Need feedback

[fromtheheartRN]

I had another colleague tell me about a situation, and I'd like some feedback--good-bad-indifferent--I'm open.

The nurse was called into the unit director's office, handed some EKG strips, and two regular, common meds (not narcs--or even a med that would be wanted by anyone seeking drugs--OTC, inexpensive stuff).

The director said, "These were found on the top shelf of the area you were working this day. Can you tell me about them?"

Of course leaving meds out is never right, but the nurse stated that he/she would have placed them in a pt med drawer.

The strips were his/hers, but were not placed in the chart because the CNA that day already pulled strips and placed those in the chart (nurse's explanation). They were 'extra.' Both the strips and the meds were found in an area that not just anyone would see--unless they were looking. The nurse admitted to probably leaving the strips there-but not the meds.

My question/concern is: if I were deep cleaning and found these items, I would have returned the meds to the pharm, and would have brought the strips to the ward clerk to be given to medical records (if the patient/s were no longer there). So we are both wondering--why would somebody (presumably) take these benign items to the director and ask that she follow it up?

Maybe because the director was concerned that if the nurse left these there, he/she could also leave narcs out as well?

I argue that, because everyone knows that narcs MUST be accounted for-and you could LOSE YOUR JOB if any of them were traced to you--and they were not given.

Sounds petty to me, and smells bad of someone out to bring trouble for the nurse-or ANY nurse-in question. This is one of our very BEST nurses!

While I am not saying that leaving stuff out is OK, but why would someone make a huge stink about it?

I mean, come on! They weren't narcs! And a simple look at the chart could have shown that there were strips posted already.

Neither item was in a place that could be readily seen by anyone--so while I know that it's bad for JHACO, the charts are always MORE available.

And, incidentally, the admin also said, "Pulling meds from the PIXUS and not giving them is 'creating a fraudulent charge' for the pt." Made it sound, to this nurse in question, like he/she had committed a crime, which she/he could be severely punished for. As a matter of fact, a nurse was fired about 3 months ago for some pretty shady sounding accusations. She had worked there as staff, charge, and house supervisor for about 20 years. Hard worker, diligent, and liked a great deal by everyone.

Also..and I need to find this out, I believe that a patient is ONLY charged for meds that are documented as 'given'-not simply 'checked out' from the unit PIXUS. If true, then that statement would have been used as a scare tactic only--why? To document 'a problem'?'

Don't get me wrong, I do not think the nurse's actions were OK-by any means, it just smells funny.

Sure, the director was right in 'following up,' but was it necessary to launch a 'full investigation?'

What do you think?

[classicdame, MSN, EdD]

As a manager I feel obligated to be as fair as possible. I cannot justify not doing a full investigation because I might miss something or be accused of bias. You need to confirm with Pharmacy how charges are done, but in our facility, if they leave the drawer the patient is charged. Someone has to be be. We do not give away anything.

[fromtheheartRN]

Need more feedback, please

[RNperdiem, RN]

All I can think is that maybe there has been a problem with drugs being diverted from the Pyxis. Narcotics are not the only drugs that have value; many prescription drugs are expensive and may have resale value on the black market.

Only management and pharmacy would know the details, and they would not share them with the staff nurses if an investigation is going on.

There is a record of how many drugs go into a pyxis.

[Agnus]

In any hospital where I have worked and drugs were pulled from pyxis they are charged, period. If meds are not given then it needs to be documented as to the reason and it needs to be documented that the physician was informed. This nurse not only left meds out but left strips as well. She does not recall leaving the meds out but admits to the strips and stated the reason for leaving the strips out. If these strips were truly extra then they need to be disposed of appropriately in the shredder. Narcs are not the only drug that need to be secured. All medications need to be secured. That is the reason they are kept either in a secure dispenser such as pyxis or a locked area. In this case the drugs were not secured.

Even though the public did not have access to the areas where these items were found they are accessable to hospital personell. Only licensed nurse should have access to meds. As for the strips this is a violation of HIPPA. Only those persons directly involved in THAT pt's care should have access.

Who knows what could have become of these items (pills, strips) had they not been reported. Yes it is more probable that no one would have misused them. But the laws are clear and are there for a reason.

It may seem extreem and excessive. Yet, if you have seen what happens when a surveyer comes in and finds these kinds of things you would not say that any longer. The hospital would be cited and possible fined. The reasons are irrelevant to the surveyers. State surveyers are law enforcement.

I am just a staff nurse but I would be concerned if I had done this and there was no investigation. These investigations go on every day in every hospital they are to protect the patient, the hospital and the nurse.

It sounds like she was asked about them. You did not say she was jumped on, yelled at, accused, etc. She was asked about this and allowed to give her version. I do not see anything unfair about this.

We do make very human mistakes like this every day. Nurses are expected to be perfect. Unfortunately the seriousness of our responsibilities and the vast expanse of that same responsibility demands perfection. Some times a system failure can be identified by these investigations. We can not repair these system failures without investigating. Often it is the nurse involved who is able to identify where the system failed.

Some times we are just over worked, stressed, in a rush etc that causes the error. Bringing it to our attention in this way reminds us to slow down and pay attention. Sometimes a nurse being stressed in a particular situation is a system failure and can be fixed.

I do not care how many years I have been practicing or what positions I have held or how good or popular I am. I make mistakes. Calling it unfair because of my personal qualities or history dose not reduce the error. I made it I must own it.

I speak from experience. lately I have taken twice very recently 2 vicodin or other narcs and administered them when one was ordered and one was charted. In every case it was absentmindedness on my part because we are always working stressed, and multitasking, so in a hurry. It has been a reminded to stop and regroup when I am pulling and giving meds.

If you think your friend is in trouble think about how I feel when I get a call at home on monday or tue about this error that occures on a friday night or saturday. (each time) I can not remember yesterday let alone several days ago. And we are talking about narcs in this case.

It sounds like you are a good friend but do not have the full picture of what might be going on with your friend, we seldom do, particularly when things are out of wack.

If indeed something "fishy" is going on this nurse needs to cover herself better and not be making these kinds of mistakes. Sometimes employers to attempt to get rid of higher paid nurses in favor of new nurses who do not make as much. Once a nurse starts to feed into the victim mindset this can create she often does not realize that she herself is adding fuel to the situation because she then becomes (or continues) to be less dilligent than she should.

The fact you have always done something and perhaps it has been over looked in the past does not make it right and this kind of action will get you fired if that is their intent.

So really more dilligence is called for not less, and not business as usual.

[kukukajoo, LPN]

Are they trying to clean house and get rid of higher paid nurses with more time in to replace with new nurses who could be paid much less?