I work at a hospital that uses pyxis for narcs and bar code med administration for giving meds. I had a pt that was hurting, I had him for 6 hrs and knew I didnt give him ivp morphine so I went to the pyxis to get it so I could scan it. I noticed another nurse took out the med but did not scan it in. pt was not her pt. I had to call the MD and say the dose was not effective and needed a different order so I did take care of the pt's pain. I have noticed this nurse taking meds out for multiple pts that were not hers, at times I have asked my alert and oriented pt's if they got anything for pain and they have stated no. in a shift most of us get into the pyxis 5-6 times to get things out, either routine or prn meds. I noticed this nurse takes 20-25 out per shift, at first I thought maybe she was just really aggressive with pain management. occasionally if we have a pt in pain on the ward and the nurse is in a procedure one of us will give the pt a prn but we would of course talk to the pt's nurse prior to giving anything. this nurse does not and the only way some of us found out they "got" a prn is by seeing the med taken out of the pyxis.
I had a pt friday that used to be a medic, she had a stress test and it was negative, that was around noon, and she was back at the ward at 2pm, when I went to dc the pt I noticed she had taken out her IV already, (pt stated she was an emt and wanted it out) no problems there. I saw on the pyxis that this nurse took out 2 2mg vials of morphine at 4:01pm and 4:27pm, her ride came about 4pm and she left about that time, the pt declined any pain at dc, the nurse didnt scan the med in the barcode system. how did she give the ivp med if there was no IV? I noticed a pattern before any of the pt's get discharged she is in the pyxis getting meds out for the dc'd pt even if it isnt hers. some pts do have long drives home and with some conditions if certainly is appropriate.
however if the pt's chest pain has been resolved why is she getting meds out for a pt she isnt even discharging.
Other nurses are noticing this as well. the nurse that is doing this is a msn nurse, she is married to a dead beat dad that works sporadically so she has to pay the child support on his 5 kids. She is vested with this employer, I generally like her. She actually got promoted to another job, she will be in charge of the hospitals palliative care program. From what I understand she will not have access to drugs in that job and they will supposedly take her out of the pyxis system it is supposed to be an administrative job. (she wanted to do overtime on the ward but they wouldnt let her because the job will be funded under a different account and she wouldnt have access to the barcode system or the pyxis. )
I guess her last day on the ward is this weekend (which I am off) and her new job starts next week.
I have noticed the discrepancies in the meds for several months (i,e, pts that are not hers getting pain meds from her and they deny getting them or say they are ineffective) in the past week the discrepancies have been massive. she has been taking out narcs based on the max prn frequency but when I go into the computer none or very few of these are documented as given.
She is a big girl (300 lbs) she did break her leg last year, she is about 50 yrs old, a good and educated nurse, the work on out ward is physically demanding and there is a lot of walking and lifting. She might just be having a lot of pain, maybe this is why she went to the desk job, or maybe she is stocking up because she wont have access any more. She wont be on my ward any more so it really isnt my problem anymore
I cant believe the powers that be havent seen where she took out so many drugs and were never documented as given. I talked with a co-worker (and a nurse) that I went to college with and we have been friends 25 years and she thinks she is just hurting because the job is too demanding physically. since she wont have access to drugs anymore she thinks we should just blow it off
what should I do with the information that I have? It can all be verified in the computer.
I feel that you are absolutely right, Connie Elder. If your charge nurse is also suspecting her but will not do anything, you need to go the next step up. I would hate for you to lose your job for not reporting something as serious as this. I am a first year nursing student and I do know nurses steal narcotics. My uncle is an RN and has stolen some for his ex wife. He, however, did not lose his licesnce. He was very friendly with the higher ups and they just terminated his position. I don't think this is fair and he should have been punished severely but there is nothing I can do. I just wish people did not have to do such horrid things like that. And to think, the nurse turning around and telling the doctor that the drug regime is ineffective? Oh my ... some serious deaths can occur and I'd greatly fear for those patients. So please, please do the moral thing and report this.
I was reading the posts and waiting to see the word "audit" - someone finally said it. Sounds like there are some holes in the system where you all work that need to be looked at. You mention that she is moving into a job without access to meds - but what about the next nurse that come along and tries this same thing? By alerting your manager to your suspicions, the hospital will at least be forced to correct their sloppy oversight. No employee should be able to get away with stockpiling narcs like this.
I kind of just opened an anonymous email account and sent the tip to the manager as a sms text message. every cell phone has an email address, like for those with verizon it is [email protected] if anyone audits the past 5 days it will be obvious who is doing this.
