I am a new grad working in a LTC facility. Recently at the facility we have hired new nurses including myself. However since 2 weeks ago when an LPN was hired, narcs have been MISSING. Whenever this new LPN counts narcs with anyone the count is ALWAYS WRONG. She comes in really early to "start" her work and asks' for the keys, before her and I count. I know stupid on my part for thinking you can trust any and everyone.
So today I decided to nip it in the bud I told my D.O.N about the errors, because I have worked to hard to have my license taken away for speculation of stealing drugs. And we came to a conclusion of having a 3 man count instead of just 2 ppl counting the narcs. We have videotapes, so the tapes can be rolled back to see where the drugs are going. I never thought I would be in this situation.
Has anyone else been in the predicament, what did you do? and what was the outcome? PLEASE SHARE WITH ME!!!
In my facility if we waited for an RN to show up for a narc count, then we would never get off. Position has nothing to do with a narc count. I am a LPN and the pharmacy nurse, and all the incoming narcs passed threw my hands. I had the pharmacy tech sign with me. Never turn over your keys with out counting. Addicted nurses prey on others. They are addicts and will lie, cheat, and steal.
Before becoming an RN I had actually worked for a short time doing hospital security. The way to catch RN's who divert narcotics doesn't rely on cameras or signatures (as nurses quite easily get others to sign off a "waste" without ever any real checks). Catching a nurse in the act is both labor intensive and time consuming. No, the way to nail diversion is by statistics, with an admission of guilt by the party involved.
Over time, pharmacy knows how much of each medication is being used by every floor on an average given day. Everything from aspirin to stool softener is inventoried and has certain usage patterns, sort of like your average week's groceries, and can be anticipated. For example say, the use of morphine on a surgical floor may be 62 Grams per day, while on a general medicine floor be 6 Grams per day. This primarily is a reflection of clinical demand, and impacts pharmacy budgets as well as drug security. Insofar as pharmacy is concerned, if the amount of an opiate used on one floor becomes statistically higher, they would then correlate the actual usage against an access schedule (ie whoever had access from that location) as well as clinical type and acuity (if a medicine floor say, boarded fresh post op surgical patients over the days in question).
If it is shown that average opiate usage is higher and there is no clinical reason, or greater use and "wastes" happens whenever nurse X is on duty (but not with other staff); they will then notify hospital security of suspected diversion. The suspect nurse is then brought in for questioning, and not surprisingly (as they're not hardened criminals or lawyers, only drug addicts) usually admit to diversion with one or two simple investigative interviews.
The actual counts, signing and countersigning for drugs is really a system of smoke and mirrors designed to distract a would be thief (a magician practices sleight of hand by directing your attention to one thing while he manipulates something else). To be frank, it doesn't really matter what the count is; nurses are only told to believe that it does. What's really historically interesting about this is, that this was being done way back in the 1980's with pencil and paper, before the widespread use of computers. One can only imagine how much easier it is to check in real time with the inventory tools that the average hospital pharmacy has today.
I am a new grad working in a LTC facility. Recently at the facility we have hired new nurses including myself. However since 2 weeks ago when an LPN was hired, narcs have been MISSING. Whenever this new LPN counts narcs with anyone the count is ALWAYS WRONG. She comes in really early to "start" her work and asks' for the keys, before her and I count. I know stupid on my part for thinking you can trust any and everyone.
So today I decided to nip it in the bud I told my D.O.N about the errors, because I have worked to hard to have my license taken away for speculation of stealing drugs. And we came to a conclusion of having a 3 man count instead of just 2 ppl counting the narcs. We have videotapes, so the tapes can be rolled back to see where the drugs are going. I never thought I would be in this situation.
Has anyone else been in the predicament, what did you do? and what was the outcome? PLEASE SHARE WITH ME!!!
If this count has been wrong for two weeks, why hasnt' someone done something about it? What actions were taken against the previous wrong counts? I'm surprised to hear that the DON doesn't know about it.
And never hand over the keys without counting first. I've always been taught that the drugs must be counted before handing over that responsibility.
When I got my first job as an LPN, 20 years ago, the RN and I shared a cart, and so also the Narc box. Turned out she was dipping into the narcotics. They hadn't hired anyone new in over 10 years, so the I was the main suspect. But, at that time, I didn't know anything was happening. They finally caught her red handed. I was so angry when I found out. Their response was why are you upset about it, the poor nurse has a problem. Nothing as how easy it could have been for me to lose my license because of this nurse sneaking drugs, and making it look like it was me.
When it comes to narc count, trust no one. This has served me for twenty years, and probably another twenty years in the future. It's not in my desire to ever face the DON and explain missing narcs. The count is right, or I call for a supervisor, even if we have to wait for an hour. I won't accept the cart. period, end of story.
