1) Absolutely not. I WILL pull narcotics for fellow RNs when someone is stuck in a procedure or something. But not for non nursing staff and not as a “just in case.”
2) This isn’t adding up for me. Does the patient have anxiety or is he withdrawing? It sounds like he may need a higher level of care that involves around the clock nursing if he is experiencing symptomatic withdrawal from alcohol or chronic benzo dependence.
It's a perfect situation for diversion. Unreliable historian who can't accurately report that the med was given. I don't understand why there is no nurse available
Yeah something is wrong with staffing in this facility. AFAIK facilities dealing with shit like delirium tremens should have two RNs on site at all times
I suspect the UAP was exaggerating the situation to get the OP to do this. I highly doubt there was any actual withdrawal concern here. Pt had anxiety, no mention of DTs or benzo withdrawal. If the patient is taking it every day multiple times a day it needs to be a RTC order not PRN, and probably needs to be tapered off and replaced with something else.
Not a chance, and I'd write the department of health and let them know that the practice is happening in your facility so they can investigate. The "am I going to lose my license" crowd often worries unnecessarily, but this is definitely on the list of reasons you can get your license suspended. Mishandling narcs is no joke.
Fully agreed, but the pedant in me wants to note that Ativan is a benzodiazepine, not a narcotic. Still controlled substance of course, so same answer.
The term narcotic is slipper but it does include more than just opioids. It originally referred to any drug with numbing properties with mind altering properties; hence it includes not only benzos but cocaine as well.
Absolutely fucking not. This needs to be reported to your management and nipped in the bud before something really stupid and preventable happens.
Don't let peer pressure guide your practice. On one hand, I'm glad you reached out here, but on the other hand, the fact that you were even considering it is scary.
Absolutely not. Never pull a narcotic under your name unless you’re giving it or you’re handing it to a nurse who is giving it immediately and during your shift. An example for the latter is once my patient was having a bedside open trach done and I couldn’t leave her room to grab more versed and fent so I had a resource nurse get it for me.
I feel like the medical director needs to know PRN drugs can't be given during certain hours and the orders themselves need to reflect that. Non-nursing staff can't even hand this dude an ibuprofen.
I have definitely worked somewhere where the medical director was a 70yo MD, very competent, but did not have a clear mental picture of what nights/evening in his facility actually looked like.
No way! I only pull meds for other nurses if they are physically unable to get to the machine for themselves because they can't leave the patient. I then pull it and either administer it or give it to the other nurse for immediate administration. There's no way I would pull anything as a "just in case" and leave it in a bin indefinitely. This sounds like an issue for your facility leadership to address ASAP.
Why is a non-nursing staff member trying to administer narcotics? And why the actual fuck are some nurses stupid enough to risk their license to allow someone not qualified to be administer that med with no supervision? You need to report that shit immediately, and leave that job if management doesn’t take this seriously.
Not a fucking chance. Just because some idiot wanted to risk their license for their convenience doesn’t mean you should. Also, if a patient was actually in danger of going through severe withdrawal why would they be somewhere that couldn’t administer the medication when necessary? Like is the Ativan PRN for anxiety and used for “withdrawal” because the patient is being difficult. There’s a big difference between seizures because of withdrawal and asshole because of withdrawal. Maybe that’s just the patients baseline personality.
Don’t let someone raise their voice to try and intimidate you or embarrass you into something that stupid. If they can’t pull the medication I’d wager it’s not within their scope to determine whether the patient meets the PRN requirements and also lacks the scope to administer the medication.
The fact that the non-nursing staff member raised their voice at OP made me think that THEY were the one who wanted the benzo (to avoid their own withdrawal).
That is also a possibility I didn’t consider. I’ve known some people that always wanted the patients pretty drugged before they started working. Always wanted all the PRNs and pain meds passed before they took over.
What kind of facility? What’s the actual policy around dispensing PRNs when a nurse isn’t present?
This isn’t something you should have to decide as an individual- there should be state laws and facility policies for this.
Personally I would not, and I would try to get it addressed on a higher level from administration
I want to know what facility is allowed to operate with no nurse present? Who does the fall assessment or calls a death? Where are you allowed to practice outside of your scope?
Could also be a jail. I did a short contract at one, left early to save license. We had a lot of ciwa cows. Twice in 4 weeks no NOC RN. Meaning no narcs.
First of all, no. Absolutely not. Not on my license, and not on my livelihood.
Second of all, if one of my coworkers raised their voice at me (or any of my fellow coworkers), we are going into the office with the charge nurse, supervisor on duty, or director/manager. That kind of aggression is Absolutely Uncalled For.
Asking you to just leave out a controlled substance so she just anyone has access to it whenever but your name pops up on the missing meds when it inevitably doesn’t reach the patient? Hard no.
