Weird meeting with manager

Rainyjanie · Mar 22, 2017

I once worked at a hospital that had a new nursing class for a rather large amount of new hires. They brought in the pharmacy board and they stated, "Look around. 1 in 10 of you will be a narc diverter". It was unnerving to think that, but I am quite sure that there probably are people out there diverting. I think this crack down by your employer is probably driven by this current uptick out there in opioid abuse. Sadly, a think a lot of good, honest nurses are micro scrutinized. I knew of another nurse who was targeted by a hospital because she was really, really good at managing patient's pain. She made sure that patient's did not have to play "catch up" with their pain meds and the hospital scrutinized here for being too good. I asked her once if she was nervous and she said, "I know the truth. And the truth will always prevail." If you know the truth, you don't have to worry about anything.

Julius Seizure · Mar 22, 2017

If at all possible, I would try to make sure someone always saw me giving and wasting narcotics, and really did watch me, rather than just "witnessing" without watching, like often happens when staff are busy. You may need those people to vouch for you later.

Maybe you could offer to help change the system at your hospital to make narcotic administration a better system. It sounds like they need the help!

amzyRN · Mar 22, 2017

I'm not nervous about it, just kind of hurt. For some reason, it hurt my feelings that my manager could actually think for a minute that I would steal from them. I would hope that the truth would prevail, as I have not been prescribed pain meds in years, only when I had my wisdom teeth removed. Of course, I would test negative for any drugs, nor have any record of taking any drugs of any drugs which can be verified. I have heard horror stories of people being targeted though which would be a nightmare for me to have to defend myself, but I would certainly do so and would also sue for defamation.

I think that real diverters have some kind of record behind them for doing so. I doubt there would be no record of using narcotics for treatment. There was a nurse who spoke to my old unit a few years back who said that she was prescribed a med for migraines and eventually got hooked on them and started diverting narcs over time. I have never heard of someone randomly stealing narcotics from their employer. I'm not saying this can't happen, but think it's probably unusual.

amzyRN · Mar 22, 2017

It sounds like your department gives out narcotics like candy. Is this normal? Do you attract a lot of drug seekers?

We do and I think many ED's "attract" drug seekers. Narcs are prescribed far too often. I'm starting to think that people should hardly ever get them unless they are in the hospital having surgery or something or have cancer, severe chronic back pain, or some similar condition.

JadedCPN, BSN, RN · Mar 22, 2017

I'm not nervous about it, just kind of hurt. For some reason, it hurt my feelings that my manager could actually think for a minute that I would steal from them. I would hope that the truth would prevail, as I have not been prescribed pain meds in years, only when I had my wisdom teeth removed. Of course, I would test negative for any drugs, nor have any record of taking any drugs of any drugs which can be verified. I have heard horror stories of people being targeted though which would be a nightmare for me to have to defend myself, but I would certainly do so and would also sue for defamation.
I think that real diverters have some kind of record behind them for doing so. I doubt there would be no record of using narcotics for treatment. There was a nurse who spoke to my old unit a few years back who said that she was prescribed a med for migraines and eventually got hooked on them and started diverting narcs over time. I have never heard of someone randomly stealing narcotics from their employer. I'm not saying this can't happen, but think it's probably unusual.

I think you need to educate yourself more on diversion. Not all people who divert meds actually use the medication for themselves, some of them give them to family members, sell them, etc. So you not testing positive for medications would be completely irrelevant in regards to the actual diversion aspect.

I also think you are taking this way too personal if it hurt your feelings that your manager questioned your practice. It sounds like there are multiple issues with the practice now, both on a personal level with you not being careful, covering your a**, sloppy practice, not doing your five rights, as well as with the actual system in place in the ER itself. Regardless, your manager appears to have a legit reason to question your narcotic practice based on the scenario you presented, so do not take it personal.

Been there,done that, ASN, RN · Mar 22, 2017

They tell us that the HCAPPS are low because of pain management. They tell us that we need to advocate better pain control for patients and that we are falling behind and that the nurse being the patient advocate needs to speak up. Pain is the 5th Vital sign. In fact a pain crisis will bump acuity up in the ED and management of it becomes the greatest priority second only to life-saving intervention. We are reminded of our low scores at least once a week. Our charts are monitored if someone is above a 4 on the pain scale, they will ask us why we have not treated the pain.

