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.
Wow. I'm flabbergasted. I cannot believe some of things people have the nerve to do. It these allegations are true, dear me she needs her license yanked from her as fast as a jack rabbit running from a prairie fire.
I also paid very close attention to her, for this reason....
She asked me to witness Ativan waste so she could pull it from the Pyxis. I asked, who are you giving Ativan to? She didn't answer. I then looked at the Pyxis and said your giving Ativan to this particular patient? She still stayed quiet. I then consigned and paid close attention to her every move.
Then why would you cosign? If she can't explain her actions, then protect your own license. I would think co signed means you are in it together, you acknowledge what she did with
it. If she was wasting a med, that meant she was to get rid of it right, but you asked her who she was
Then why would you cosign? If she can't explain her actions, then protect your own license. I would think co signed means you are in it together, you acknowledge what she did with it.
If I had it to do over again, I wouldn't have. I was suspicious and decided to just pay attention to what she was doing.
Your management will expect you to treat this as a confidential matter and maintain a respectful, rather than a hostile work environment.
Thats correct. I worked with her a couple nights ago. Tension filled the room. I told my manager I hope you don't expect me to watch her every move. I was told to just worry about my own nursing practice. So, I don't know.
But that could cost you your license as well couldn't it.
I don't think it could. I was witnessing a waste. That's what I consigned for. I wasn't witnessing what she then did with the meds. The situation didn't feel right, that's why I paid attention afterward.
If she was wasting a med, that meant she was to get rid of it right, but you asked her who she was
giving it to.
It's possible and very common to waste 1mg of a 2mg vial or 5mg of a 10mg vial. Witnessing that type of waste would not make you a part of any wrong-doing with the remaining dose.
I stated "The Asian nurse" because this is what the patient said, verbatim. In front of four staff members. Each wrote a statement of what they heard. Two evening shift RNs have reported patients ask for meds that aren't ordered, and when they are told they cannot have them, they say something along the lines of 'ill just wait for the night nurse, she'll give it to me.'
I know I did the right thing.
Hey, I didn't say I think you're crazy, I've no reason to doubt you have observed what you stated. And as I said,I'm taking it on faith that you're only concerned for the patient. But you asked for advice, and my take is that to pursue this further (other than writing up incidents, which you should do) could make you LOOK like someone with a vendetta. And mentioning someone's race can put people's backs up. I understood that you repeated it because it was what the patient said. I'm telling you that it could sound racist, repeated. I don't care how many other people heard it and I'm not calling you racist. I'm saying how it could sound.
You are trying to do your best for the patients, but you could damage your own cause and reputation. I've seen it happen before. An administration in denial will say "Just why are you so interested?" It isn't fair or right, but it happens.
If you ask for advice, you'll get advice, not all of which you'll agree with. If you want headpats and to be told you did the right thing, ask for headpats.
One question I have...how is she charting against meds that aren't ordered?
And I feel your pain. When a nurse was caught diverting and replacing meds in the pyxis with similar looking pills, management came to us, the other nurses, and said, "how could you not know this?" Uh, cause she was good. How about, why wasn't pharmacy doing pyxis audits? It can be a blame game. Good luck.
I also paid very close attention to her, for this reason....
She asked me to witness Ativan waste so she could pull it from the Pyxis. I asked, who are you giving Ativan to? She didn't answer. I then looked at the Pyxis and said your giving Ativan to this particular patient? She still stayed quiet. I then consigned and paid close attention to her every move.
Do not EVER cosign for anything until you look at the order, the patient, the dose, the waste....do NOT let this nurse pull you into her whatever-ness. Be direct about it. "Ativan is not ordered for this patient, until I see an order, I will not co-sign for you"
Know that the pyxis is a wonder machine which records and sees all. As is the camera attached to most ceilings above said pyxis. And if she is overriding to get meds that have no order---don't witness them.
I am unclear on how this is all happening, however, uninvolve yourself to tying your name on it.
There is parent company websites that have areas for ethical complaints. Use it. Each time a patient makes a statement regarding this stuff, do an incident report. Every time. CYA.
Finally, just to throw it out there, is there standing orders/protocol that a cocktail can be given for agitation, etc? This may be what is happening--she is using those standing orders or protocol for the wrong reasons. Regardless, her documentation needs to match the pyxis.
Investigations can take a long time, as this may mean her license as opposed to just her job.
Do not EVER cosign for anything until you look at the order, the patient, the dose, the waste....do NOT let this nurse pull you into her whatever-ness. Be direct about it. "Ativan is not ordered for this patient, until I see an order, I will not co-sign for you"
Know that the pyxis is a wonder machine which records and sees all. As is the camera attached to most ceilings above said pyxis. And if she is overriding to get meds that have no order---don't witness them.
I am unclear on how this is all happening, however, uninvolve yourself to tying your name on it.
There is parent company websites that have areas for ethical complaints. Use it. Each time a patient makes a statement regarding this stuff, do an incident report. Every time. CYA.
Finally, just to throw it out there, is there standing orders/protocol that a cocktail can be given for agitation, etc? This may be what is happening--she is using those standing orders or protocol for the wrong reasons. Regardless, her documentation needs to match the pyxis.
Investigations can take a long time, as this may mean her license as opposed to just her job.
He clarified that he was witnessing a waste, not cosigning an admin. And it sounds like she's pulling and charting the meds under patients to whom they are assigned, but then administering them instead to other patients to whom they are not. He reports that the patient on whom the med was charted denied receiving it, and patients who don't have those meds ordered are telling other staff that this nurse gives them those meds anyway/he witnessed her give something to a patient who didn't have a med ordered for that route and tell the patient it would have an effect that none of her ordered meds would have.
CBlover, BSN, RN
419 Posts
Wow. I'm flabbergasted. I cannot believe some of things people have the nerve to do. It these allegations are true, dear me she needs her license yanked from her as fast as a jack rabbit running from a prairie fire.