A long time ago, when syringes still had non-retractable needles, drug-dispensing pxysis were not in existence, and ANY nurse could take keys....I worked with 2 RNs that were diverting narcs (remember capujects, anyone?)...
by placing the unused carpuject drugs in the used sharps container!! They got away with it for a while (They were PERSONAL FRIENDS OF THE DON of the hospital....and they blamed every other nurse...until I caught them in the act and reported it...that ended the saga of missing narcotics...
I still believe ANY nurse can/should take keys...life working as a nurse is too frenetic (frantic/hectic) to chase one nurse around for keys....let's get real, people...been there - done that - it does NOT WORK!!
Oncoming and offgoing nurse count and offgoing nurse can't leave until All drugs are acounted for, and ongoing nurse does NOT accept an INCORRECT COUNT. Can it be more simple?
What can I say but "ouch!" Nasty situation. You have my sympathies. As other posters have pointed out, if not in so many letters, CYA.
Why? I'm an LPN, I manage my own sub-acture assignment and hold my own narcotic keys. My unit manager is also an LPN. One first shift frequently the only RNs in the buliding are the DON/ADON and some MDS nurses. On the off shifts frequently the only RN in the building is the supervisor. When an RN has a floor position they have the same exact duties and responsibilites as the LPNs working on the floor (we don't do anything in my facility that's not in the LPN scope of practice in my state, i.e. there are no IV pushes).
This is a common state of affairs in my LTC/Sub actute facilities, and is not a situation that is nasty nor is it a situation that requires anyone's sympathies.
In my country, the RN carries the ultimate responsibility for day end and day opening narcotics checks. She/he is also ultimately responsible for the safekeeping of those keys. Regardless of the amazing capabilities of my ENs (Enrolled nurses-your LPN/LVN equivalent) they cannot be held responsible for discrepancies in the drug count. Nor would it be fair to them....it's not in their scope of practice.
Well FYI in *MY* country and in my state it is well within my scope of practice to hold narcotic keys. I'm just as responsible for my narcotic box, the safekeeping and administration of the narcotics as the RNs I work with are. Please don't assume the scope and practices are the same everywhere. It certainly sounds like the OP is in the US in a state where she is working along-side LPNs that are responsible for narcotics.
Well FYI in *MY* country and in my state it is well within my scope of practice to hold narcotic keys. I'm just as responsible for my narcotic box, the safekeeping and administration of the narcotics as the RNs I work with are. Please don't assume the scope and practices are the same everywhere. It certainly sounds like the OP is in the US in a state where she is working along-side LPNs that are responsible for narcotics.
And for yours: I merely state my country's laws and practices. I do not judge your country's laws and practices, merely state for clarification why I made my initial observations. I do not presume to judge.
BTW, everyone, in "MY" country, it is already 2011, so Happy New Year.
I never take control or hand over the keys and the narc log until that count is completed AND accurate. The few occasions that the count has been off, I told the offgoing nurse that I'd wait until the count was resolved or the missing narc was written up.
Under no circumstances should anyone under the rank of RN be carrying the Schedule drug cupboard keys.
I see nothing wrong with an LPN having the narc keys. A licensed nurse whether RN or LPN is held to the same standards. LPN's and RN's equally have been known to divert narcotics.
i was in such a position many years ago as a fresh new green lpn workin nnder a young rn that had been inn the hospital for 8 years, i question her position on a certain matter and she quoted" no other lpn has ever question me in this way ever," need less to say, several narcs came up missing(like 10 percocets on a ob floor, thay only she and i had access to in the narc room since it was only her and i on the floor 7p-7a shift, to make a long story short, i said we were not living this narc room untill house supervisor came to narc room to find the missin percocets and i was about to pick up the phone in the narc room to call him up to the floor, before i could finish dialing the ext. the rn had found the 10 percocets in the trash can, she had apparently throwed them out by mstake without signing them out first and i could not believe what had happeded, i was so scared as a new lpn. i phoned my lpn nursing instructor and asked her advise on how to handle this situation, her reply" turn your notice in today effectively asap, explain what happened to the DON and never look back. The reasoning ny lpn instruction simply stated " she will be out to get you from now on because you question her in a situation and she did not like it. So again my instructor said" who are they gonna believe, someone just started or a rn that's been there for 8 years. So i trusted my lpn instructor and that's why i called her, she had been an rn for 25 years and she stated" sharon there are some viscious nurses out there and you will learn in time. so i did what she said to do and never looked back because i trusted this rn instructor. my question is, does this happen alot in ahospital setting if you make a rn ****** @ you??????
Lovely_RN, MSN
1,122 Posts
Well you know how the saying goes: Fool me once shame on you; fool me twice...bet there won't be a twice right?
Sometimes we have to learn by experience and hopefully you did.