Need Advice... Nurse stealing non-narcotic medication

[JSSCELI]

I am a new nurse and I am not sure exactly what to do regarding this issue. I am about 4 weeks into my first job as an RN and yesterday my preceptor asked me to see if any of my patients had PO Zofran. I asked why and she said that one of the nurses was feeling nauseous. She stated that the nurse she was asking for had asked for PO Phenergan but that she felt better giving her Zofran. I replied by saying "no, none of my patients have PO Zofran". I'm sure I had a funny expression on my face because she followed up with the fact that she frequently took medication like Mucinex or any over the counter medication from patients, reasoning with me by saying "you can get them from the store. So it's okay." And I responded by saying "you can't get Zofran from the store and even if you could the patients are still having to pay for the medication that you're taking from them."

I'm at a loss and I can't get this off my mind. I feel like taking any medication out of the pixis under a patients name is stealing from that patient. I've already had issues with this preceptor and next week I'm going to finish my orientation with another nurse. (This preceptor frequently leaves the floor to talk on other floors or to go outside and smoke. There was one instance when a patient was going into ARF and we had to call a rapid response. She was outside smoking and wouldn't answer her phone when called. Another instance just recently was that one of my patients was having chest pain and I was having to make all of the decisions and call the doctors all by myself. Being new and never having to deal with those things alone are VERY SCARY!)

Anyways... I know what the rules are regarding a nurse stealing/diverting narcotics from a patient. But I don't know what the rules are if it's non-narcotic medication. Also, I did not see this nurse take anything. It was merely a conversation. I don't want to cause a stink over this since I've already had issues with this nurse. But, I just can't get it off my mind. Is this something that I should take to my manager. Or is it something I should file an anonymous incident report over? Or should I just ignore it all together? I don't know what to do and if she does end up in trouble she's going to know it was me that ratted her out. Any advice?

[MedChica]

Oh, wow. We divert non-narcs at my facility. None belonging to the residents but the facility? Yeah.

What do we give? Tylenol 325mg and 500mg. Ibuprofen 200 mg. Allegra 160 mg. Vit A and C. Ointments like theragesic, vaseline, Eucerin and A/D. Those clear eye drops, as well.

It'll usually be the pain meds. Sparingly. About 3-4 times a month, I'd say. An aide or housekeeping or dietary or office worker will come around with a headache, allergy flare-ups or feeling generally 'under the weather'. We medicate.

If a nurse has 'the crud', they'll just ask the med aide for some OTC (as we don't keep anything but PRN narcs on our carts).

It's been awhile but when the pollen and ragweed levels rise? I've popped an Allegra or two, myself.

Until I read the responses on this thread, I didn't actually consider it 'Fraud, Waste and Abuse' because it's seen as 'not a big deal' when anyone does it. When I worked the Med Aide cart as a GVN, I was instructed to give this or that coworker Tylenol and such by my nurse/preceptor. The charge saw. They do it, too! I suppose it's all 'fraud, waste abuse' when you look at it...but different specialties just have different liberties when it comes to these things? I'll raise the issue when I go back to work, though.

I'd never pull the pt's meds for personal use, though.

[EaglesWings21, ASN, RN]

Just a nursing student here, but saying "it is just a tylenol" really in my mind does not make the situation seem any better. How inexpensive is it to buy your own bottle of acetaminophen?

It seems like you should just take safety measures like every one else has suggested and unless you have solid proof reporting her would really probably not do any good.

As far as your patient coding and her not answering her phone, document that and maybe even fill out an incident report. I admire you for calling the doc and handling that situation well as a new nurse. I am sure many new grads would not be able to handle that!

[chrisrn24]

Oh, wow. We divert non-narcs at my facility. None belonging to the residents but the facility? Yeah.

What do we give? Tylenol 325mg and 500mg. Ibuprofen 200 mg. Allegra 160 mg. Vit A and C. Ointments like theragesic, vaseline, Eucerin and A/D. Those clear eye drops, as well.

It'll usually be the pain meds. Sparingly. About 3-4 times a month, I'd say. An aide or housekeeping or dietary or office worker will come around with a headache, allergy flare-ups or feeling generally 'under the weather'. We medicate.

If a nurse has 'the crud', they'll just ask the med aide for some OTC (as we don't keep anything but PRN narcs on our carts).

It's been awhile but when the pollen and ragweed levels rise? I've popped an Allegra or two, myself.

