also, the med was not reported missing until 10 pm, and I had worked from 6a-6p that day...the med was found missing 4 HOURS AFTER I LEFT THE BUILDING!! This is so absurd that I even have to go to this damn meeting tomorrow, and I will not be compensated for my time. (i.e., not paid!!!) I also let the agency I work for let me know that I felt that my job should be behind me, and stand up for me. I need to find a regular job!! I love working for the agency but agency nurses get dumped on always. I never realized how much bs comes with being a nurse!!!

Hope I can hack it, cauz this is enough to drive anyone crazy!@!

I feel my reputation is on the line all the time.

How do you handle the pressure?

P.S. I am going to take a recorder with me to the meeting so I have a record of all that is said so that if I need to, I can hire an attorney and have proof of all that was said.

most of the places i worked at the oncoming nurse counted the meds and the offgoing did the book..

however she did accept the count and the keys and therefore the mistake was on her watch

first lesson that a newbie learns..everyone covers their behind n matter who they have to hang out to dry

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

I go out of my way to be extra polite to other nurses because 1) I am a new nurse and respect those w/ more experience than me and 2) I am a visitor in their facility, they know the policies and regulations better than me.
Unfortunately, many experienced nurses do not fall into the stereotype of the "honest angel," and they will perceive your extra politeness as foolishness. Always be assertive, so that these types of nurses will not run over you in the future. After all, you are not accepting these agency assignments for the purpose of making friends with these nurses.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

If you are not getting paid for it why go? Put your statement in writing, including what you've said here. Request their narcotic counting policy, and request a written reply. Give a copy to your agency and have the letter registered and sent to the facility. The accusation is indefensible, call their bluff and tell them that if they continue to make such slanderous statements you will speak to a lawyer and look into charging them criminally. Go offensive- not defensive- so they dare not besmirch your good name. If you really feel tough, demand a written apology to the agency and you. If anything they have said or done causes you to lose your job you could collect damages, and so could the agency.

Man, so rarely are you completely in the right, and your opponent is completely in the wrong. Relish it, kick their hind end, then tell them to turn around so you can stick their narc sheet up their ugly butts!

catslave

Specializes in LTC/SNF. Has 5 years experience.

I've always counted the cards at the beginning of the shift and the book at the end of the shift, however I always observe both the cards and the book at narc count, making sure the nurse I count with signs the book when narc count is completed. I've had some oncoming nurses say they'll sign later and that's not cool with me.

bill4745, RN

Specializes in ICU, ER. Has 15 years experience.

I've always counted the actual meds if I was incoming, and also looked at the sheets as well for the count.. Seeems to be a better way to CYA.

Oncoming gets the narcs, offgoing the book. Period. And if SHE came up short it is HER problem. NOT the shift before. Period.

Good luck, but stand firm: Drugs and sheets agreed. We signed off. There was no error on MY shift.

Elektra6, ASN, BSN, RN

Specializes in Home Health, LTC, subacute. Has 16 years experience.

A nurse who'd been burned taught me to count the bingo cards at the start of my shift being careful to look at the SHEETS as well. I don't care if it takes longer. Although she was burned by a nurse who took out Percocet and put Extra-Strength Tylenol in the bingo card and taped it. That would be hard to notice on shift change. That's why I don't tape in meds on the bingo card. I would rather waste them or give them out of sequence.

gentlegiver, ASN, LPN, RN

Specializes in Geriatrics.

I've always counted the cards at the beginning of the shift and the book at the end of the shift, however I always observe both the cards and the book at narc count, making sure the nurse I count with signs the book when narc count is completed. I've had some oncoming nurses say they'll sign later and that's not cool with me.

That's the way I do it too, I make sure they look at the page to ensure they see the number & drug I read off is the same as the one they are looking at. As for signing, after we finish the count I open to the page for sign off, sign it, then hand it to the nurse taking the book along with my pen if necessary. I don't leave until they sign off.

My pet peeve is when I come on shift and they read the narcs off then sign and say "Oh Yah, there are some Narcs in the fridge, check them later, I gotta get going", trust me, I don't sign until I check the fridge and have them look up the info in the Narc Book. Ticks them off when thier in a rush but I believe in the "CYA" principal

indigo girl

Specializes in Too many to list.

If they are going to make you come in to talk to them about it, then I think you should contact an attorney. I have never heard of any facility doing this before, and I have worked in many thru several agencies. Canoehead may be correct about not going. I would get legal advice. You may think it looks bad, but saying the wrong thing could look worse. Reschedule that appointment if you feel that you must go, but talk to an attorney first.

Just remember that the oncoming nurse signed the book. To me that means that she accepted the count as being correct.

In the future, when you count, if you are going off shift, then you get the book in most places.

Let the oncoming nurse view each page, and you both agree that what is in the drawer is what is on the page. That is the safest way to count. If they do it a different way, then you both should still be viewing those pages together.

Good luck, and be careful. Being an agency nurse, you are always going to have to prove yourself to everyone.

i agree w/canoehead.

this is total bunk.

regardless of how count was done, the other nurse accepted it and signed the book.

imo, the burden is on her to defend her actions.

i always cross-check the book count against the card.

i've had a couple nurses who have tried to pull a fast one in the past.

but regarding your situation, there isn't anything to discuss.

count was accepted as such, and the other nurse was in error if she signed, not being sure.

she has the explaining to do.

don't let anyone put this on you.

best of everything.

leslie

thank you all so much! I went to the meeting and it went very well. It became very clear to those investigating what truely happened. Thanks everyone

LuvWounds

Specializes in ENT, NH LTAC, WOUND CARE.

Let me tell you that once she excepted the keys and signed the book its on her. If you took or didn't take the narc she excepted the keys and now its her responsibility, not yours.

Usuually the out goiing nurse will have the book and the incoming will have the pills to count. Depening on where you work the way its done varies. Where I work I count the cart by myself and so do the other nurses unless you don't know or trust the person. If for some reason the nurse forgot to sign for a narc you will just flag it for that nurse to sign. But I will tell you that you can not trust every nurse. Nurses are said to be the biggest drug abusers, because they have acess.

Rule of thumb ALWAYS CYOA= cover your own A_ _

Do remeber in it all narcs are a federal offense. Remeber all the time, money and sacrafices you put into becoming a nurses and not let anyone jepordize your license.

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