Would you agree that it is okay for a CNA and an RN to do the daily narc count?

[JaredCNA, CNA]

It has always been my understanding that narc counts are done by two RN's or an RN and an LVN in the hospital setting. Of course, this may be only my understanding because I've never seen it done differently.

At 0400 the charge nurse told me to help her count the Omnicell. She's been a nurse for 29 years and worked at this particular hospital for the past 17, so I assumed she was aware of policies and what-not. However, she asked me because the other nurses were busy with admits, so when one of them showed up at the desk, she told me nevermind and had one of them do it.

Does the policy on narc counts vary from facility-to-facility, or is there an organization or policy (Nurse Practice Act or state BON, for example)? If it is a facility policy, then I can find it. But I'm not comfortable counting with a nurse if there are state policies against or if it is a violation of the nurse practice act.

[pagandeva2000, LPN]

I wouldn't feel too comfortable doing it unless there is a policy that states it. And, to be honest, I would question any place that states that an unlicensed person can count narc, even with an RN. If the other nurses were too busy, she should have waited.

What you can do, though, is give your state BON a call or send an email asking them if this is allowed. I know my BON is great for responding quickly to emails as well as sending copies of their position regarding any question I asked about.

[JaredCNA, CNA]

Pagandeva,

I understand what you are saying. I was confused because I know that the nurse who delegates a task or asks a CNA to assist with a task is held ultimately responsible for the outcome and accepts responsibility since we are, in a sense, acting under their license.

There's a gray area, and I will probably be better off asking the BON if it is okay, then checking facility policy. I am not very comfortable with doing it, even if it is allowed, because I do not know anything about discrepancies or how to resolve them, or even if they are resolved properly against the system count.

However, if it is allowed by the BON and my facility, I also don't feel comfortable refusing a task that is delegated to me.

[medicrnohio, RN]

I would check with facilty policy first. Even if the BON allows it, facilty policy may not. That being said, it has always been my understanding that narc count must be done by two licensed nurses.

[ilstu99]

It has always been my understanding that narc counts are done by two RN's or an RN and an LVN in the hospital setting. Of course, this may be only my understanding because I've never seen it done differently.

At 0400 the charge nurse told me to help her count the Omnicell. She's been a nurse for 29 years and worked at this particular hospital for the past 17, so I assumed she was aware of policies and what-not. However, she asked me because the other nurses were busy with admits, so when one of them showed up at the desk, she told me nevermind and had one of them do it.

Does the policy on narc counts vary from facility-to-facility, or is there an organization or policy (Nurse Practice Act or state BON, for example)? If it is a facility policy, then I can find it. But I'm not comfortable counting with a nurse if there are state policies against or if it is a violation of the nurse practice act.

I would say no to that. I don't know how yours is done, but we have to have access to the Omnicell medication system in order to witness a count because it asks for our username/password. Our CNA's don't have Omnicell access.

I did glance at the Texas statutes, and I think the only exception to "no" might be a medication aide permit holder. Otherwise, if I can't delegate it, I doubt I can share it either.

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=11&ch=224&rl=Y

[RN1989]

I have worked in multiple states and it was never ok for any unlicensed person to get near narcs, much less count them.

[chevyv, BSN, RN]

I worked as a PCA in a hospital and had to count with the rn every shift. She counted and I ok'd the count and witnessed to the lock up. I always wondered why a PCA would be part of that. After reading this thread, I would have looked up the policy. I'll remember this for my future. Thanks all.

[Smokey9283]

I used to count Narcs when I was a TMA at a LTC facility. That being said, I am guessing that narc reconciliation checked in hospital protocol. At the hospital that I work at, we have the pyxis system. The pharmacist and pharm tech do narc reconciliation not the nurses.

[HeartsOpenWide, RN]

I have worked in multiple states and it was never ok for any unlicensed person to get near narcs, much less count them.

I live in California and am am in a BSN program. Before that I was a CMA (still am technically, just not actively) and we were allowed to do narc counts as well as dispense them (mostly in injection form, before I left our office got rid of all PO narcs and now only uses injectable forms; except for the liquid pharmaceutical cocaine, but only the docs can use that!!--for nose cotarizations...)

The way I observed narc counts done in the hospital is one nurse counts and the other write down and confirms that that is the number. I do not see why a CNA could not at least confirm "yes I see 6 of X pills too"...it not rocket science, and it does not require critical thinking skills...but I would defiantly check with the facility first!

[hisblueskies]

I don't think the nurse should have asked you to do it and she could get into trouble for doing so. Only licensed nurses are permitted to do narcotic counts. You need to let the floor manager know what happened.

[leslie :-D]

i've had an aide count w/me 1 time.

i had no choice, and would have rather had the signature of another witness than to receive and sign alone.

leslie

[pagandeva2000, LPN]

I am seeing so many blurs with the titles and scope of practice, that no wonder there is always confusion. I can see, maybe if the CNA is certified to administer medications, but even then, traditionally, narcotics has been the domain of the nurses back in my day.

This is why slowly, but surely, they take nursing as a joke. I am not saying this to criticize or down CNAs-nothing of the sort! But, where is the line drawn and WHEN?