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?

[floridaRN38]

What's a "pt"? What's a "u"?

Seriously, you can type out "supervisor" but not "you"? What's "AAO"? Text speak is against the terms of service, and besides that it's just rude and unprofessional.

And disrespecting a fellow nurse without knowing a thing about the situation other than what your 90 year old father told you? One Percocet may not have been enough for his pain, perhaps he needed two. Maybe he needed Dilaudid. Maybe he got it and forgot it. You weren't there and you don't know.

I've been a patient or the family member of a patient all too often in the past ten years. Maybe I'm just lucky, but I've only encountered one nurse that scared me. She was on orientation and her preceptor promptly set her straight.

Dilaudid? Really !? LOL

[Remy Ox]

I am a big patient advocate. But it appears that she wants to see the outcome of her reporting NOW, or she will report to someone else again ANONYMOUS. What is the motive of hers. Maybe I'm having this hard time understanding because she does not give full details but it is understandable on the internet. But something seems off to me. It is most subjective except for what she believes are "med errors" and the word of patients (who can lie, manipulate or forget when they take pain medicine)

For me to possibly ruin career I must need more evidence. I'm protective of patients but I won't accuse someone of something without hard facts or serious suspicions with fact.

[mrsboots87]

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.

In my facility, narcs are blocked out from being able to be signed out until exactly 2,4,8 hrs after the last dose was signed out. Whatever the order is for. Doesn't mean nurses don't give it a little early sometimes for reasons stated any another poster, they then just wait until the time the computer allows to sign to sign. I am also LTC so a lock and key is the only thing between a nurse and narcs.

[mrsboots87]

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!!

I also give the most PRNs on my unit and I sometimes worry I will become the focus of a complaint. The good thing is we have cameras in the halls at my facility and I sign everything out as I should and give to the residents right away, so I know I would be fine. But people like this OP still make me worry a little.

The he reason I give the most PRNs is because I believe people shouldn't have high anxiety or be in pain if they have PRN orders for relief. I have a guy who calls out all night and gets combative with cares if he doesn't get PRN Ativan at HS. I am the only person who just gives it too him at HS. The family doe not want it to be a scheduled med because they think we will just snow him. But he truly needs it. But every time I sign the narc book, there is maybe one or two other nurses who gave it to my 15 signatures.

I also give PRN morphine more frequently than others in our hospice residents. I due watch for signs of pain, but I feel other nurses just don't think about it as much because the patients can't usually vocalize their pain while actively dying.

Basicall, OP, don't assume. Unless you see her pocketing or swallowing pills direct from the NARC box, it is not your job to report it any higher than your manager. You could potentially ruin someone's career over a suspicion. Also keep in mind, I have plenty of alert and oriented people who sometimes think I didn't give them their pain meds when I know for a fact I did. Sometimes they just forget or have intermittent confusion. It happens. She may very well be diverting. She may not. But that's not for you to be judge and jury on.

[Remy Ox]

I also give the most PRNs on my unit and I sometimes worry I will become the focus of a complaint. The good thing is we have cameras in the halls at my facility and I sign everything out as I should and give to the residents right away, so I know I would be fine. But people like this OP still make me worry a little.

The he reason I give the most PRNs is because I believe people shouldn't have high anxiety or be in pain if they have PRN orders for relief. I have a guy who calls out all night and gets combative with cares if he doesn't get PRN Ativan at HS. I am the only person who just gives it too him at HS. The family doe not want it to be a scheduled med because they think we will just snow him. But he truly needs it. But every time I sign the narc book, there is maybe one or two other nurses who gave it to my 15 signatures.

I also give PRN morphine more frequently than others in our hospice residents. I due watch for signs of pain, but I feel other nurses just don't think about it as much because the patients can't usually vocalize their pain while actively dying.

Basicall, OP, don't assume. Unless you see her pocketing or swallowing pills direct from the NARC box, it is not your job to report it any higher than your manager. You could potentially ruin someone's career over a suspicion. Also keep in mind, I have plenty of alert and oriented people who sometimes think I didn't give them their pain meds when I know for a fact I did. Sometimes they just forget or have intermittent confusion. It happens. She may very well be diverting. She may not. But that's not for you to be judge and jury on.

Me too. When I worked in ER many nurses thought people were drug seeking and I say, even if they are addicted, they still could feel pain, they are human. Many times I would get ignored for request to get the pain relief for patients, and the doctors refused to write orders until X-ray came back positive for fracture or other real things happening to poor patients. I could have been accused too but I was just doing the right thing for patient.

[MaxAttack, BSN, RN]

What's "AAO"? Text speak is against the terms of service, and besides that it's just rude and unprofessional.

I've been told it means awake, alert, and oriented. If AAO is considered unprofessional, then I have a feeling even you might want to review how you chart.

Nursenicole1, diversion is a strong allegation. Have you tried discussing your concerns with the nurse in question? If the nurse is diverting, it might make her think twice. If not, maybe you'll learn something about her practice. My view on pain management is vastly different than most of my co-workers, and I'm sure I've been flagged for it. But I have close family who suffers from chronic pain and I'm a little more sensitive to this issue than most.

You did what you should've done. Don't hang on to unproven accusations.

[ComeTogether, LPN]

I just have to say that I would medicate a patient as often as possible if I didn't think they were getting adequate pain relief from other shifts and the non-verbal or regular pain scale and their orders indicated I should.

You reported it to the DON, I say leave it alone unless or until there is more to report.

[Conqueror+, BSN, RN]

We are not allowed the one hour before/after with narcotics. It has to be 4-6-8 hours. It makes sense because you will have patients that get morphine every three hours instead of every four if that were the rule.

[chorr]

I, too, wkd /c day nurse who handed out multiple doses to multiple patients. Whole/partial cards found empty, no pink sheets, and missing log sheets. All in 1 shift. We're told we were crazy. Home got pharm to resend new cards/papers, when we couldn't get existing Rx filled. Supposedly if more than 2 cards missing, DEA has to be notified? Would really like to see something done, but not at expense of my long career.

[mrphil79]

You told someone in a position of authority.

What happens from there is no longer your responsibility or concern.

There are a few things to consider here...

1 - You seriously have to KNOW your accusations are true. Otherwise, you are potentially putting this nurse - as well as yourself - in a really awful position. You want her fired because a patient had no clue what pills she received and since she couldn't specifically tell the name of it, just assumed she didn't get it?

For example: "Did I get my oxycodone, you ask? That other nurse didn't specifically say, and it must be important since you're asking - so no, I guess not."

2 - Not only is your employer under no obligation to report back to you on any aspect of anything after you made your accusation, they actually have to respect privacy laws and absolutely NOT tell you anything.

Anything having to do with any kind of HR issues cannot be discussed with anyone besides the employee and appropriate management. This may bother you, but flip it around - if you're being disciplined for something, would you want your DON to discuss it with anyone other than you?

Nope.

And by law, they can't.

This is a good thing.

3 - You did your due diligence and reported the issue to an appropriate person - it's time to walk away from the issue.

Your moral and ethical obligation has been fulfilled.

[NuGuyNurse2b]

Why were you told you were all crazy?

[chorr]

While "high"nurse takes care of old people, stealing meds they pay dearly for, I should ignore it. My DON told us we were crazy. If nurse gets fired from one facility, they're just gonna go to another! Is this how we show"sisterhood" as nurses? Makes me wonder now when StBdNursing publishes 6 pgs of surrendered, suspended, and revoked licenses in newsletter, just how many they've missed! I think your"Frozen" attitude-let it go-is doing our patients a GREAT DISSERVICE. I was not trained to be thst kind of a nurse.