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.
in our facility we can only borrow a narcotic if the supervisor does not have any in the back up and the supervisor has to approve. meaning i sign out the narcotic from patient A to give to patient B and the supervisor signs with me. it's our policy though. other facilities i have worked at frown upon borrowing no matter how badly the patient needs it. it just depends on where you work and what the in house rules are.
And facility policy is not going to protect your license.
"now i have a question...when you "borrow" a medication from patient a to use on patient b do you ask patient a's permission? borrowing anything without permission is theft. those meds don't belong to you or the facility, they aren't yours to borrow or lend."
you must be an excellent nurse always finishing the med pass on time and always in compliance.
i do what i am comfortable with as long as i know it's safe for my patients. i will take the risk as i know many many nurses do the same thing in my facility. if it puts my patients on jeopardy then i will not do it.
can you imagine if i make waves now after working in that facility for almost 4 years now? especially in this economy. no thank you i need my job to pay my bills.
thank you for posting though because now i know there is at least one person who doesn't borrow and always in compliance with the med pass in ltc. i know many many nurses who work in ltc and they borrow and not always in compliance with the 1 hour window.
and also to add, i have not borrowed in a long time because now i took it upon myself to order all the medications in my cart when they are due even though it was originally assigned to 11-7 shift. the last time i borrowed was metformin when i had a new admission and when the pharmacy delivered all the meds that night, i put the 1 metformin pill back.
to repeat, i know i am not supposed to borrow but i have to do what i gotta do. i don't have access to the pyxis in my facility. only the supervisor has access and sometimes you have to wait for a while because the supervisor is in chagre of two buildings with 400-500 patients.
i won't wait for the metformin that was supposed to be given at 4:30pm with supper and give it at like 6pm or 7pm because that's when the supervisor gives it to me.
I am the DON and I can assure you I know how to get things done. I get them done the RIGHT way that not only protects the residents, but YOUR license as well. We don't make the laws but we need to make sure they are followed.
You have to borrow sometimes in LTC but I would not borrow nacotics without permission. i would have told the nursing supervisor to be productive and get the narc from the ebox instead of telling me mr. x is in pain for 30 min while I was dissolving a possible incident with residents. What a lot of nurses do not realize is that it should be a TEAM effort to provide proper nursing care.
I had my ADON tell me the other day that "borrowing" was technically stealing. So I said to her "would you like me to hold the med? I will" and then she said "No thats not what I am saying, they need there meds" She wants me to while Im doing my med pass to get on the phone with the pharmacy and manually re-order the meds. I replied: " I have a 2 hour window to pass meds to 38 residents, and then I have 3 dressing changes, 2 g-tubes, and 10 finger-sticks, every min counts so I cannot do that" You should have seen her face she had nothing to say and acted like it was the first time she heard of such a thing.
Ok here's my chance to learn something new. Why is borrowing a bad thing? Does it make it harder to catch a true diversion of meds? Does it wrongfully charge another pt for the med? I can see it could cause an inadvertant dosage error, but otherwise, why not take the easiest path?
"ok here's my chance to learn something new. why is borrowing a bad thing? does it make it harder to catch a true diversion of meds? does it wrongfully charge another pt for the med? i can see it could cause an inadvertant dosage error, but otherwise, why not take the easiest path?"
like what i said i don't borrow narcotics so i am not worried about that. when i borrowed the metformin, i followed the 6 rights of drug administration: right patient, right drug, right dose, right time, right route, and right documentation.
we do "share" some stock meds in my facility, such as, tylenol, mylanta, mom, aspirin, etc...so i don't see the difference. narcotics is different because you count how many are left and signed your full signature.
My best friend is in NS...he's going to be great (of course I'm biased because I think he's great) and he had a homework question just like this.
He went through lots of different scenarios and I can't remember all of them but we did make a 'real world in a bad job market' scenario.....we said "maybe the nurse would be terminiated because the the DON had a friend that needed a job". That's not what he turned in as his answer (I'm not sure what his final answer was) but after reading through the posts I'm wondering...do you think our 'joke' scenario (or rather bad joke) is possible?
Possible, yes- but there has to be documentation by the facility that there were actual problems; how severe these problems are can be very varied. But yeah- there is favoritism out there.
"and yes, i worked ltc/snf/sub-acute for years. i never borrowed a drug. never."
when was the last time you worked ltc? what year? never borrowed even colace, vitamin c, and mvi? i commend you then!
did you also finish your med pass within the 1 hour before and after window all the time? if you go over 1 minute the allowed window, did you write medication error report? i hope so!
i would like to know where you worked and how many patients you had on a shift? maybe i can apply there. i work 3-11 shift and have 25 patients with 5 gtubes, 6 fsbs, 1 trach, 6 wound dressings, and very heavy med pass (average meds 10-15 per patient). i am always out of compliance with the 1 hour window and yes management knows about it and they never make me write a medication error report for lateness because i would be writing like 10 every day.
the ltc i have worked have stock meds for the non prescription items, no need to borrow. there is a big difference breaking a policy ( being late with meds) and breaking a federal law. that being said, i think they wanted this nurse out.
Wow. I suggest your LPN friend go and take her NCLEX and work somewhere where she does not have to make these awful priority ethical decisions on her own. She may always be able to represent herself within the nurse practice act........and show that a reasonable person working with the same license in the same capacity would do the same thing. Although that is so nebulous as well! Maybe the LPN could have filed an incident report right away on herself so all others would understand her aims were humanitarian and necessary at the time....done without remorse or shame. I still think the DON just doesn't like her. I have seen far too many lousy nurses retained because they knew how to kiss *&%. oxoxox again
But yeah- there is favoritism out there. 
kids
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And facility policy is not going to protect your license.
'House rules' don't matter.
State laws don't matter.
It's a FEDERAL law your facility is telling you that it's ok to break. http://law.justia.com/cfr/title21/21-4.0.1.1.15.html
Are they going to pay your bills when you don't have a license or go to jail?