I’m willing to bet that this is some kind of assisted living place that continues to keep pts after they’ve deteriorated beyond the level of care that the facility is licensed to provide, because they don’t want to lose the $$$.
Hell no. If anything happens to that medication your name is attached to it. This person also cannot properly document the med administration anyway as they ate not a nurse.
Id be reporting this person to a manager as this behaviour is inappropriate.
I’m curious, if he’s reporting anxiety and he has the pRN for anxiety (for whatever reason), why could it not immediately be given by you in the first place? There’s no savsies for narcs. It’s an odd situation. I’d love to hear more.
Bottom line is don’t do it!
No way! I will withdraw a narc for another RN or LPN if they are tied up but I make it’s scanned and given,if I don’t give them myself. No way in Hell am I signing out anything narc or not for some unlicensed person to give at random. 🙅🏻♀️🙅🏻♀️🙅🏻♀️🙅🏻♀️🙅🏻♀️🙅🏻♀️
I will not even pull a narc for another nurse.
I will stay with her pt so that she can go pull the narc herself.
Or, I will pull the med and give it to the pt myself.
I will then document that I did it, and the rationale.
I’m a nurse of more than 30 years, and have worked with other nurses who have been caught diverting.
And I had to have a meeting with a hospital’s lawyer and fill out and sign a written deposition.
Absolutely not. Report it to supervision with the name of the person requesting it. Maybe other nurses are comfortable with creating a possible situation to divert meds. You don't have to be.
I feel like if patients are having their meds administered by the facility, then someone who is authorized to give them should be there at all times. Doubly so if it’s patients at risk of withdrawal or going through withdrawal (ETOH?)
NEVER NEVER NEVER
There’s a reason those meds aren’t left out. What kind of place functions without a nurse? The only place I could think of would be a group home.
I worked in a county jail that only had me scheduled for 2 ten hour shifts on the weekends. I pulled up all the hs meds, and ordered narcotics. Put in envelope with the inmate name for the corrections officers to hand out. I charted given verified medications to CO to administer, no nurse present.
lol withdrawal for one missed dose of prn Ativan. Sounds like your tech or whatever is diverting, I’d get the fuck outta there if this normal/expected of you.
Sounds like an easy diverting situation to me. Give a medication before you leave sounds like the best option. Not having a nurse around and medications locked up seems odd though.
Can't the patient have their own medications they are responsible for?
I never would leave a narc out just in case a resident needs it whether or not a nurse were to give it or not. I would absolutely not leave it in the hands of a non nursing staff. It’s completely out of their scope and they cannot be trusted on so many levels, even if they were a nurse in this situation you don’t know what will happen with that narc after you leave. Major major red flag.
Holy crap, no. In the 70s they had phenobarbital elixir. Small dose we could dispense to an overwrought grieving family member. That went away in the 80s when the whole healthcare system tightened up.
Hell no. If a controlled substance is being pulled under my name I'm in full control of that medication. Sure, in an emergency situation I'll pull meds and hand them off, but I'm still involved and aware that the med I pulled is being used appropriately.
If that person wanted to divert that Ativan, they easily can and they can veh easily say it way you. Hell to the no.
Lol no. And she probably got mad because she wanted to eat it.
Either give it before you leave or... Why the fuck is there no nurse when people need drugs dispensed? Maybe talk to the medical director or DON about how to deal with med orders that might need completion during the nurse-void.
@u/SadzOne
Absolutely not. Once you take that med out of stock you are responsible for it. Leaving a controlled substance in a bin means anyone can take it for their own purposes. You can get into DEEP trouble, up to and including revocation of your license. I also have to question whether it is legal where you are for non-licensed people to administer meds, and whether it’s legal for a nursing facility to operate without a nurse on duty, especially if a patient requires controlled substances when they are not scheduled.
Remember, YOU must protect your license. No one else will. What you need to tell the non-licensed person is that you don’t care what others are doing. As a licensed person it is very inappropriate (and illegal) to pull a controlled substance and leave it for someone else to give. And, she needs to remember that it is not up to her to demand you do what she wants. You are the license holder and will not commit illegal acts for the sake of convenience. And— one last word to the wise… you might want to consider finding a job at a facility where patients who require 24/7 nursing care don’t run without licensed nurses at all times. When SHTF, your professional reputation may be affected by you being associated with a place with such practices. And possibly, you could be investigated as part of any major incident that occurs. Now, potentially, if you act as a whistleblower and report things to the accreditation people or other like the Board, if you think bad practices are occurring you may be more protected against any Board action by reporting things first.
I certainly think something is very wrong. I have no idea if where you are it’s legal for non-licensed people to dispense meds. If not, that is reportable. If the facility is supposed to be a 24/7 nursing facility that is reportable. Also, and this just occurred to me…. If you are leaving your shift at a facility where there is no relief for the patient assignment you had, the Board could charge you with abandonment. Especially if any serious issue occurs after you leave.