Wow. Good for you. A hard decision, but the right choice. Once again, I'm glad I didn't have to make it. If I ever do, I'll remember this discussion and I only hope that I, if put in a similar position, would have the courage to seek the right choice, above the easy one. This is why ignorance is bliss--but you can't be ignorant to something you really know, deep down, is the truth.
Wehn a nurse contemplates doing something like this, she needs to first of all think of her pts and what harm can happen to them? A nurse calls to tell the Dr. that the current pain regime is not working, the Dr. increases the pain medication, the nurse gives it, (since the nurse stealing the drug)is off shift at this point, the pt, goes unconscious and has to be transfered to the ICU and if the pt isn't transfered the pt receives some Narcan? This could of all been prevented if the nurse had been reported in the first place. We have to remember that we as nurses are pt. advoocates. Do not talk to this nurse who has the drug/theft problem. She will only become defensive and could turn the tables on you, especially if she somehow obtained your sign on information to the pxysis and has been stealind rugs under your name. How will a person feel if the nurse if this nurse who is stealing drugs dies off an overdose? That can't be explained to her 5 kids but maybe to her lousy husband.
This is akin to covering up for that other nurse when
I had to call the MD and say the dose was not effective and needed a different order
rather then tell the truth. Even if that nurse leaves, there could be repercussions much later and you could be in serious trouble. Like others, I agree this needs to be reported ASAP. Just read your latest post... I think you made the right decision.
I think you are a very nice person but need to report this to management, especially with her going to palliative care, even if she doesn't have access to the pixis. There is a problem here and something needs to be done about it.
Even good and educated nurses get into trouble. Those are not mutually exclusive.
I would have a meeting with my manager and tell them everything that I had observed. My manager would then run the investigation and I would be out of it. Also, this would not necessarily cost the diverting nurse her license although it would probably cost her job. My state and others have programs for nurses with drug problems. It's a strict program with monitoring but a nurse is still able to work as long as she complies with the program.
If I know of a nurse diverting and do not report it, I can lose my license. We have a duty to report.
It can be heartbreaking though when a nurse develops a problem. Consider this, we really don't know what she's doing with the meds. Maybe she's using or maybe she's selling them. Whatever she's doing it's wrong and reflects poorly on nursing.
This needs to be reported and not through an anonymous text message. You need to come forth and state all the evidence you have. This is your obligation. It sounds like she increased her diversion this week to stockpile drugs since she is leaving and won't have access to drugs in her next job.
Reporting is hard. I have done it twice in my career. Once was a person high or drunk on the job, a non nurse. The other was a diversion thing using the pyxis. Myself and another a co-worker had to testify to the Board of Nursing against a registry nurse over a year after reporting. I would advise you to write down everything you remember now, put it away for safe keeping.
The people in the best spot to notice this issue are the co-workers, not the "powers that be". Management doesn't know that a patient's IV was dc'd at 4p but a narc was checked out at 4:15pm on that patient. Management doesn't know that she is taking drugs out on other nurse's patients. It is your responsibility to report theses things when you suspect them you do not have to be 100% positive.
Specializes in ER, NICU, NSY and some other stuff.
You can also be sure that pharmacy hasa system in place to see how much medication that this nurse is taking out.
If all of your facts are true you will actually place your own license in danger by not reporting. anonymous isn't going to work later, everyone might decide to claim that they were the anonymous tipster. You can call your ethics hotline.
Umm and palliative care is an awesome place to be for someone with a diversion problem............
She may not have pyxis access, but these pts may be on pca devices, some folks will actiually steal pain patches right off he patients. Or how about. "You look busy, how bout you pull out some pain meds and I will give those for your." Then her name appears no where and the documented care giver take the fall in the end. Oh and people who NEED the meds aren't getting them and suffering.
If Nurse A finds out that Nurse B pulled narcs out of the pyxis for Nurse A's patient, wouldn't Nurse A ask Nurse B what Nurse B thought Nurse B was doing? If not, why not? Help me here. I'm just an ignorant new grad.
Sarah Hay
184 Posts
I feel that you are absolutely right, Connie Elder. If your charge nurse is also suspecting her but will not do anything, you need to go the next step up. I would hate for you to lose your job for not reporting something as serious as this. I am a first year nursing student and I do know nurses steal narcotics. My uncle is an RN and has stolen some for his ex wife. He, however, did not lose his licesnce. He was very friendly with the higher ups and they just terminated his position. I don't think this is fair and he should have been punished severely but there is nothing I can do. I just wish people did not have to do such horrid things like that. And to think, the nurse turning around and telling the doctor that the drug regime is ineffective? Oh my ... some serious deaths can occur and I'd greatly fear for those patients. So please, please do the moral thing and report this.
:redpinkhe Sarah Hay, SN