Whatever "they" tell you , does not mean you are exempt from errors.I get it, but YOU made an error, not the system. You are feeling pressure to medicate ASAP, slow down and do it right.

Ruby Vee, BSN · Mar 22, 2017

I work in a busy ER and am constantly giving pain medications. We have an error-prone system where it's easy to pull a narcotic on the wrong patient and administer it to a different patient. This has happened numerous times to people on my unit. They are also very particular about timing of narcotic medications, if you are over 15 minutes late in giving the med, they write you up. My last ER job, narcotics couldn't be pulled without a physician order being verified and you couldn't override narcotic meds. This made it easy to avoid these stupid errors. There was one incident where I forgot to chart a narcotic. The patient was writhing in pain and I gave the med and probably forgot to scan it. I feel bad about these things and feel like an idiot. Not only that I was interrogated by my manager who in the course of the meeting the way she spoke to me made me feel like she thought I was stealing medications, which no one has ever accused me of. I have never every stolen anything in my life.
Not only do I feel like an idiot but now feel so weird, like they think I'm a narc diverter at work and don't trust me. I also worry if I make another mistake I will be fired. I have never ever given narcs so much at this hospital and the system they have makes it easier to pull the meds on the wrong patient. I might make a mistake again because of the frequency of giving the meds. I will try very hard to be careful, but now I feel so bad about my job, nursing in general, like the hard work I do is unrecognized and the mistakes are all that stands out.

Forgetting to chart a narcotic is a different thing from your system making it easy to pull narcs on the wrong patient. Have you made more than one error? It sounds as if the meeting with your manager was appropriate -- forgetting to chart a narcotic, especially when you're new to a job -- is a big red flag. You are now on the radar -- quite appropriately, I might add. Nothing weird about it at all.

We all make mistakes, I'm the very first one to say that. But it sounds as if you're being dismissive of the potential for future mistakes because you don't like the system. Increase your vigilence instead of decreasing it.

Ruby Vee, BSN · Mar 22, 2017

I'm not nervous about it, just kind of hurt. For some reason, it hurt my feelings that my manager could actually think for a minute that I would steal from them. I would hope that the truth would prevail, as I have not been prescribed pain meds in years, only when I had my wisdom teeth removed. Of course, I would test negative for any drugs, nor have any record of taking any drugs of any drugs which can be verified. I have heard horror stories of people being targeted though which would be a nightmare for me to have to defend myself, but I would certainly do so and would also sue for defamation.
I think that real diverters have some kind of record behind them for doing so. I doubt there would be no record of using narcotics for treatment. There was a nurse who spoke to my old unit a few years back who said that she was prescribed a med for migraines and eventually got hooked on them and started diverting narcs over time. I have never heard of someone randomly stealing narcotics from their employer. I'm not saying this can't happen, but think it's probably unusual.

You are taking this far too personally, and it appears that you know nothing about drug diversion.

Esme12, ASN, BSN, RN · Mar 22, 2017

We do and I think many ED's "attract" drug seekers. Narcs are prescribed far too often. I'm starting to think that people should hardly ever get them unless they are in the hospital having surgery or something or have cancer, severe chronic back pain, or some similar condition.

Oh amyz....I am so sorry you are going through this...it sucks. However, as an ER nurse I am going to give you sage advice that has accumulated over an extensive career and you might not like what I have to say.

The ER is a very dangerous place and not in the way you think. Over crowding, low scores, inexperienced ER management, and a blind self serving greedy senior administration can be lethal to RN's. We are pushed and shoved, and stretched to the max that it is near impossible to keep up and keep everything straight.

But....as a nurse with a license it is imperative that you follow policy and procedure to the letter. In the ER we are expected to be...perfect. Yes, I know...we are overwhelmed and that is administrations advantage. Your last job was 100% correct about not being able to remove narcotics without and order.

I would check your policy carefully and I am willing to bet there is a policy about verbal orders. Many ER's have this policy however...they seldom follow it until they want to because there has been an..."INCIDENT". Every "INCIDENT" that is followed up on has to have a corrective action with too often the nurse is the corrective action. We are expendable. We do not generate revenue.

