The Keys- working with nurses on probation

[christinaquilter]

I am not starting this post to decry the fact that there are nurses on probation for drug related offences. I'm making this post to ask you to tell me how to work with them. Safely and legally. I will relate the following info and ask my questions:

Two days last week a nurse new to our facility was giving to me to "train". She was to receive only two days of training and then be on her own. On the second day of her training I was, of course, also filling the position of two regular staff nurses (working two nurses desks.) At the end of her second day of training I "gave her the keys" and allowed her to pass the evening meds (after all, she's own her own in a few hours) and count narcs with the oncoming nurse. The count was correct. No problem.

Two days later, After she "no-calls, no- shows" up for work, I find out that she's on probation for drugs and cannot legally carry narc. keys. Now the count was right, but whether or not any patents actually received the meds she signed she gave is between her and God.

I ask you, where does the liability lie? (Other than with her!) My work was AWARE of this when they hired her... yet it was NEVER communicated to me. Could they have told me? After all, it is public record. Am I liable at all? Is there anyway to prevent this in the future? (Aside from looking up the licenses of everyone else I work with?!?) Due to the no-call she will no longer be working at my facility but am I required to report this in anyway?

Does it make matters worse when I mention that my DON is ALSO on probation for (An OLD) drug-related offence? I think she's a LITTLE touchy about the subject, and I wont find any support there...

Thank you for your replies,

Christina

[canoehead, BSN, RN]

If they didn't tell you about restrictions on her licence there was no reason for you to treat her with any more caution than any new employee. I think you are faultless. In the future though, it might be wise to ask specifically, and request a written introduction letter from the DON that addresses license restrictions, and previous experience for all new employees. for myself, I would be very blunt about why I needed that letter, but you may choose to be a little more vague.

[exnursie]

the only person at fault is the nurse with the restriction who accepted the keys and knew her restrictions. it is also too bad that she was put in that place , ie given the keys while supposedly still orienting and was trained when so short staffed.

i think that the situation she was placed in was something that she did not expect, and while reacting wrong, she was also somewhat set up to fail. if it is customary to only orientate for 2 days, and to be short staffed, maybe she realized that the job was not safe or appropriate, and apparent that it would be difficult to follow the key restriction after what was thrown at her??

instead of assuming she stole drugs and called in because she was using, is it possible the count was accurate, and she did not come back because of the job itself??

i believe that is against hippa to disclose anyone health history and to inform the staff is not allowed. it is also part of the ada act and would be discriminatory. also, 40 + states have alternate programs that do not disclose discipline to the bon if the nurse enters voluntarily and is compliant with the terms. so, a nurse can be an addict and in recovery and no one has that info unless she chooses to share it. even if the bon is involved, and it is published, that is not an indication that narcs are restricted.

i suggest you do some research about addiction and nurses and recovery . i suspect you have negative ideas and you may be surprised to learn some facts instead of using generalizations and prejudicial views. people in recovery are some of the best workers out there, but they keep quiet because of the stigma and judgmental people who have false and unbending views.

[LoriAlabamaRN]

Regardless of your hesitation due to the DON's past history, you need to go to her. When that nurse accepted the keys, she knowingly violated the terms of her probation. This needs to be reported to the BON- you have an obligation to do so.

Lori

[ZASHAGALKA, RN]

You are not at fault, but you still have to protect yourself.

The nurse with the restrictions KNOWS her obligations and failed to live up to them.

The facility failed also. But there might be a question whether your boss failed here, or YOU DID. And that might come down to her word vs. yours. And in that case, YOU handed her the keys.

While you aren't at fault, I WOULD BE THE ONE TO REPORT THIS - and get your side of the story out, first. If your facility has a standing peer review committee, I would file a peer review complaint (against the restricted nurse, but with enough information that you are ALSO stating your case in protection of yourself). Don't go through your boss, file it directly with the committee - you have that right. Your policy book should tell you exactly the steps to do this.

You should do this because what happens, after the fact, IF your supervisor says she specifically told you.

If you don't have a standing peer review committee, you should skip your boss in the chain of command and file an incident report to HER BOSS. You have every right to skip a level of chain of command when you think the complaint will have repercussions to you IF you use that link. And the complaint is two-fold - against that nurse, and against the situation that led to her working on probation and it not being told to you or staff.

You should have some protection - if YOU didn't know, then nobody else at or below your level did. At the least, an email or other posting should have been sent to EVERYBODY warning them of the restrictions on the nurse and warning against surrendering narc keys. That is the key component of the program: that it is 'open knowledge'. But it will be easier to prove this now then later.

Finally, This is key. That program is a 'second chance' - not a third, fourth, fifth, etc. She needs to be reported to her program. Each State has a different name for that drug abuse nurse program, but the program HAS to know this, so they can file their findings with your BON and permanently bar her from working as a nurse. Either your peer review committee HAS to do it, or you do.

