i have a "hypothetical" situation and i would like to get advice or feedback.
i have a friend who moved to another state and is a nurse. well here back in the "home" state i found out that her nursing license was suspended due to diversion ( not of narcotics, but one for a prescribed med and the other two were otc) and for falsifying work notes as well.
well she now lives in state b and has a current license in good standing. the two states are not part of a compact agreement.
should this be reported to state b or should i just let nature run its course and not say a word?
i have a "hypothetical" situation and i would like to get advice or feedback.
i have a friend who moved to another state and is a nurse. well here back in the "home" state i found out that her nursing license was suspended due to diversion ( not of narcotics, but one for a prescribed med and the other two were otc) and for falsifying work notes as well.
well she now lives in state b and has a current license in good standing. the two states are not part of a compact agreement.
should this be reported to state b or should i just let nature run its course and not say a word?
once again this is a hypothetical situation.
thanks!!!
nicenurse lpn
uhhh...thanfully i do not have any "friends" like you.
as i stated earlier this is apurely hypothetical situation. i only wanted to get opinions and feedback regarding this particular situation. i would not report b/c as others have pointed out, this person is states away. it was interesting to say the least about the variety of the different opinions. and fyi i am not a "barney fife" wannabe lol. it surprised me to see how hostile some of these replies were.
nicenurse lpn
i guess i'm not understanding why you presented this question the way you did. what is your question? that a nurse might use one patient's med for another patient? that such a nurse can continue to practice? whether you should report that person? that it's ok to look up someone else's license? what exactly is the question?
if it's purely an ethical conundrum, why didn't you say something along the lines of "in your experience is it ok to "borrow" another patient's meds?" or "would you report a nurse who "borrowed" another patient's meds?" or something to that effect.
also, you did not give, or perhaps i missed, the information about who she gave those meds too. did she take them herself? did she use them for another patient?
i will tell you that in some ltc/snf facilities, there is such a level of disorganization in management that there are often occasions when patients do not have the meds they need and it becomes a question that comes up daily, hourly, every shift. do you not give your patient the med they need, or do you take the med from another patient. remember, these facilities, unlike hospitals, do not have an in-house pharmacy. if you're lucky, you can track down some left over cards from a patient who has been discharged, or whose meds were changed, if not, you have to do some real soul searching about what you're going to do. hopefully then, you are able to call the pharmacy and let them know what you did, so the meds can be reconciled. it can be a real war-like experience in some of those facilities.
also, to be honest, i've never heard of a nurse having their license suspended for such an infraction. possibly, there might be a tag on it, but i've known nurses who divert narcotics who do not have their licenses suspended. they are required to go through a whole process of education and reevaluation and they get a tag, but they do not get suspended.
Especially since the new NCLEX makes nurses "think critically," as opposed to the old NCLEX, when everyone got 1,000 questions and tested over two days. (Just in case you missed that comment from a newer nurse.)
I didn't miss it, I ignored it b/c it's not a "teachable moment," lol, its just nonsense.
I am sorry you looked into this and are now faced with this dilemma. However, diversion programs are taken very seriously as a way to protect the public from impaired nurses and to help impaired nurses retain thier licenses and get help with recovery be it forced through random drug screenings, strict supervision and mandatory 12 step program attendance. The diversion program in my state lasts five years. It is a rigorous program. Usually confidential unless other circumstances. If one is not compliant with the program then it becomes public and the name of the offender will go into a notification to all BONs in the nation and the license could be revoked or suspended. If you are activley aware of an impaired nurse, in my state, it is the law through the nurse practice act to notify the board. But I have always been of the mind in any conflict situation one should approach the person first and call the kettle black try to work things out and move from there. Once again these diversion programs are rigorous and cut no slack they mess with your life... I'm talking about having to attend 12 step meetings up to six times a week for years no cut backs, random drug screenings 1-6 a month that could cost up to $38 per screen with a $27 a month processing fee. The goal is the nurse gets clean, stays in recovery, and is a safe practitioner. But with all of this it is understandable that it is hard to be compliant and want to continue the diversion program...
