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?

[psu_213, BSN, RN]

except the 7:15 and 2:45 times

When I worked on the floor, I would have been suspicious of any nurse that got out of report by 0715 (sarcasm icon goes here)

[BuckyBadgerRN, ASN, RN]

Op, are you ever coming back?

[rnccf2007, BSN, RN]

Excellent post. My first thought to OP was ere is one nurse who gives out WAY more pain medication then any other nurse. It has always seemed weird to me but tread very carefully, when you can potentially ruin someone's life. OP states that this

[rnccf2007, BSN, RN]

Tread very carefully. You can potentially damage a nurse's career and life. Have witnessed incidences where some nurses are afraid to give pain medications (morphine prn, for example) to dying patients, because they feel it will hasten their death...I then call the doctor and get a morphine drip. Nobody should die in pain, if it can be helped. Also, have had patients..."seekers" give me BS that when the last nurse gave me my pain meds they worked...are you not giving them to me...are you giving me less? I don't play that game and always CYA.

I guess my point is to let management do their job. It takes a lot of investigation to identify a diverter. Been through this experience myself. A nurse was diverting drugs and setting up other nurses to take the fall. It took almost a year of investigation...including the DEA.

[Nursenicole1]

Sorry for the late reply. Thanks for everyone's opinions I really appreciate it. I am going to leave it alone and look for a new job. I know this nurse is stealing pain medications and I do not want to be associated with it. Some have asked why I may want to do it anonymously is because my DON and this nurse have worked together along time and are friends. I think this is part of the reason a proper investigation is not occurring. I know my DON would not like me going above her to be sure a real investigation is done.

[dishes, BSN, RN]

Did you do incident reports for the patients who said they did not receive their pain medication? An incident report is not 'going above the manager', it is advocating for patients who were harmed when they did not receive adequate pain relief and can prevent more patients from being harmed in the future.

[CoffeeRTC, BSN, RN]

As a LTC nurse, I find this very frustrating and a common occurance. I've seen it happen a lot.

if ther is one nurse that is the only person that medicates all the patients all the time and you have really good, top notch nurses on the other shifts that do their jobs and medicate PRN....There probably is something up. It escalates too. Maybe their med isn't helping them like it should (because they really aren't getting it) so the doc gets called for an increase. I've see this happen. Or a resident that might get it once a day now seems to be getting it every 4 hours like clock work when the nurse is going a double. Normally it is the more confused or non verbal resident this would happen on.

Diversion is so easy in LTC but hard to prove. What we try to do to prevent it is d/c meds that aren't used a lot. Change up the nursing assignments. If you can interview residents do that to get as much information as you can.

[heron, ASN, RN]

As a LTC nurse, I find this very frustrating and a common occurance. I've seen it happen a lot.

if ther is one nurse that is the only person that medicates all the patients all the time and you have really good, top notch nurses on the other shifts that do their jobs and medicate PRN....There probably is something up. It escalates too. Maybe their med isn't helping them like it should (because they really aren't getting it) so the doc gets called for an increase. I've see this happen. Or a resident that might get it once a day now seems to be getting it every 4 hours like clock work when the nurse is going a double. Normally it is the more confused or non verbal resident this would happen on.

Diversion is so easy in LTC but hard to prove. What we try to do to prevent it is d/c meds that aren't used a lot. Change up the nursing assignments. If you can interview residents do that to get as much information as you can.

It's good start, but when evaluating the need for those doses I think that it's important to know whether the residents whose meds are being looked at are actually showing any signs of uncontrolled pain. Increased behaviors or increased intensity of behaviors? Presence or absence of non-verbal signs of pain (there are scoring methods for this like the PAINAD scale)? Are there changes in those indications observed after the questioned doses are given, especially by staff other than the nurse under investigation?

Is one nurse overtreating or fabricating sx to cover diversion or are other staff undertreating residents who are unable to verbalize their distress?

[Pangea Reunited, ASN, RN]

Is one nurse overtreating or fabricating sx to cover diversion or are other staff undertreating residents who are unable to verbalize their distress?

Exactly. I am often the only nurse who gives pain medication to non-verbal or confused patients. It's often obvious that they're hurting, but if they can't ask, people just don't care. And I will often give them one more dose on the way out the door ...hoping it will hold them over until I come back that night. I encourage others to do the same. Sometimes they're receptive, and sometimes they're too busy taking selfies to bother.

[OCNRN63, RN]

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?

^^YES!!^^

[Quilterbeth]

Yes it is. A PRN med is not governed by the one hour rule. Giving a scheduled med is one thing, but a PRN is dictated to be given at specified intervals AS NEEDED. Giving a PRN early could constitute a med error as the PCP has specified how often these meds can be administered

[Ginger702, RN]

I think the nurse should get warned first, and if it continues happening management should get involved.