It doesn't matter if she took any narcs, or not. She violated the terms of her probation.

~faith,

Timothy.

[exnursie]

Wow!! You guys are brutal!!

To think that it is OK to broadcast her recovery facility wide is mind boggling!!

News flash!!

Addiction is considered a disease, and while some disagree, until the AMA changes this, there are HIPPA laws in place!! And confidentiality laws. And discrimination laws!!

To err is okay, to repeatedly err is not. Timothy needs to get his facts right, there are many states that allow multiple chances, and this action of taking the keys is a minor one, and one that was not taken advantage of or repeated.

She was placed in a spot that should never have occurred, and by not coming back signifies that she realized the danger there. Unless she diverted and you have proof, your report is wasting taxpayers money. Or maybe not. The BON could look into the inadequate supervision and lack of monitoring and assigning a task to a new nurse who was not adequately prepared to do the job independently. Probation aside. she was treated wrong.

Has anyone of you that is so anxious to crucify this nurse considered what it would be like to be in her shoes??

Imagine that for just one day you had to ask coworkers to give your narcs, having to interrupt them to do your work? To have the guts to even look for work in this position takes a lot of courage . To deal with such moronic and fear filled thinking seen here just magnifies the situation.

[BKRN]

Wow!! You guys are brutal!!

To think that it is OK to broadcast her recovery facility wide is mind boggling!!

News flash!!

Addiction is considered a disease, and while some disagree, until the AMA changes this, there are HIPPA laws in place!! And confidentiality laws. And discrimination laws!!

To err is okay, to repeatedly err is not. Timothy needs to get his facts right, there are many states that allow multiple chances, and this action of taking the keys is a minor one, and one that was not taken advantage of or repeated.

She was placed in a spot that should never have occurred, and by not coming back signifies that she realized the danger there. Unless she diverted and you have proof, your report is wasting taxpayers money. Or maybe not. The BON could look into the inadequate supervision and lack of monitoring and assigning a task to a new nurse who was not adequately prepared to do the job independently. Probation aside. she was treated wrong.

Has anyone of you that is so anxious to crucify this nurse considered what it would be like to be in her shoes??

Imagine that for just one day you had to ask coworkers to give your narcs, having to interrupt them to do your work? To have the guts to even look for work in this position takes a lot of courage . To deal with such moronic and fear filled thinking seen here just magnifies the situation.

I do not think that anyone is trying to crucify this nurse. They are simply telling the OP what her OBLIGATIONS are. I do think that this incident should be reported to the BON. Why should the OP put her licsense at risk? It's not like she is being a tattle-tale. The nurse in recovery should not have taken the keys-she is an adult. Yes, it may "suck" to have everyone looking over your shoulder but this is what happens when you are placed in a position of trust and YOU CHOOSE to do the wrong thing.

Having said that....I do feel sympathy for those with addiction I am sure that it is difficult to beat. But, I feel more sympathy for those patients that may have missed their pain meds because of someones selfishness.

I would report this incident to the BON and would not feel guilty about it. If she did nothing wrong than nothing will come of it.

[ZASHAGALKA, RN]

Wow!! You guys are brutal!!

To think that it is OK to broadcast her recovery facility wide is mind boggling!!

News flash!!

Addiction is considered a disease, and while some disagree, until the AMA changes this, there are HIPPA laws in place!! And confidentiality laws. And discrimination laws!!

To err is okay, to repeatedly err is not. Timothy needs to get his facts right, there are many states that allow multiple chances, and this action of taking the keys is a minor one, and one that was not taken advantage of or repeated.

She was placed in a spot that should never have occurred, and by not coming back signifies that she realized the danger there. Unless she diverted and you have proof, your report is wasting taxpayers money. Or maybe not. The BON could look into the inadequate supervision and lack of monitoring and assigning a task to a new nurse who was not adequately prepared to do the job independently. Probation aside. she was treated wrong.

Has anyone of you that is so anxious to crucify this nurse considered what it would be like to be in her shoes??

Imagine that for just one day you had to ask coworkers to give your narcs, having to interrupt them to do your work? To have the guts to even look for work in this position takes a lot of courage . To deal with such moronic and fear filled thinking seen here just magnifies the situation.

My facts are straight. You agree to waive HIPPA to be part of this program. Part of this program is private mentoring, but part of it is that EVERY nurse you work with must be aware that you are in the program so that more eyes are upon your actions and behaviors.

That is the law. You don't have to comply - but you don't have to get your license back, either.

You can't hide behind confidentiality laws while you are in this program.