as i stated earlier this is apurely hypothetical situation. i only wanted to get opinions and feedback regarding this particular situation. i would not report b/c as others have pointed out, this person is states away. it was interesting to say the least about the variety of the different opinions. and fyi i am not a "barney fife" wannabe lol. it surprised me to see how hostile some of these replies were.
nicenurse lpn
how can it be hypothetical, if a real situation exists?
it sounds like you do have an interest in a particular situation....
and maybe or maybe not, have gone forward with.
as for the perceived hostility, this type of subject can evoke strong emotions from some.
it can be received as malicious, to purposely try and destroy someone's livelihood.
i really, really wish you'd move on, and worry about yourself.
pennynurse in my state the drug screens are 76.00 a pop they are observed which means you have someone with you inspecting your junk and can be up to 3x a month. not to mention iop which cost 1100.00 and the 1 year aftercare which is 1080.00 or the minimum 3 month suspended lis. then you have restrictions for at least 3 years, oh yea there is the addictionologist which is 200.00 so yes our program is very strict but thank God there is help when you want / need it
I'm not going to judge what's done in other settings, but I have never seen or heard suggested in my unit to "borrow" a med for another patient. I would go as far to say though, that if I were inclined to do this in another setting, I would draw the line at any controlled substance.
I'm not going to judge what's done in other settings, but I have never seen or heard suggested in my unit to "borrow" a med for another patient. I would go as far to say though, that if I were inclined to do this in another setting, I would draw the line at any controlled substance.
Unfortunately, this is something that is all too real in some LTC/SNF facilities, where there are no resources for patient care. Try doing a wound vac change or suction a trach without proper supplies! It's a nightmare and puts good nurses into some really difficult ethical situations all the time.
The bottom line is that it is not something a nurse would do without thinking of the consequences, however, the management of some facilities is so poor, corrupt, or disinterested, there is no accountability, no support, and no interest in providing resources to take care of a patient who is only seen as a source of revenue. The nurse is constantly being pitted against the system and administration in order to provide care, and has to do things that are not necessarily "right" in order to take care of the patient.
Those are some facilities, not all. I worked at one a long time ago and ran screaming for the hills.
What the heck? I have NEVER given another patient someone else's drug. Are you telling me that you give people's medications to other patients? You have GOT to be kidding me. I am not a wet-behind-the-ears nurse, I have 3+ years experience and work in a critical unit pushing meds all the time and I have NEVER done this and to be frank, I have never heard of another nurse doing this.
I guess I *will* have to babysit all the nurses that might take care of my parents in the future if that's the norm among nurses. For pete's sake...
When you work LTC, and meds come once a day and a patient has a med ordered that isn't in the emergency box (usually an actual tackle box you'd take fishing, or other such non-medical object), it's common to find a card with the same med and get the patient started on it instead of having to wait until the next day. If meds are delivered at 8pm, and you work days, and got the order at 9am for a daily med- you want to get it going :) It's not just yanking some random pill, or pulling something from an acute care med system. In acute care, you get your meds MUCH more quickly. In LTC, you get them when you get them. There are some situations when you can get the STAT pharmacy to deliver- and that's still a good hour away at best- but it better be a major life/death issue before dragging them out of their holes.
Don't assume something is a disaster when you haven't worked that type of nursing :)
Which is worse- finding someone else's dose of dig (the correct "new" dose) to give to a patient with a new dose change, or giving the old dose-or no dose- with risk of harm, and waiting maybe 12-24 hours to start it? Nobody likes it, but nobody likes getting dinged for not starting meds in a timely manner either. Especially w/family breathing down your neck :)
The bottom line is that it is not something a nurse would do without thinking of the consequences, however, the management of some facilities is so poor, corrupt, or disinterested, there is no accountability, no support, and no interest in providing resources to take care of a patient who is only seen as a source of revenue. The nurse is constantly being pitted against the system and administration in order to provide care, and has to do things that are not necessarily "right" in order to take care of the patient.
Those are some facilities, not all. I worked at one a long time ago and ran screaming for the hills.
I worked at a facility where meds were borrowed all the time. A nurse in another building constantly wanted to borrow Fentanyl patches. I always insisted that she come to our building and sign them out herself. When the patches for her residents came in, she would come to my building and sign the patches in. She can risk her own license, not mine.
