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.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
"I caught..." Really? Nurses are just cruel to each other. Making speculations about another professional's actions that can affect their livelihood. And what if you're wrong?
And what if that nurse is administering meds improperly and harms a patient? Have you never had to work with a nurse who was engaging in shady medication practises? They can be quite crafty and deceptive. And if you see things that don't add up and you don't report, you can also be held liable.
This is not a playground where it is naughty to tattle. These are people's lives and you have a responsibility to protect and advocate. Don't most nursing schools have ethics classes where they cover this?
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.
The nurse managers and administrators are given direction by legal and human resources advisors, who advise them to ensure there is adequate evidence before taking action. The most helpful thing you can do at this point, is keep quiet about it.
..."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."...
Absolutely. At the end of the day, its not up to us but management to do the investigative work.
If you are the only other nurse on the unit, then you are in a tough spot to try and refuse to cosign.
Again, you are only witnessing that the UNUSED portion of a med is discarded appropriately; not as witness to where the rest of that med goes. Be sure when you sign as witness, you INSIST the drug be wasted at that time, in your presence. If the nurse declines to do that, then I would state to them that I cannot cosign the waste.
Tough spot to be in, for sure. Just make sure YOUR medication handling is spotless. You cannot control someone else's practice. Sounds like they are digging their own hole, for sure.
I had a similar situation occur when I worked in OB-GYN.
A nurse i had had worked with for a very long time was diverting narcotics. The night nurses all talked about it, but they were such a den of vipers, I felt angry with them for making these speculations. The speculations were based on this nurses habit of always assigning herself to the gyn's and carrying the narcotic sheets around with her all night. All of her patients were medicated with two Percocet every four hours. This is unusual, as most patients use their pain meds as needed.
it wasn't until one evening, she had asked me to take a discharge patient out to the front lobby for her, that I realized she was doing this. The patient was in obvious pain and I suggested I could give her one more dose of meds before she left. She said her nurse told her she could only get Tylenol. I brought her back to the unit to see what I could do for her. When I looked up her chart, the nurse had documented she had given her narcotics. The patient denied that she got these, and appeared genuinely puzzled.
this occurred the fri night before my weekend off. Over the weekend, I called my nurse manager at home to talk to her about it. Several weeks went by, and nothing occurred. In the meantime, I watched this nurse decompensate before my eyes. She would come in with her hair down and wild, when it had always been neatly pulled back, her nails became broken and jagged, her speech was slurred, her eyes wild, and her behavior was frenetic.
i went to the DON. Then I started noticing some activity. They let go of the nurse manager. I noticed the evening supervisor coming in and running reports on the Pyxis, which we had recently acquired.
Still, this went on for a very long time, and it was alarming to watch this nurse get worse and worse. I went to the DON again. She confided in me, which she probably shouldn't, that they had tried several times to get this nurse into treatment, but the nurse denied she was using. They eventually fired her for stealing. At the time, our prn's were not in the Pyxis. We would all from time to time end up with a Tylenol or vit e in our pockets, and end up throwing it our lockers at the end of the shift when we emptied our pockets. They found an ASA in her locker and got her for "stealing".
these things can be very hard to prove. But trust, that if you've taken this up the chain of command, they are working on it.
oh, and forget about the BON. I had confided in a friend at work who called the BON and she was told she could be sued if she made a report. They don't want to take reports from other nurses, but if a patient makes a report, or the admin, there would be a witch hunt. Believe me. The BON is NOT your friend.
i don't have any other advice, but just can offer you my support. I know how difficult it is to work with these situations. Hang in there.
The nurse no longer passes meds when I'm working with her. She seems scared to death. She has become very quiet, and very sweet. Which is a 180 of what she used to be. She worked an evening shift yesterday and told one of the 3-11 nurse's that "she has learned an important lesson". I know the investigation is still on going. I can't imagine them just giving her a slap on the wrist for this. So, I'm not sure what's really happening. My manager is pretty tight lipped about all of this. I'll update as I get more information.
