New nurse, I thought I did the right thing...

[Cdonocdo]

Hi everyone. I'm hoping I can get some support and maybe an answer to the situation I'm currently in. I'm a brand new nurse, and I've currently been employed by a Home Agency as a Private Duty RN. The patient we are working with has 24/7 nursing care provided by RN's and LPN's. We administer her medication, which also includes Morphine Sulfate (which is kept in a locked box) Every time a dose of morphine was used, we wrote the amount and signed inside the Medication Count log as well as the administration record sheet. Part of this count records the amount in the bottle, the amount being administered, and the amount left in the bottle. This serves as our med count of the controlled substance. I worked with her on Friday 7-3 and kept record of all medication and administration of the morphine and signed off for 3 pm at the end of my shift. The next girl administered the proper amount of morphine, stated the correct amount was in the bottle no problems etc.. and signed her signature for her morphine administration at 4pm. Please keep in mind that this is a homecare case- and the agency did not even provide us with a bound medication count book- it was a half-ass binder that the nurses put together just to have record. So the weekend goes by, and I return Sunday morning for my 7-3p shift. The nurse I was relieving was rushed to get out, and the patient was laying in the hospital bed (completely raised) with both side rails up and urine was seeping through onto her comforter. My priority was to get the patient safe at that moment, so I took 10 minutes to clean her up etc... I then go to count the meds for 8am, and the morphine sulfate was missing about 6ml's. The first thing I did was call my supervisor and inform them of the disc., I called the patient's health care proxy as well as her Doctor to inform them of the potential medication error/med diversion that I came upon. I was scared that the patient received 5ml's of Morphine instead of the 5mg's that her 0.25ml dose is made up of. Her resp. were fine, and there was no sign of opiate overdose etc. The supervisor then called the nurse I relieved, and she stated "yes I knew it was short, and I forgot to tell the on-coming nurse" But this girl has even signed off with her signature at 0600 stating there amount that there was suppose to be, not the actual amount of morphine inside the bottle. So my supervisor starts an "investigation" of the med loss, and suspends everyone (including myself) until the matter is handled. I was not given grounds for suspension and have called several times, but no return phone calls have been made to me. The brief explanation I received was along the lines of "two nurses have to double check the med count and sign each time", which I can understand. But we are alone with this woman all day, and there isn't a second RN around to account for it. I always track the last shifts morphine usage amount and ensure that it matches up to the recorded amount being in the bottle. I did research online about this, and Yes- two nurses have to sign for narcotics.. but this was only applying to Accredidations of Long Term Care Facilities and Hospitals. I would just like some opinions on the matter, I thought I was doing the right thing by reporting the discrepancy but then got suspeneded.... I'm upset, this is my first nursing job and I'm heartbroken.

[catladynurse]

yes, you did do the right thing, you always call you supervisor immidiatley if there is a discrepancy with narcotics. im betting that the nurse was in a hurry on purpouse. you always always always do the narcotic count together whenever possible, she basically bullied you. if your supervisor wont return your call i would call her boss and explain the situation and that you feel the the nurse you relieved is diverting. or at least not following policy. it goes well in your favor that you reported immediatley and that she admitted neglecting to do the count. and your boss has to suspend everyoine involved in this kind if incident. breathe!!

dont let nurses bully you. they will try, dont let em!! always do what you feel is right and keep the lines open with your boss.

personally i think she took the ml's and set you up., so fight for your job and your licence.

[nursel56]

Just a few thoughts for you on the matter, about what I've observed working in Private Duty with respect to narcotics and diversion at least in my state.

First, when I first went to work for a PDN agency I was not asked to do any type of drug screen. As I had been out of the field for a while that fact really didn't make a huge impression one way or the other.

In working for two different companies I found there is no standard protocol for narcotics counting, so we ended up with a makeshift system much like you describe that isn't tracked by your agency, and thus there is no protocol for what to do if a discrepancy is found.

The "count" system is only adhered to in a somewhat haphazard fashion on a company-wide basis because comparatively few clients have back to back skilled nursing care 24/7. They don't know whether or not two nurses will be available to witness the count in most patient homes is not a given for there may be caregivers, family members and others who also have access to the narcotics but aren't obligated to count and sign for every dose given. They forget, get the wrong info from other family members, leave the meds out in the open, etc. because their jobs aren't at risk if a dose or two or three is missing.