What if your parents were in an LTC facility, and their prescriptions were unable to be filled for whatever reason, for 24 hours or more?
What if your parent was hypertensive, but their clonidine script hadn't been filled yet? What if Mr. Smith down the hall had a month's worth of clonidine? Would you rather the nurse let your parent sit for who knows how long and stroke out because you don't think the nurse should "borrow" a clonidine from Mr. Smith's supply (and pay it back when your parent's supply comes in)?
What if your parent were in pain, and their Percocet script hadn't been filled yet, but Mr. Smith had a month's supply of Percocet? Would you rather have your parent sit there in agony than have the nurse *gasp* borrow a Percocet from Mr. Smith's supply and pay it back when your parent's Percocet comes in?
Well, since it's not worth your time to respond to my post, babyRN, I'll respond for you. If it were my parent in either of those situations, I would sit back and shut the hell up and let the nurse do what they have to do to take good care of my parent. This is nowhere even near the realm of a nurse diverting controlled substances for their own use. A nurse that is willing to stick their neck out to do what is right for the patients entrusted in their care is NOT a nurse I worry might hurt someone. A nurse that is unwilling to do so, on the other hand.......
I apologize if I'm coming off as abrasive, but as you correctly inferred, I'm passionate about the subject, and as I have stated in another thread, what is legal, what is moral, and what is ethical, are not necessarily the same. Please note that this is not meant as a personal attack!
I will tell you that in some LTC/SNF facilities, there is such a level of disorganization in management that there are often occasions when patients do not have the meds they need and it becomes a question that comes up daily, hourly, every shift. Do you not give your patient the med they need, or do you take the med from another patient. Remember, these facilities, unlike hospitals, do not have an in-house pharmacy. If you're lucky, you can track down some left over cards from a patient who has been discharged, or whose meds were changed, if not, you have to do some real soul searching about what you're going to do. Hopefully then, you are able to call the pharmacy and let them know what you did, so the meds can be reconciled. It can be a real war-like experience in some of those facilities.
Also, to be honest, I've never heard of a nurse having their license suspended for such an infraction. Possibly, there might be a tag on it, but I've known nurses who divert narcotics who do not have their licenses suspended. They are required to go through a whole process of education and reevaluation and they get a tag, but they do not get suspended.
Agreeing mostly w/the above...
It's not so much about management disorganization, but the procedure for getting meds from pharmacy (and d/c'd meds should never be used for patients still in the facility- they're not supposed to be on the floor once the patient is discharged- and yes, I know it happens anyway- but those meds are destroyed by the DON/delegate and the pharmacy consultant- and depending on what they are, the d/c dates and # left have to match).
A new order at LTCs is generally faxed to the pharmacy, and the med is delivered with the next scheduled med delivery- usually in the late evening. You have to make decisions re: the patient waiting, or getting a still current med from someone else. There are 'emergency drug boxes'....they're not for "code" type emergencies- though many places keep minimal IV supplies. It's often a tackle box, filled with a 24 hour supply of antibiotics (various), cardiac meds, pain meds (minimal choices), NSAIDs that aren't floor stock, etc. It's a 'get-ya-by' kind of thing. But it's in no way exhaustive of the meds someone may need.
When patients arrived (especially on Fridays- NOTHING good comes from Friday admissions), and it was fairly early in the day, if the family had brought the meds from home (as instructed), and I told them when the meds would arrive from pharmacy, they'd be upset (understandably). If the person who had the meds w/them had also been giving them at home, I turned a blind eye if the family gave the meds needed before the hs doses (since I knew they'd be there by then). For patients who got new orders who had been there already, it's borrow (against policy), or the patient goes without. If it was something they needed sooner than the delivery time, there was no way I was going to have them wait.
If it was a pain med, when the new cards came in, a dose from the new card was replaced on the 'donor' card w/tape, so the counts were correct. (If the pain med was in the emergency box, no problem- got it there)
It was a nuisance- but most nurses did what they had to do; the DON knew what was going on- but it was a don't ask/don't tell type of thing. The patients needed the meds.
Nccity2002, MSN, RN
208 Posts
uhhh...thanfully i do not have any "friends" like you.
i'd say, mind your own business.