Nurse stealing narcs advice

[Nursenicole1]

I have a dilemma I have been facing at work for sometime now. There is one nurse who gives out WAY more pain medication then any other nurse. It has always seemed weird to me but now alert and oriented patient are telling me they are not getting their pain medication when she is saying she is given them. Also this nurse will give more than what's prescribed if it's one every 8 hours PRN she will give one at 715 and 245 (shift is from 7-3). I have went to my DON multiple times about this and she said she did an investigation but nothing has happened no days off or anything. At the very least she making regular med errors (literally everyday she works) with giving them to frequently. But I know she is always taking them as well. I don't know what I should do. Should I go above my DON so something gets done about it? If so who do I report it to and is there anyway to do it anonymously?

[emtpbill, ASN, RN, EMT-P]

It's very disheartening when you approach a manager and you don't feel the appropriate outcome has been reached.

A few years ago we had an RN who would give narcotics to almost every patient( critical interfacility transfer) , it was brought to his direct manager who said they reviewed everything and while it was a lot, he documented everything to appear that it was appropriately dispensed. This one RN accounted for 97% of all narcs dispensed by all RNs and medics.

Needless to say this RN was found overdosed in his house one night. The outcome was not good and we attended a funeral the next week.

[NurseGirl525, ASN, RN]

Maybe an investigation was done and it was determined she was not stealing. Why do you think she is at least committing a med error? You can give out meds 1hour before and 1 hour after. So if the meds are due every 8 hours like you say, she is not committing a med error as 7-3 is 8 hours.

I guess accusing somebody of diverting is a huge deal. You are potentially destroying a career so you better be 100% sure you know this is happening. Jumping to conclusions is not 100% sure. You did the right thing by talking to your higher ups. She says she investigated. Let him/her handle it. You have absolutely no idea what is going on behind the scenes. They may be gathering more evidence, be calling HR on how to handle it...... Just because you are not seeing immediate termination means nothing. It takes a lot to fire someone with that type of accusation. They need proof. Let them gather that.

[dishes, BSN, RN]

now alert and oriented patient are telling me they are not getting their pain medication when she is saying she is given them.

Did you do incident reports on every patient who told you they did not receive their pain medication?

[KelRN215, BSN, RN]

Maybe an investigation was done and it was determined she was not stealing. Why do you think she is at least committing a med error? You can give out meds 1hour before and 1 hour after. So if the meds are due every 8 hours like you say, she is not committing a med error as 7-3 is 8 hours.

I guess accusing somebody of diverting is a huge deal. You are potentially destroying a career so you better be 100% sure you know this is happening. Jumping to conclusions is not 100% sure. You did the right thing by talking to your higher ups. She says she investigated. Let him/her handle it. You have absolutely no idea what is going on behind the scenes. They may be gathering more evidence, be calling HR on how to handle it...... Just because you are not seeing immediate termination means nothing. It takes a lot to fire someone with that type of accusation. They need proof. Let them gather that.

This. The NM cannot and should not share the results of an ongoing investigation with the nurse in question's colleagues.

Giving q 8hr pain meds at 7:15 and 2:45 isn't a med error.

[Remy Ox]

They may be still investigating, and they don't have obligation to tell you cause it isn't about you. You reported your suspicions you did your part. And I agree with another comment, 7am and almost 3pm is not a med error. Just remember its right thing to advocate for patients but if you are wrong you can still ruin your coworkers career

[lifelearningrn, BSN, RN]

You did your due diligence and reported. The rest is on them. Continue to document it when a patient claims to have no gotten their meds, or anything else she does that is out of line (don't document suspicions; only observable facts).

The investigation is your employers responsibility, not yours.

[morte, LPN, LVN]

I don't think the hour before and after applies to PRNs...

[Rose_Queen, BSN, MSN, RN]

I don't think the hour before and after applies to PRNs...

Why wouldn't it? Otherwise a nurse would have to drop every single thing she/he is doing to go give that PRN right on the dot.

[Ruby Vee, BSN]

If you're going to potentially damage someone's career and jeopardize their livelihood by reporting them for narcotic diversion, you should be willing to stand up and do it without being anonymous. If you say you KNOW this person is using drugs, then stand up.

On the other hand, if you think the person may be using drugs but aren't 100% sure, then you have no business reporting that they are. Report what you SEE, not what you THINK.

If a medication is due every eight hours prn, then 15 minutes on either side of it is not a big deal. An every two hour prn med would be different. If the patient has been waiting for everyone to get out of report so she could have her pain meds and is in significant pain, it seems kinder to go ahead and medicate her before going into report so that the next nurse doesn't have a patient in uncontrolled pain to deal with.

You already talked to your manager; you've done your due diligence. It is now up to your manager to follow through. It is also not your manager's duty to report to you how the situation is resolved. If there is disciplinary action, you don't get to know about it. It's confidential.

I don't see any facts in the original post -- except the 7:15 and 2:45 times which seem pretty sensible to me. Are you sure your concern is narcotic diversion or potential narcotic use rather than getting someone into trouble?

[Remy Ox]

If you're going to potentially damage someone's career and jeopardize their livelihood by reporting them for narcotic diversion, you should be willing to stand up and do it without being anonymous. If you say you KNOW this person is using drugs, then stand up.

On the other hand, if you think the person may be using drugs but aren't 100% sure, then you have no business reporting that they are. Report what you SEE, not what you THINK.

If a medication is due every eight hours prn, then 15 minutes on either side of it is not a big deal. An every two hour prn med would be different. If the patient has been waiting for everyone to get out of report so she could have her pain meds and is in significant pain, it seems kinder to go ahead and medicate her before going into report so that the next nurse doesn't have a patient in uncontrolled pain to deal with.

You already talked to your manager; you've done your due diligence. It is now up to your manager to follow through. It is also not your manager's duty to report to you how the situation is resolved. If there is disciplinary action, you don't get to know about it. It's confidential.

I don't see any facts in the original post -- except the 7:15 and 2:45 times which seem pretty sensible to me. Are you sure your concern is narcotic diversion or potential narcotic use rather than getting someone into trouble?

Exactly

[Pangea Reunited, ASN, RN]

I give a lot of pain medication, too. Sometimes I'm the only one who gives it to a particular patient (non-verbal, PEG tube, grimacing, huge wounds, for example). And I will frequently give it a little early if the next dose is due right after change of shift (as a courtesy to the oncoming nurse).

I also have patients claim they "didn't get" their pain medication, on occasion. Sometimes they're attempting to manipulate and get an extra dose, other times they're just really drugged up and actually can't remember.

Something may be going on with your co-worker, but it may not be. Hopefully not!!