Don't get discouraged. I had a similar situation happen early in my career. I had to do the same thing and it does feel uncomfortable, but, over time the nurse that I reported was caught and reported to the state. No one wants to report one of their own, or wants to believe that these things happen, but our jobs as nurses are to take care of and protect our patients. I think you did the right thing. Time will tell if this nurse gets caught and how she will have to answer for her deeds. If she is not guilty of any wrong doing then she will at least be more careful and more mindful to stick to protocol.
Specializes in Complex pedi to LTC/SA & now a manager.
Just an update.
The nurse no longer passes meds when I'm working with her. She seems scared to death. She has become very quiet, and very sweet. Which is a 180 of what she used to be. She worked an evening shift yesterday and told one of the 3-11 nurse's that "she has learned an important lesson". I know the investigation is still on going. I can't imagine them just giving her a slap on the wrist for this. So, I'm not sure what's really happening. My manager is pretty tight lipped about all of this. I'll update as I get more information.
Your manager SHOULD be tight lipped as this is a personnel matter and a need to know issue. People have a way of blabbing their business especially if they refuse to take responsibility. Keep your mouth shut to coworkers.
Terminating someone or referring for a substance abuse treatment is not a quick process. Don't assume nothing is being done. She may have been spoken to by management or another coworker clued her into being investigated.
Recently I had a patient who was prescribed 1-2 Norco PRN Q4.
It was documented that the patient had been taking 2 pills every 4 hours on the dot each PM shift since she was prescribed the norco.
I was expecting a patient continually asking for her pain meds. Nope. The one time she asked for pain meds, I asked about her pain scale. It bordered giving 1-2. She stated, 6-7. 7 is the order for 2 pills.
I told her I was trying to decide weather she needed 1 or 2 pills. She stated, "Oh, I didn't know I could take 2. No, I'll take just one."
This raised an eyebrow on my part. I wondered, hmmm. I really can't see so and so diverting or stealing narcs. But it's possible, I guess you never really know.
As the next 2 days with this patient proceded as such, I kept my mouth shut. I wasn't going to make such a serious allegation.
Then on the 3rd day, I went to give her 1 pill, and the patient stated she needed 2 pills. She got agitated and said "everyone knows 1 pill does not help me when I have PT (on the PM shift.) I have always gotten 2 pills."
I gave her the second pill and felt so bad that I had even an inkling of suspicion of another nurse. Turns out this patient randomly gets very confused while still appearing completely with it. You wouldn't know unless you cared for her for a few days in a row that she experienced such forgetfulness and confusion. I would give her her meds, check her BG, and an hour later she was saying she needed her meds and BG checked.
I never mentioned my very brief "hmmm, I wonder" moment nor did I come on AN seeking advice when I had this inkling of suspicion. Good thing, because I felt so bad for having been suspicious.
I worked IP psych for a few years and until you have worked with that population as a nurse it is hard to understand their level of manipulation, lies, and genuine forgetfulness/confusion caused by their meds and disease processes. Not to mention the common presence of drug and alcohol addiction amongst this group. It can add up to real trouble for the nurse who doesn't handle things "just so."
I was thinking the very same thing. In another setting, this would be way more suspicious to me. But it's psych. I've seen way too much deceit and manipulation among certain patients with varying diagnoses. I think so far, OP has done what she can do. OP reported it. Let the chips fall where they may.
I understand if OP has a genuine concern for the patients. But I agree that better judgment would have made her intervene then and there and directly asked the nurse, hold up. What's going on?
Looks like it's been swept under the rug. Nothing has happened.
Hopefully not swept under the rug, though we don't always know what's going on behind the scenes. Management may not want to discuss what they are doing.
TriciaJ, RN
4,328 Posts
And what if that nurse is administering meds improperly and harms a patient? Have you never had to work with a nurse who was engaging in shady medication practises? They can be quite crafty and deceptive. And if you see things that don't add up and you don't report, you can also be held liable.
This is not a playground where it is naughty to tattle. These are people's lives and you have a responsibility to protect and advocate. Don't most nursing schools have ethics classes where they cover this?