Narcotic diversion, but not to self

[LowPaidNurse21]

I would like your opinion in this matter that happened to a friend of mine recently who is a LPN. Disciplinary action was metered out to her and her employment terminated because she was acused of diverting narcotics, but not for personal use.

All the web searching about narcotic diversion related to diverting for personal use. According to my friend she was working on a very heavy sub acute unit and the normal procedure for ordering stat medication for new admissions who havent yet received their medication from the pharmacy was to generate a one time order so that one can be taken from the Emergency box in the nursing office and that order is used to fax to the pharmacy so they can replenish that pill taken from the e-box.

Whilst on the unit she was in the process of processing the admission orders for 3 new admissions on her shift and 1 new admission that came in 30 min prior her shift begining at 3pm. While imputing the orders for the admissions she saw 3 residents in a verbal dispute 2 of them are mentally alert and were confronting the third who is not mentally alert to time, person or place. The third who is in a wheelchair because she was not able to bear her weight and prone to falls attempted to stand from the wheelchair while attatched to a lap belt, she also attempted to push the wheelchair backwards when the brake was initiated and her chair doesnt have anti-tippers attatched and may fall head first backwards in the wheelchair. The nurse upon seeing what was going on and what can happen, stopped what she was doing to quell the situation and prevent a potential incident. The nurse whilest in the process of removing the third resident was confronted by the nursing supervisor on duty and was told that mr. X was ringing the call bell for the past 30 min asking for a pain medication. The nurse not being able to immediately go to the nursing office to get a pill from the e-box gave mr. X a narcotic pain med which is ordered for him btw same dose same everything (hes one of the new admission) from another resident blister pack , mr. Y ,who was due in 30 min. The nurse generated a one time stat order for mr. X to replace that pill taken from mr. Y to give to mr. Y in 30 min. since hes is on a standing order every 8 hrs. The nurse while in the process of now getting that pill to replace the one given told the nurse supervisor what she did and the nurse supervisor said that she diverted narcotics and disciplinary action had to be taken against her. This ultimately lead to her being terminated....aka asked to resign in lieu of termination for narcotic diversion-not to self but to another resident for which the same medication is ordered. Not to mention that the resident who was given the pill initially refused it asking for an injectable. My friend said that she had to do some 'patient teaching' that his purpose in a sub acure rehab is to gradually be weaned off the heavy formulation that is used in hospitals and acute care settings. This eventually led to him accepting the medication and then told that its every 4 hr so he is entitled to another in 4 hrs for breakthrough pain and in 2 hrs tylenol could be given as per doctors orders.

My friend now feels that nursing is a thankless job and that its like saving somone from burning building only to save them and you yourself die. All parties in the scenario live to see another day and be pain free and the nurse is the one left to bite the bullet. Not to mention that on that day she completed the admission orders for 3 new admissions and did 16 hrs while doing her job for 55 residents on a sub acute / long term care unit.

Nursing is more paper than people, you spend more time writing to cover your ass than take care of people. Not to mention that everyone wants to sue your ass and the very people you are taking care off think of you as their personal butler. And each of them want you to be there at their beck and call as soon as the call bell goes off.

[agldragonRN]

that is not narcotic diversion. that is called "borrowing". i know we are not supposed to "borrow" but if you go to the pyxis for every single med that is not there, you'll be passing meds all day. this is the reality of ltc. i personally would not "borrow" narcotic because it is counted and needs to be accounted for.

your friend was being resourceful but got burned. why was she terminated right away? no warning or suspension first?

eta: in my per diem job, borrowing narcotic is even allowed by the don. you just put the patient's name on somebody's narcotic sheet and sign. i cannot do that in my full-time job because the don does not allow it.

[rainfallrx]

I know that borrowing is wrong. I also know what its like to be busy and wanting to make your patient comfortable as soon as possible. I don't believe there was intent to do anything unethical at all. In my opinion, she was wrongfully terminated! If anything, a verbal warning or coaching would have been sufficiant. Good nurses get punished too and its a shame! Sorry for your friend!