The makeshift counting system isn't auditied by anyone and there are no sanctions in place should discrepancies occur.

So when a situation like yours happens, a response that almost doesn't make sense occurs compared to what would happen if this occurred where there was standard protocol for narcotics counting, such as immediate drug screening for everyone involved and other steps. I haven't heard that it is common practice to suspend every nurse who had contact with a patient without informing the nurses of what and why they did this and some idea of what they could expect to happen after that.

I know there are nurses on this forum who run ethical home health agencies and do know what should be done and have instituted thorough and fair review procedures. I wish all of them did, believe me.

Therefore, I think you should consider getting professional legal advice before this mushrooms any further. Best to you. I'm so sorry this all blew up in your face on your first job, and yes, you did the right thing. If only everyone did. ((hugs))

[DebPrimaryCareGiver]

Ok,upfront...I am not a nurse, but because of a major life change that occurred in our family back in Jan. of 2009, I'm seriously thinking of going back to schoolto get my degree in this! I was thrown in to the deepest end of the ocean -sink or swim time - and taught myself how to completely care for my suddenly ill mother, because I was the only one of 3 siblings at the time that was willing and able to do so. Anyway, I moved into my mom's rehab facility and lived there with her 24/7...taking notes, asking questions, watching carefully…so that when she was released, I would be able to attempt to take care of her atthe level she was receiving in the hospital. I did have a great group of AMAZING nurses who took me under their wing, and on their own time (within the law) taught me as much as they could and made themselves available to me around the clock those first few weeks, to answer my questions, etc.

I'm in my early50's and my sweet momma was then 80 yrs old...but I felt like I was bringing home a new born baby again (I've had 3), but this was so different, and to me,so much more difficult. I was so nervous and scared of making a mistake. I took what I had learned from past jobs as a paralegal and bank officer...and created our four page "Spreadsheet/Log and listing of meds, treatments, exercises,her vitals (all of them), and even her bathing, bowl and urine habits (in and outs). My mom has end stage COPD and CHF, as well as sudden onset of Lewy Body Dementia. My older sister stepped in to help after I blew out my back and required surgery to correct, and between the two of us, over the last 3 &1/2 years, we have it down to a fine science – but the sitters that come in to help find it way to over whelming and usually quit after one time.

I've said all of this, to say that first; Nurses, such as yourself, are SO very needed and appreciated beyond anything you could possibly imagine! Families,such as ours, would do anything to have that kind of help from a caring,careful, thoughtful, diligent, professional nurse such as yourself! I'm so sorry that this company has treated you as they have...but obviously they don't realize what they have in you, and it sounds like they have no real plan that makes sense to fall back on when things like this happen! And unfortunately, they do happen.

I agree with the poster who said you should seek legal counsel! (That is what I still do, when I can. The attorney I work for is great and gives me flexible hours so that I can take care of my mom) Most attorneys, in almost all states, give a free 30 min consultation, so I would at least check that out. Your job,license and reputation are very much worth fighting for!! Hang in there and do not give up!

You are a rare breed and the nursing field needs more conscientious people like you! It seems extremely obvious to me, based on what you have told us here, that the nurse who left in a hurry before your shift, helped herself to the missing doses. Unfortunately, the missing narcotics thing has happened in our home health care situation before too.

In our case, to relieve my sister and I occasionally, we would use a"sitting" agency (none were nurses) to watch mom for 4 hours or so,while we went to the store, took a nap, etc. Our situation happened in the beginning, before we became wise to the fact that all of those type of meds must be locked up with only my sister and I knowing the location and code to access them - but I'm sure it happens all the time, especially in home healthcare situations. The double counting system is great...I agree...but as you said, in a home health situation, there isn't always 'time' to give report and sign log sheets regarding meds, etc., when you have one person relieving another. Unless you take your phone and take pictures of the bottle, the number of pills, etc., with some type of time and date stamp, proving that when you left - all was as it should be, I don't know what else would help protect you and others like you in these types of situations.

Just don't give up or let this dim your spirit! I only pray that one day we will be able to get a nurse to care for mom, just like you! This journey, by far, is the absolute hardest thing I’ve ever had to do in my life…and social services doesn’t seem very helpful, as all they want to do is put my mom in a home. I wish you the very best and keep us posted on how things turn out for you!