Unsafe Practice by Coworker

[EmpathyInAction]

I started a new job about 10 days ago working in a SNF where my patients still need a lot of acute care. Patients with fresh surgical wounds, feeding tubs, PIC lines, etc. With serious conditions. The nurse that I typically relieve has some really bad habits including leaving meds where they shouldn't be. The thing is that apparently she has been doing this for a while and the other nurses I have been training with are like "oh, ya, she does that". She has a lot of bad habits, the meds is just the worst of it and everyone acts like it's normal. She's leaving meds that she has pulled to give to patients in random places in the med cart. Like a cup with 5 or 6 meds just sitting in the cart. Her logs show she has given all her meds but then I find two or three of these cups in the cart. To me it means that people aren't getting their meds (including narcotics). I just don't really know what else to do since this is considered normal to my coworkers. I talked to some friends who are nurses and they said basically to talk to her and don't tell. I don't want to be an outcast in a new place, but I really feel like this is something that should be corrected and not view as "ok cuz it's typical". It shouldn't be typical. Thoughts?

[calivianya, BSN, RN]

The way she giggles about "forgetting" to chart narcs is alarming to me. I would want a third person involved in every narc count so it can't turn into a your word versus hers kind of situation. Would it be possible to set this up that there is always a third party watching the narc count?

[jadelpn, LPN, EMT-B]

The nurse in question is really setting herself up for quite the diversion scam. Ya'll know she leaves med cups in the cart. And she has set herself up to be a nurse that everyone just adores "That wacky nurse that everyone loves" then ooooppppsss giggle, giggle, snort " I totally gave that Vicodin, OMG, I totally remember that now...." then "I just forget to chart and waste.....you know how I am!!"

I don't think you have any other choice than to get a third person to stand amazed and confused while this nurse's idea of a narcotic count is happening, or to have discussion with your nurse manager.

[bluegeegoo2, LPN]

I have worked behind nurses who were "funny" with the count as you describe. My personal practice in those situations is to have them hold the narc book to where I can see the numbers they are calling out myself to verify the number they tell me is the actual number of meds on the card and in the book. It would be waaaay too easy for a diverter (not saying she is, for the record) to tell you that there's 12 norco when there's only 10. If that happens then obviously you're count will be off and YOU look like the diverter.

I also worked behind a nurse who left a cup of meds behind in the top drawer of the cart. The cup happened to be full of narcotics. I had a med aide for that cart and since the meds were not discovered until a bit into shift, management "couldn't" put it on the nurse. Fortunately the med aide was absolved as well, but still. That nurse was eventually termed for diversion on other incidents.

I have also had plenty of experiences where I found a cup of meds at shift change and the off-going nurse genuinely forgot to give them and was grateful for me finding them. Maybe the resident was OOP or in therapy or an activity or getting their hair done. It happens. It shouldn't happen daily though.

The point is if something feels "off" about someone's behavior there's probably something to it. Be careful and protect yourself.

[EmpathyInAction]

That's exactly it! Something feels off. Either she has a complete lack of concern for procedure or she's intentionally not doing things properly. Either way, it's bad. I went ahead and spoke with the shif nurse manager last night. She apparently had been told that "someone" was leaving cups with "1 or 2 vitamins" in the cart. We had a quick but thorough chat and she said that they would be doing some random cart audits during her shift. She was also already aware that this person has a habit of not signing out narcotics. I am glad I spoke with her. I became a nurse because I feel I am meant to care for others. I also believe strongly in the service of others. I am not properly serving my patients by doing nothing about the situation. I have to protect my license as well. Thank you for all your replies.

[caliotter3]

It didn't take me long working in LTC to figure out that I had to do a drawer by drawer search of the med cart before accepting the keys.

[TriciaJ, RN]

The way this nurse is doing narc count should make the count sheets look odd. It would appear that on all her shifts there would be multiple entries for narcs signed out just prior to narc count. It would be her signature on them, no one else's, but OP's signature would be on the subsequent narc count. Which could make her look like an accomplice. I'm glad OP reported this and that the facility is taking this seriously. It's really tough to be the new person and have to deal with a glaring problem like this. And shame on the other nurses for laughing it off all this time.

[lovinglife2015]

I had not yet addressed the other RN. This is my first time encountering a situation like this, which is why I was seeking advice.

I'm curious why you wouldn't simply ask her? It's a very serious problem. Talking to her would've been my first plan of action. Reporting her, my next.

[EmpathyInAction]

Although I didn't explicitly say so, I've still been working with a preceptor as Im very new to the facility. I guess I thought it was an obvious inference. My preceptor is one of the other nurses who treated this as normal. So as I said, I felt unsure how to handle the situation.