Until I read the responses on this thread, I didn't actually consider it 'Fraud, Waste and Abuse' because it's seen as 'not a big deal' when anyone does it. When I worked the Med Aide cart as a GVN, I was instructed to give this or that coworker Tylenol and such by my nurse/preceptor. The charge saw. They do it, too! I suppose it's all 'fraud, waste abuse' when you look at it...but different specialties just have different liberties when it comes to these things? I'll raise the issue when I go back to work, though.

I'd never pull the pt's meds for personal use, though.

Same here.

I would never take a med from a card or a personal container but many times I've taken ibuprofen, acetaminophen, refreshing eye drops and the like (OTC meds) for myself and my coworkers.

[BrandonLPN, LPN]

I've given stock Tylenol to staff who say their back hurts or something. Or a little cup of maalox or something like that. The stock meeds aren't billed to any resident. I guess you could make a case that they pay for it in a roundabout way, being as they provide the revenue and all that. But then, they also pay for the electricity, heat and toilet paper in the staff bathroom in that sense.

I think this is a different matter in LTC than it is in acute care. In a nursing home the Tylenol comes in a big old bottle that is for everyone. No Pyxis. I would imagine with a Pyxis one would have to "pretend" to sign the two tyl pills out for a specific patient. That's a whole different ball game.

[BrandonLPN, LPN]

Oh, and I hope refresh eye drops aren't really a stock med at anyone's facility. That just sounds gross and like an infection control issue. Eye gtts should always be specific to one resident only.

[NurseGirl525, ASN, RN]

I guess just looking at this from a strictly business standpoint, yeah your patients end up paying for those meds. I know I am just a pre-nursing student but having worked in business for many years someone has to pay for those meds that people are taking. That cost ends up going on to your customers. You can't take anything at all from work. You know want to know why your clothes or shoes cost so much? Because people steal. They steal this stuff and the amount of money a company spends to keep people from stealing is absurd. And who pays for it? Not the company. They wouldn't make any money. You do. The nonchalant way people are talking about taking Tylenol from a hospital is crazy. It costs your hospital money. The hospital doesn't pay for it, the patient does. Stealing is wrong whether it is a Tylenol or a hydrocodone.

[wooh, BSN, RN]

We can get OTC meds from our pharmacy. I see it like a bandaid. If I need a bandaid, I'm going to get one.

Zofran isn't OTC. But whatever. I've got bigger things to worry about than someone using some zofran. I'd rather they do that than they go home leaving me to pick up a bunch of extra patients or have them puking on a patient.

[lmccrn62, MSN, RN]

I worked with a nurse who hoarded medications. He would take left over medications and put them in his locker. I never saw him do it but it was the joke of the unit. I began suspecting he was using a paralyzingly agent on patients in the ICU to keep patients still. Before I could take my suspicions to my boss I was hauled in and questioned whether I knew. She showed me 2 large bags if medications. I told her he would joke about a stash he said but never believed he had that. He was fired for diversion of medications and reported to the board if nursing and he lost his license. The lesson I learned is to speak up if you suspect wrong doing. You can only report what you know.

[ArtClassRN, ADN, RN]

They could have been testing you, to see where you were on the "Stealing stuff from work spectrum." Looks like you put yourself on the "Not cool" list, which is a good place to be.

Get used to it. Many "more seasoned" RNs tend to start considering the supply room and kitchen to be their own personal stockpile.

[pknurse]

Report what? It's a matter of stealing, whether from the pt or the hospital. Zofran is not going to impair you cognitively, although its true that it is not an over the counter medication. I don't see why the BON would care about this, though.

Does not matter what drug it was/is. Stealing is stealing. Refer to the Disciplinary Actions portion of your state BRN site and browse people's files (which are public record). Nurses receive actions for stealing medicines like Zofran.

[pknurse]

The patient is only charged with whatever medication that you documented was actually given to them. Just because it is in their med drawer, pyxis, or somehow available for them, does not mean they are charged for it. They can only be charged with what was actually administered to them, otherwise, that would be fraud. (This is not to condone stealing, but it is stealing from the facility, not the patient.)

However, if the chart is ever audited (e.g. medical billing office), Omnicell/Pyxis will show the medication removed while the patient MAR will show the medication wasn't given. In general, most hospital stays/medications are pro-rated per clinical pathway.

[Bubbles]

What about the other issue of this nurse being off the floor for cigarette smoking?