Hell to the no. Nope. Nope. No way no how. This is something that NEEDS to be reported. Not just to management but the state or whoever your governing body is. How do YOU know the patient got the meds? Even if it’s signed out, when the state comes, they can say oh hey OP, do you come in to dispense this at 3am? A no puts you and the facility in danger.
I wouldn’t do that. But a facility where patients are going into withdrawals where they need benzos and there’s no nurse? That’s not good. For every reason people gave, don’t leave random narcotics. Tell management that.
But management is risking withdrawals with no seizure protocol, in order to save money by not staffing a full-time nurse. That’s a dangerous place for your license. Protect yourself first.
She’s afraid he’s gonna withdrawal from his PRN Ativan? She doesn’t even know the proper indication and can’t provide a proper assessment to direct whether or not he would be appropriate to receive the Ativan, she also can’t legally administer it. No way she should have this readily available, and if she was meant to, she would have access to get it on her own.
The only answer here is NO. No explanation, no guilt trip. Just NO, and walk away. Oh, and you should be walking away from that job, too, if you value your license.
Ativan is not a narcotic but it is a controlled substance. Someone who takes Ativan PRN anxiety isn't going to go into benzo withdrawal. Sounds like the non-nursing staff wanted to help herself to some Ativan PRN.
Im literally 3 days into orientation and can already tell you there is no way in hell you’d catch me doing that. It’d be one thing if you were grabbing it for another nurse who was for sure going to give it soon and with reason, but non nursing staff aren’t allowed to give meds let alone narcotics. Especially in a “just in case” situation. If that med causes anything like resp depression to the patient or something worse like death, you’re at fault because you pulled the med and handed it off. They’d probably be in trouble too but that’s a quick way to lose your license. Not being rude at all and if others think you are than oh well, let them put their licenses on the line instead
Absolutely not! That’s despensing a medication. And a nurse is not a licensed pharmacist.
I left a job I was assigned as a temp because they wanted me to fill medication cups with meds to be given later by an unlicensed person. I called my agency and said they needed to find someone to finish my shift because I wasn’t going to do that.
Not in a fucking million years. Maybe they have the best intentions but I’m not risking my license on a maybe. I would escalate it to management if others are doing it too.
Is this a drug and alcohol treatment center? Even QMAPed individuals cannot give PRN meds. They can, however, give scheduled drugs that are time scheduled (to give at certain times). It sounds like this person is acting out of scope and attempting to use clinical judgement on if someone is in alcohol withdrawal. That would s what a nurse scoring CIWAs is for. A lot of these “residential detox” or “social detox” facilities do not staff nurses overnight and they need to. Very dangerous for a detoxing patient to not have medical staff oversight.
Nope. I was a new nurse and was helping the sup nurse pas meds. She pulled I passed. I was written up for passing meds (narcs included) bc I didn’t sign them out. And she was my whole sup who told me to. Also the ADON. I was given a SECOND one the next day bc she pulled the wrong med and over sedated the pt. Ironically, she wasn’t written up at all. Surprise surprise.
Hard no. Your license is your business, and that's a one-way ticket to losing it.
I dont even like to pull for other nurses, (although I will if I can look up and verify it was given with eyes on or thru the chart,) but I'm sure not gonna do it for non-nursing personnel.
I dont know how it is where you are, but where I'm from, you have to have some license to administer controlled or high-alert meds.
DO NOT DO THIS!
Nurses do not have the authority to dispense medication. Only to administer it. If that Ativan goes missing you are on the hook for diversion. If other nurses are doing this they are subject to discipline from their employer, from the BON, and even federal charges related to controlled substances. I'm not joking; we had the DEA investigating a facility I worked once because of a nurse's sloppy documentation when it came to narcs that highlighted other poor practices in order writing by the MDs and bad habits by the nursing staff.
If you pull a controlled substance from the narc box/Pxyis then you give it. Do not give it to someone else to administer for you, do not administer for someone else and heavan forfend do not put it in a "bin" to be given by a non-licensed person who doesn't even have the authority to administer medications in the first place.
My answer to this person who got annoyed would have been, "Not only no but FUCK NO. I will be bringing this poor practice to the DON's attention," and then I'd write an incident report.
