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?

[jadelpn, LPN, EMT-B]

Unless you see it, OP, you do not KNOW that anyone is stealing anything. There are nurses who give PRN's right on the money or close to it, as to not have a patient being in pain and playing catch up for the shift.

These are also patients who can have a great deal of anticipatory anxiety or feeling as if their pain control is not adequate, or even a manipulative edge to them.

To advocate with them, I would most certainly document accordingly, do an incident report, and even bring up to social work/MD/Case manager that the patient is stating they are not getting their pain medications--as the current regime may not be suitable or alleviating the pain.

Are you getting report on these patients? Do you have to do narc count with the nurse in question? If the answer is no, then you really need to tread carefully. To accuse based on partial knowledge of the entire situation can be career destroying.

There really are nurses who medicate on the dot, PRN or not, or within a 15 minute time frame, even a half hour if policy allows--and there are patients who will manipulate the on-coming nurse with "I did not get my meds". And what would the response be for that patient? Either "I will medicate you as soon as I am able to do so as the MD ordered" or advocating for breakthrough pain medication.

For all you know, the patient could have been on the bell since a half hour after the dose asking for more pain med. It doesn't necessarily mean that the nurse is stealing it for their own use. And the bottom line is that you do not KNOW you ASSUME given a set of circumstances that perhaps you don't practice yourself. Doesn't mean it is incorrect however, just not how you would do it.

[1sttime]

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

Lets use some critical thinking about the medication administration times- Scheduled meds are set on a schedule programmed into a computer, PRN meds are based off of a time of first dose given.

Most medication administration times do not make a difference (unless specified "must take on empty stomach" or "do not mix with") , and when you realize this and give all of the 0800,0900, and 1000 medications at 0900 plus the PRN that was due at 0800 or 1000 it sets you up for a good day...

There are plenty of hospital policies which don't make sense, and plenty of evidence based practice policy which is based on bad evidence.

The one thing that is true is to cover yourself- get the order for PRN X 1 Now, and PRN every 4 hours as needed- or have the interval changed if the RN taking the original order did not set you up for success.

[2bnpcout]

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?

agree with this. I have seen something on this nature happen first hand. A nurse reported someone else for doing something VERY inappropriate. That nurse reported it to management and a decent investigation took place from what we understand.

it was proved in the end to not be true. The nurse being accused hired a lawyer and sued the crap out of the nurse that reported her, I can't remember what they called it, maybe defamation of character.. I think. It was taken very very serious and from what we heard, the court ripped the nurse who reported in apart for having no solidifing evidence rather just word of mouth and drawing personal conclusions.

Be careful..

[Tenebrae, BSN, RN]

I work in LTC and in my country, we have alot of foreign trained nurses who often appear to be afraid of giving pain meds.

Me, if the person appears to be in pain, either by verbalised pain, or a high modified abby pain score, and they have medications due, I'll be giving it.

Fortunately all our narcs are given with a witness and both nurses sign and date the controlled drug book, the patients medication signing chart. I also document in the patients notes that I gave PRN X drug, why I gave it, at what time and with what effect.

As others have said, make damm sure you have exemplary evidence before you go trashing someones reputation and career

[SHGR, MSN, RN, CNS]

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).

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

I was thinking the same thing. I worked in a facility like this.

[Conqueror+, BSN, RN]

I would prefer to have a few nurses who were diverting slip through the cracks than to have one good hard-working nurse go down over misconceptions and outright lies

[Gillyrn08]

Many states have assistance programs for addicted nurses and coworkers can report them for investigation due to suspicious behavior. They are offered treatment and monitoring. Look it up to see what your state has. I feel like you do have the responsibility to report her for patient safety and for her safety. If she is willing to steal meds from work than she definitely has an addiction problem and is unable to help herself right now. She needs someone else to help her. If she is in the clear then an investigation will clear her, not ruin her.

[SunnyPupRN]

I work in a burn unit. Our a&o patients often recieved oxy q4hrs or even more frequently, with prn breakthrough iv, and additional prn iv + po for wound care, and scheduled oxycontin. These patients still co pain 10/10 even at rest. You've reported it, set it and forget it.

Thank goodness for nurses like you. I couldn't do burn unit. Sorry for going off track. Anyhow, I agree, chronic pain, acute pain or tolerant pts could surely be a & o. In fact, I have had med-tolerant pts accuse an off-going nurse of not giving them their dose, when I signed the med out with that nurse and witnessed the administration. Occasionally, the pt may attempt to obtain an extra dose, so there is always that possibility.

[i'm not one to label pts as 'med seekers.' I'm just offering another possibility in this scenario.]

[Jojo281950]

Report to your state regulating department and they will do an unbiased investigation. Stealing a patients pain med when they are in pain is despicable.

[GaleSRN, BSN, RN]

As a Nurse Manager, I would respond just the way your manager did. It is not appropriate to tell you the result of the investigation. Early in my career I was the victim of a drug abuser. The LVN signed out meds in my name. (I have a very easy signature to forge). She finally got caught when she did it on a day I called in sick.

Trust me, if she is stealing drugs, she will make a mistake and get caught. They all do.

[NurseD, BSN,RN]

it's my understanding a Q8hr prn can only be given 8 hours apart upon patient's request, not automatically.

[Steffy44]

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. .

at my hospital you cannot give PRN meds an hour early or late. The earliest we can give pain meds is 10 minutes early. 30 minutes like this case will get you in big trouble. I agree she better be sure. The most concerning part is the patients saying they aren't getting them. Problem is this nurse doesn't know if they are doing a deeper investigation. They aren't going to run around saying we're doing an undercover investigation.