Narc count

[dubspot]

I am a 8 month old new RN. I have a question about the "narc count". I work at a nursing home/rehab center. I usually work the 7-3 shift, and 9 times out of 10 the 3-11 nurse is always 15-20 minutes late. This is one particular nurse that is always late, and she typically works on the same days that I do. Giving her report plus counting the narcs usually take 20+ minutes. At 3:15 I gave up waiting for this particular nurse, so the other RN on the same shift and myself completed the narc count as we were waiting for the incoming nurse. I got a call the day after this event saying that I may get a written warning for counting with a day shift nurse instead of the incoming nurse. my question is, if the narc count was correct, no meds were missing, and the incoming nurse SIGNED the narc log saying that she counted with me.. can i really be written up for this?

[MoopleRN]

If the incoming late nurse singed she counted and didn't and your name is there...it's a problem

Yes and no it's a problem. The problem for the incoming nurse is if she signed it was correct and it later on proved not to be, it's on her. OTOH, if the count later on was incorrect, there will be an investigation that may include the 7-3 nurse who doesn't need that hassle... CYA!

[tyvin, BSN, RN]

It's a problem. I don't want anyone counting my narcs...period. It's true, I don't trust anyone with the narcs but myself (been there, done that). The problem is, you haven't done anything to get this late nurse to be responsible to show up on time. Write an incident report next time, or write her up; have you even talked to this nurse about her behavior? This is business not pleasure and if she's showing up late why isn't management doing something (how does she sign in and not be caught coming in 20 minutes late all the time?

[amoLucia]

I'd bet the freq tardy nurse has a daytime job that she's leaving and just getting to you guys when she does.

Thank you Moople for seeing my point!

[toomuchbaloney]

I read the OP to state that the count was being completed and signed by two day shift nurses, not that the second shift (tardy) nurse was signing a count she didn't participate in.

This is a really good question and it appears that you have followed the specifics of the policy. The drugs are controlled, secured, and amounts verified by two professionals.

Now you are faced with two problems, management which is expecting something that is not specified in policy/procedure and a peer who is disrespecting you and your time.

Please meet with your manager, bring a copy of the policy and prepare to discuss the need to document appropriately and in a timely fashion regarding the "narcotics". Ask his/her assistance in resolving your problem. Discover if the shift to shift count is required or simply an example of "we've always done it this way". The oncoming nurse has no standing to demand that she be allowed to accomplish the count unless she is willing to be available at the beginning of her scheduled shift to complete it. Make the manager aware that the unexplained and persistent tardiness is interfering with your ability to complete your shift in a timely fashion. Perhaps you could record your report for the oncoming nurse?

Good luck.

[dubspot]

today I met with the DON and she is doing an "investigation" of this matter. I really need some reassurance now from you guys. Here are the facts, the 3-11 nurse and I both signed the narcotic log, and all of the narcotics are there (there are no discrepancies in any of the meds). my DON is now calling this "falsifying documentation". can my job/license be in jeopardy? I would understand if some of the meds were missing.. and I do take responsibility for not following "protocol" and counting with the other nurse. but I think this is just getting out of hand, like they are just digging for a reason to fire me

[lmccrn62, MSN, RN]

You didn't follow the policy. Two are suppose to count at the same time. The 3-11 nurse late or not should have never signed if she didn't count. You have opened yourself to a problem. Never think narcotic counting isn't a big deal you might end up in legal mess.

[toomuchbaloney]

Why didn't the nurse who counted with you sign the document?

Why would the tardy nurse sign something she didn't even witness much less participate in?

What the heck were you thinking?

today I met with the DON and she is doing an "investigation" of this matter. I really need some reassurance now from you guys.

Unless I'm misunderstanding (and the nurse signed the log *without* having actually counted with you), no false reassurance to be found here... you deviated from the accepted practice and you may face consequences...

Here are the facts, the 3-11 nurse and I both signed the narcotic log, and all of the narcotics are there (there are no discrepancies in any of the meds). my DON is now calling this "falsifying documentation".

I don't think it's falsifying documentation unless the documentation or written policy specifies *who* must sign the count. Still, you did not follow the standard facility practice...

can my job/license be in jeopardy?

Job, yes... particularly if you're an at-will employee. License, probably not unless there is evidence of willful fraud or theft.

I would understand if some of the meds were missing..

It's a big deal even if there are no discrepancies because the structure is in place to track controlled substances and the DEA takes that stuff *very* seriously... and more so all the time. If an audit were to reveal poor tracking, there could be serious repercussions to the facility.

Don't downplay this.

and I do take responsibility for not following "protocol"

In what way do you take responsibility? Your closing words in this post communicate to me that you don't *really* take responsibility and that you're trying to justify doing something that you know that you should not have done.

but I think this is just getting out of hand, like they are just digging for a reason to fire me

I don't think it's getting out of hand... narcs are a big deal... even before they go missing.

Diversion and theft are huge problems and the protocols and policies, written and "tribal knowledge," exist to help mitigate them.

I doubt they're "digging for a reason to fire" you; terminating at-will employees is very easy and requires no "digging." I think they're seriously concerned about your judgment.

[tyvin, BSN, RN]

ooh....this is why I was stern with you about the narc count. It's very serious business. I hope the investigation takes into account you are the one who pointed the finger (so to speak) aren't you? If I were you I would take the day in question and all events after along with these posts and start a serious journal. Is your place union...if so call them. Also, how many times you can pinpoint on a calender that the nurse was late and the narc count was done wrong. If you go into work look at the sheet (if they haven't taken it away) and confirm your dates...write it all down just in case you need to defend yourself.

Hang in there; you're new and everyone makes mistakes. You were only trying to rectify it by asking advice on here when you should have been directed to your charge, which you were, but now this...

We've all been where you are at some time or other in our careers...

[amoLucia]

If you have your own malpractice insurance, now would be the time to give them a call to ask their guidance.

[lub dub]

It is accepted practice that oncoming & offgoing shifts count narcotics together. While the 3-11 nurse who signed was very wrong for signing off on a count that she never did, you are also in the wrong for essentially signing off on the fact that you counted with that 3-11 nurse. Best of luck to you.

[toomuchbaloney]

"We've all been where you are at some time or other in our careers..."

I have made mistakes, I have made patients, peers, and employers angry. I have been fired.

I have never participated in the behavior that the OP has described. I have never been complicit in an RN signing something which they didn't do, particularly as related to something as sensitive as narcotic counts and documentation.