[StrwbryblndRN]

I am sorry. Borrowing seemed like right thing to do at the time.

"Nursing is more paper than people"...Exactly. Sad though it is.

[NeedchangeofPace]

This post has an awful lot of detailed info for a friend....just saying

[locolorenzo22, BSN, RN]

Regardless, she should NOT have given medication from another resident's pack and simply asked the supervisor if she could get the med from the ebox for that 1x dose use, or help her settle down the out of control residents? It is not a diversion to give a medication that was ordered for somebody else to another patient if the drug is the same and you have orders. You borrow it if you HAVE to, and replace it in blister pack when the other one comes up. sometimes nursing is tough, and you can't get to things as quickly as you'd like. it sucks, but it's the profession.

[OldNurseEducator]

This post has an awful lot of detailed info for a friend....just saying

My thoughts exactly!:)

[Esme12, ASN, BSN, RN]

Whilst I was reading this, I too was struck by your personal knowledge of the situation. I am sorry your friend is experiencing this....nursing is a thankless job. I am curious if there is a policy at her facility about "borrowing" patient drugs and what that policy says. If the policy says that you cannot then they are perfectly within their right to terminate her. Most policies state "disciplinary action up to and including termination"....which give facilities plenty of leeway. New York is an "at will" employment state which means they can fore you if they don't like your hair.

I am not so sure I would have resigned......I might have let them run with the ball and see where it took me while sought legal counsel. I know borrowing meds is common but I would not have borrowed a narcotic. Today's mentality of automatically guilty is scary and best to be avoided at all costs. I will say I have seen more innocent nurses make some poor decisions (decisions a diverter would never make"knowing how" NOT to get caught) and get run in the ground for diversion as the real diverters go free. Which again is why all practicing nurses should carry malpractice insurance as it will help you protect your license.

Your friend should talk to a lawyer as she may have a wrongful termination suit as this is not diversion. But it maybe misuse or improper use of a narcotic....still a reason to be terminated. It stinks but it's the facts.

I hope your friend feels better and finds another job soon...Good luck

[Whispera, MSN, RN]

It seems you or your friend did what you thought was right at the time, and you did your best to keep all your patients comfortable and safe.

I think it's possible you chose the wrong course of action however. It seems that to go back to the nursing office to get the medication from the e-box would have taken no more time (given all the paperwork that needs to be done for both scenarios, and also considering you had to convince the patient to take the medication) than what you actually did. Also, doing it the way you did adds confusion to the whole process. I had trouble keeping it straight, and wonder if you did too? Most people might, especially in the busy environment you describe.

Yes, we borrow from one patient's medications for another patient's needs. It can get complicated! It's not diversion, but if it's not in policy, we get in trouble for it. I don't think it called for firing. Nurses are needed. Most facilities don't fire for a first offense since that means they'll have to hire someone new and orient her or overburden the other staff. They do "counseling" and watch the nurse closely.

I don't think malpractice insurance covers what happened to you. I believe it only helps if a patient files a malpractice or neglect suit against you. Lawyers are expensive, and out of the budget of most people. Consider contacting a legal aid service if there's one near where you live, if you think you have a case. Most law schools have them so students, who are often quite sharp, can get experience. In the meantime, you could consider talking to your manager, the director of nursing, or the person who runs the facility about all of this. What do you have to lose?

I wish you or your friend luck and peace in this, and hope it works out for you. It's a rough, rough situation and falls hugely into the "if it can go wrong it will" pile-o-trouble!

[CVmursenary]

wow that is ridiculous, the DON must not no how to get things done as an RN

[Mom2boysRN]

I won't borrow narcotics, but no this isn't diversion. Everyone got what was prescribed to them.

[SuesquatchRN, BSN, RN]

The DON wanted this nurse gone. Period. And found a way to get rid of her.