I know we are human but we are not allowed "mistakes". I know that is unfair but it is the truth. You know from school...if it wasn't charted, It wasn't done. As of right now you removed a controlled substance, possibly without an order, and there is no documentation as to what was done with that controlled substance. Yes...they can report you to the BON and yes you can be terminated. Yes the BON can take action...

1) failure to properly document a controlled substance.

2) behavior consistent with diversion

3) behavior inconsistent with prudent nursing standards (five rights)

4) Patient placed in "danger" related to the lack of documentation...possible overdose

5) Failure to follow policies and procedure.

Failing to document administration of narcotics properly is a patient safety issue, the risk being that a patient could potentially suffer a negative outcome if another dose was administered because an earlier dose was not documented. Being aware of the potential consequences and failing to do the required documentation is serious misconduct for a nurse.

http://www.nursinglaw.com/discrimination-religious-institution-exemption.pdf

http://www.rn.org/courses/coursematerial-10004.pdf

I know this is scary stuff but it is very real if they wish to pursue you. Find and read the actual policy regarding the administration of narcotics in the ER. Many ER's that I have worked and managed have strict "NO VERBAL ORDER" policies unless it is a code situation....for this very reason. I have seen MD's bold face lie to safe their own behind. I have seen stellar nurses fall victim to bureaucratic malarkey because they needed "a corrective action".

I am not trying to scare you. I am trying to impress upon you how important it is to educate yourself...the hospital won't do it for you. They want you uninformed so they can control you. If you don't have malpractice insurance...get it. I hated the shenanigans hospitals did...but for 37 years I have loved my patients.

Knowledge is power. ((HUGS))

BedsideNurse · Mar 22, 2017

They tell us that the HCAPPS are low because of pain management. They tell us that we need to advocate better pain control for patients and that we are falling behind and that the nurse being the patient advocate needs to speak up. Pain is the 5th Vital sign. In fact a pain crisis will bump acuity up in the ED and management of it becomes the greatest priority second only to life-saving intervention. We are reminded of our low scores at least once a week. Our charts are monitored if someone is above a 4 on the pain scale, they will ask us why we have not treated the pain.

Pain is the 5th vital sign--a catch phrase pushed by our government to the 10th degree for years (think Big Pharm lobbyists), and patient surveys (and the money attached), are essentially what put us in the heroin crisis we have now. We've learned nothing; still giving narcs out like candy to all.

amzyRN · Mar 22, 2017

Forgetting to chart a narcotic is a different thing from your system making it easy to pull narcs on the wrong patient. Have you made more than one error? It sounds as if the meeting with your manager was appropriate -- forgetting to chart a narcotic, especially when you're new to a job -- is a big red flag. You are now on the radar -- quite appropriately, I might add. Nothing weird about it at all.
We all make mistakes, I'm the very first one to say that. But it sounds as if you're being dismissive of the potential for future mistakes because you don't like the system. Increase your vigilence instead of decreasing it.

There were 3 times I pulled a narc out under a similar sounding name and administered it to the patient it was intended for. Pharmacy was able to go and correct these once the error was located (ie the dose removed from pyxis was traced to a patient med administration) This is the common issue that occurs frequently in the department. There was one time where I removed a dose of Dilaudid (with a physician order) and it did not get charted. Because the patient was crying I may have me just given him the dose without scanning first and forgot to scan after. It was a repeat dose, I knew the patient and dose I was giving. I've done this with a seizing patient too, give first then scan. That is the first time in my career that I have ever not documented a narc given.

My plan is to print a label every time I have a new patient and bring it to pyxis so that I know that I'm pulling it on the right patient. Then I'm going to always scan or chart narcs before I give them even if the patient is writhing in pain. No more am I going to put myself at risk. If this takes longer too bad.

Been there,done that, ASN, RN · Mar 23, 2017

"There were 3 times I pulled a narc out under a similar sounding name and administered it "

Stop right there. You bypassed the first 2 rights of medication administration ..the right patient and the right drug.

"This is the common issue that occurs frequently in the department. " So, if your friends jump off the bridge.. you would follow.

Take responsibility.