And I seriously dispute the fact that a recovering addict purposely breaking rules regarding access to narcotics is a minor violation. That is a career ending violation - and she was told that from the start.

~faith,

Timothy.

[Altra, BSN, RN]

Wow!! You guys are brutal!!

To think that it is OK to broadcast her recovery facility wide is mind boggling!!

News flash!!

Addiction is considered a disease, and while some disagree, until the AMA changes this, there are HIPPA laws in place!! And confidentiality laws. And discrimination laws!!

I disagree. The issue is not the confidentiality of the health status of the nurse, but the fact that the OP stated that this nurse was on probation and could not carry narc keys as a provision of that probationary work/license status.

[babynurselsa, RN]

This is a RESTRICTION. This nurse knew it as did administration. Do you not think it would be useful information for the person orienting her to know????

If I was orienting someone with experience I would not think twice about whether it was appropriate or not for her to have access to the keys UNLESS I had been advised otherwise.

So along your line of thinking it would be a violation to pass on the info that this person has a lifting restriction?

[Barb2000]

I work with nurses in this type of program, and each state is different on requirements of the key restriction. In Florida, the nurse does NOT have to tell EVERYONE she works with. Only her supervisor (the charge nurse if on nights), and whoever is going to be the person to pass her narcotics since she/he is not able to do this. The supervisor fills out reports that get sent to the board if they feel the nurse is having problems. It is the nurses responsibility to let that charge nurse know about the restriction, and ensure that someone else will handle the passing of those meds. I also hadn't been told by admin about one of the nurses with this restriction, BUT she told me as she is required to for her first night of work. And a few times other RNs tried to hand her the keys, or get her to count meds, and at that time she did tell them NO, and when asked, explained why. She didn't have to tell them why, if she didn't want to, but she did have to refuse the keys, and anything else associated with narcs. It's too bad that admin did not pass this on to staff, but still, it is the restricted nurse's responsbility to inform those who need to know. States also monitor a restricted nurses employment status, and if they quit, the state wants to know why. So, they will eventually find out anyway. And if she took the meds, a required random drug screen could pick this up. The DON should be approachable on this subject. If she agreed to hire the nurse with the restrictions, she should have ensured things were set in place to help her be successful in her return to work. It could just be that the nurse realized it was too difficult to work at that place, that the DON didn't at least care enough about the nurse to assist with her re-entry into nursing with restrictions, and felt it was better to just not return as she was risking relapse at that facility. She may have already notified her monitoring counselor of the situation. The DON should have a copy of her restrictions with her counselor's name and phone #, so she should be the one to follow up on this. As a recovered addict herself, I would have expected her (or him) to have handled this better for everyone involved.

[ZASHAGALKA, RN]

I work with nurses in this type of program, and each state is different on requirements of the key restriction. In Florida, the nurse does NOT have to tell EVERYONE she works with. Only her supervisor (the charge nurse if on nights), and whoever is going to be the person to pass her narcotics since she/he is not able to do this. The supervisor fills out reports that get sent to the board if they feel the nurse is having problems. It is the nurses responsibility to let that charge nurse know about the restriction, and ensure that someone else will handle the passing of those meds. I also hadn't been told by admin about one of the nurses with this restriction, BUT she told me as she is required to for her first night of work. And a few times other RNs tried to hand her the keys, or get her to count meds, and at that time she did tell them NO, and when asked, explained why. She didn't have to tell them why, if she didn't want to, but she did have to refuse the keys, and anything else associated with narcs. It's too bad that admin did not pass this on to staff, but still, it is the restricted nurse's responsbility to inform those who need to know. States also monitor a restricted nurses employment status, and if they quit, the state wants to know why. So, they will eventually find out anyway. And if she took the meds, a required random drug screen could pick this up. The DON should be approachable on this subject. If she agreed to hire the nurse with the restrictions, she should have ensured things were set in place to help her be successful in her return to work. It could just be that the nurse realized it was too difficult to work at that place, that the DON didn't at least care enough about the nurse to assist with her re-entry into nursing with restrictions, and felt it was better to just not return as she was risking relapse at that facility. She may have already notified her monitoring counselor of the situation. The DON should have a copy of her restrictions with her counselor's name and phone #, so she should be the one to follow up on this. As a recovered addict herself, I would have expected her (or him) to have handled this better for everyone involved.

I know in Texas, you aren't allowed to work the night shift while in TPAPN.

And the rules are different, I know. I am aware of the rules here because I have seen several people in the program, but in all honesty, not since the advent of point of care narcotics dispensers (pyxis) that don't require actual narc keys. At that time, all the nurses needed to be aware so that the keys didn't inadvertantly get passed to that nurse.

These days, it probably is an issue of the nurse only has to tell the people getting her narcs for her.

~faith,

Timothy.