Need advice about unethical nurse

[Big-RN]

Hello,

I caught one of the night nurses at our psych unit using the Pyxis as a resource and dispensing medications to patients as she sees fit. This nurse primarily works as the only RN on the unit. The nurse in question charted in MAK that she gave two IM injections to a patient. I watched the nurse and she did not give this particular patient any medication. I then woke him up and asked if he had gotten an injection and he said no, he's been sleeping all night.

This nurse then went to another patients room told the patient she was going to give him something for the voices. I checked what she had charted, and what was charted was ambien and vistaril. She then went back into the room an hour later and checked on the patient. A mental health counselor asked the nurse what she gave him. The nurse's response was, "the cocktail". This particular patient just got back from the ICU with a very high cpk and in addition to not having "the cocktail" ordered, he didn't have any IMs ordered.

It has been suspected for some time that this nurse has been doing this, as evidenced by patients coming to the nurses station asking for medications that are not ordered for them, then saying well the nurse on night shift gives them to me.

I wrote her up, told supervisor and my manager, but it seems this is getting swept under the rug. The nurse has not been suspended and continues to work as the only RN on the unit at night.

Need advice here.

[icuRNmaggie, BSN, RN]

Have you personally seen or heard her administer IM medication without an order?

If she has been flagged for diversion her pyxis access is being tracked and the investigation is ongoing.

If a patient reports receiving IMs, check for bruising and recent

needlemarks. Write the report and describe that and only what the patient said.

[Big-RN]

What I witnessed was her pull three medications (haldol, ativan, Benadryl), NOT give the IMs to the patient she pulled and charted them for. Then 3 hours later she told a different patient she was going to give him "something for the voices". Ambien and vistaril were charted for this patient. When an MHC asked this nurse what she gave the patient, the nurse responded, "the cocktail". This was heard by three staff members. This patient did not have haldol ordered and all IM PRNs were D/C after he returned from the ICU with the high cpk.

[Big-RN]

Even if she is now being tracked, what she is doing is very easy when there is one nurse on the unit. She pulls meds for a patient, scans the barcode label from their chart, and charts in MAK that the meds were given. She then has these meds to give to whatever patient she wants.

[dishes, BSN, RN]

You reported it, your next step is to trust that management is investigating it, the process is time consuming and confidential, it is unlikely you will be given any details about the investigation.

[Hygiene Queen]

This is very scary... gives me chills, actually.

Did any of the other staff come forward and reported the things they have seen or heard, or was it just you?

I'd be writing everything down and encourage others to do so too.

[Big-RN]

My concern is why is she allowed to continue to work (alone no less!!) while they investigate. Why isn't she suspended until the investigation in complete.

[TakeTwoAspirin, MSN, RN, APRN]

Big-RN,

I'm sorry, but if she is the only RN on duty then who are you and what are you doing there to witness all of this?

[Big-RN]

Yes!!!

A nurse wrote her up yesterday because a patient came to the nurses station asking for trazadone. When the nurse saw the medication was not ordered for this patient, she told him he could not get it. He said well they gave it to me last night. When asked who "they" is, he replied, "the Asian lady in third shift".

[roser13, ASN, RN]

What I witnessed was her pull three medications (haldol, ativan, Benadryl), NOT give the IMs to the patient she pulled and charted them for.

Your "proof" is pure speculation. I'm not sure what your write-up consisted of but I cannot see any hard facts that you could report. 4 folks "witnessing" a nurse saying she gave "the cocktail" to a patient means absolutely nothing unless the nurse then stated the exact drugs and those drugs were not prescribed to the patient.

You are attempting to report a negative. How can you prove that the nurse did not give the meds that she charted? Unless you were at her side continuously all shift, the answer is that you cannot. Patients are notorious for forgetting, confusing and/or outright fudging the truth. I hope that you are not expecting your administration to take action on a report substantiated only by negatives and patient answers.

[Big-RN]

I am a night nurse that works on the unit, opposite days that this particular nurse works. I've recently signed up for extra nights and our manager is allowing two RNs on night shift a few times a week.

[Big-RN]

The security tape will show the patient she charted the meds for never left his room all night, and this nurse never entered his room. Also, the term "cocktail" in psych means haldol, Benadryl, and Ativan.