By Jackie Russell, RN BSN JD
MNA Nursing Practice and Regulatory Affairs Specialist
“There’s 50 mcgs. missing, that can’t be accounted for. Do you have any idea what may have happened to the 50 mcgs?” asked the nurse manager.
“I don’t know,” replied the nurse. “I must have given it.”
“But it’s not documented, the nurse manager said, and the pharmacy report doesn’t show it was wasted either.”
“Well,” said the nurse, “I could have lost it in my pocket. You know how you can lose drugs from the syringe into the cap? Maybe that’s what happened.”
“Sure, maybe so, but let’s review your documentation,” replied the manager. “Let’s look at your cases. Maybe you can explain what happened.”
Diversion is the transfer of a regulated drug to another person for illicit use. Did the nurse divert? Maybe, but maybe not. Either way, there may be serious implications, including loss of your job and your license. There may even be criminal charges. If you are notified by your employer there are drug discrepancies in your documentation and they need to have a chat with you, do not discuss with anyone until you have contacted your Union representative! Your Union representative will advise you on next steps.
If this nurse admits, she could be terminated for theft (depending on your contract), reported to law enforcement or the Drug Enforcement Agency (DEA), reported to the Board of Nursing, and/or be suspended and monitored by the Health Professionals Services Program (HPSP). Or, depending on the circumstances (every case is different), her employer may continue to monitor her charts for regulated drug discrepancies.
If you are a nurse with a substance use disorder, please get help. Easy to say and hard to do? There is support for you. The Minnesota Health Professionals Services Network’s (HPSP) purpose is to protect the public, but its goals are to “promote early intervention, diagnosis and treatment for nurses and other health professionals with an illness and to provide monitoring services as an alternative to discipline by the Board of Nursing.” https://mn.gov/boards/hpsp
A few tips. Don’t pull drugs for other nurses! Document your patient’s vital signs, pain control, and any procedures — from start to finish. Record all medications and be sure to record every mcg or mg of any drug pulled. Your employer is watching closely.
Great blog Jackie. If anyone needs help with substance use disorder the Nurses Peer Support Network is a not for profit resource here in MN. NPSN is a community of nurses helping nurses with substance use disorder. npsnetwork-mn.org
So important to ask for help and protect yourself, your license and of course the patients you serve.
Thank you for this blogpost Jackie. This is a great start on MNA’s part in sounding the alarm and identifying on-the-Job risks nurses face when working with narcotics and other controlled substances. Facing increasingly aggressive and extensive auditing oversight, nurses must practice with an over abundance of caution when dispensing, administering and wasting unused portions of narcotics. As Jackie indicates in her blog, whenever approached about an issue of suspected medication mis-management, always contact your union representative before answering any questions.
This is a great post!
Nothing causes me more worry than the number of nurses I see putting their patients medications in their pockets. At least once a month, I tell my coworkers how dangerous that practice is. Monitoring for diversion is very real and just having a habit of putting medications (even non narcotics) in your pockets puts you at risk for increased monitoring and suspicion.
It might be a pain, but carry medications in your hands or use a plastic bag to transport a patient’s medications from the med room to their room. That way medications are always visible and you don’t have to worry that anything gets lost in your pocket.
I think many nurses, both new and those with experience underestimate how essential it is to have a good practice around handling medications and required documentation. Once you get into the habit, it becomes second nature and protects your license and your patients.
Thank you for your comments! I couldn’t agree more.
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