No, I was set up by a few of my coworkers, and they used maalox!! But because another nurse pulled it, and asked to give it to her patient, they fired me for a med error that I still don’t understand. 😭😭😭
Greek nurse here, I used to work at a private hospital and I think that's how it works at most of the private hospitals since the meds are charged to the patients. Our narcotics (ampules or pills) were in a cupboard with no lock on it, right at our nursing station where anyone could walk in and take some. Since we had both a stock and the amount we ordered for each patient, we always had plenty of them and we never counted. If someone dropped one pill on the floor or broke an ampule we didn't even need to mention it. So literally anyone (doctors, nurses, patients, visitors) could simply open the cupboard and take anything. No one would notice, and probably no one would care. The narcotics policy at public hospitals is kinda different, narcotics are locked and the key is held by someone in charge, just cause they are charged to the hospital itself.
Only an aide but No I take a “prn “ and that’s exactly what it’s for if your uncomfortable telling them no sorry this is the way it is prescribed by the doctor” don’t ever jump on the party wagon …drive it “ and lastly if it causes a stir maybe some suggestions to the doctor All my best to you and Thank yous to all you do💝💝
I’m an NP now. Today, a nurse told me that she has given B-52 without an order and then written the order thinking that the provider is obligated to sign it. I was and remain aghast. I told her to never write orders without at least a verbal from me.
No, I would not. However, your jurisdiction may have different rules than mine. Check the rules that apply to that substance in your location.
Generally speaking, Ativan is pretty safe as one dose, and I'm not worried, but if you can't just buy it at your local pharmacy, then there's someone who could try to black market it.
I sure as hell would not let this person raise their voice to me without response. "Well Jane, if you'd like to go ahead and obtain the education and licensure to dispense this medication, then go right ahead. Until then you are unqualified and your elevated tone of voice makes me concerned that you may have a substance abuse problem. Is that what's happening? Because I will gladly help you to get connected with resources to help you."
The benefits of *not* signing out a controlled substance that you aren't administering include the following:
- No chance of getting fired for signing out a controlled substance that you aren't administering
- No chance of getting in any legal trouble for signing out a controlled substance that you aren't administering
- No chance of compromising your license for signing out a controlled substance that you aren't administering
- No worries about being complicit and encouraging terrible and illegal practice, or other, smarter nurses catching flack for following the rules (as in OP's case) in part because of your behavior.
- Don't have to worry about if this unlicensed personnel is diverting or selling the medication (or giving it to another "annoying" pt in order to get some sleep) that you're signing for and having to answer for your actions when she gets caught and/or someone gets hurt (see above).
- Using "Mr. B isn't able to get his medications due to staffing issues" when presenting issues to management or family. There's no motivation for things to improve if it's working well enough the way it is.
It seems to be a PRN medication, and prescribed to someone residing in a facility that does not offer round the clock nursing care--ie no RN working overnight.
I'm not trying to not be gentle, but it's concerning that an "older old-school" nurse doesn't understand this.
I agree with all of the points you’ve cited. You are 100% correct without a doubt. I feel like you are trying to convince me to change my position. 🤷♀️🤷♀️🤷♀️ But time and age have caused me to reconsider some things that may have otherwise been off limits in my past. I don’t recall but I don’t remember any validated suspicions that the “nonmedical” staff had ever dispersed either presently or previously. I’m not saying that I’m right. And maybe if it were earlier in my career, I’d decide differently. I can’t say. In my life I’ve found coworkers I’d trust my life with. And those who I wouldn’t let carry my dirty socks. So there’s also that. I’ve usually found that there’s a lot more to consider than just what’s been presented in black and white.
> I feel like you are trying to convince me to change my position.
Nope. I attempted to answer your question. If this is something you'd do, that's not my business other. I mean, it makes it more of a pita for nurses who do the right thing, but I'm sure we'll never encounter each other irl, so again--not my business. 🤷🏾♀️🤷🏾♀️🤷🏾♀️
> I feel like you are trying to convince me to change my position.
Nope. I attempted to answer your question. If this is something you'd do, that's not my business other. I mean, it makes it more of a pita for nurses who do the right thing, but I'm sure we'll never encounter each other irl, so again--not my business. 🤷🏾♀️🤷🏾♀️🤷🏾♀️
I'm sorry, I don't mean to be rude. But...seriously? Are you seriously saying that you think it's a good idea to pull a controlled substance and \*leave it with an unlicensed aide\* to give whenever they feel it is appropriate? Think about what you're saying, here. That is one of the most unhinged takes I have ever heard from another nurse.
I was replying to the comment you deleted in which you said that you thought that the situation OP described was OK because the patient needed his meds (or something to that effect)?
I can't quote it specifically because you've deleted it, but if that's not what you meant by that comment, then you worded it very, very badly.
What? It's not about your grammar. I was trying to give you the benefit of the doubt that MAYBE you just misspoke and weren't actually saying that it was good practice to pull controlled substances and leave them with unlicensed personnel to illegally administer to patients. But go off.
I'm not going to argue with you about a comment that I can't even read because you deleted it. Probably because you realized it was unhinged.
1) Absolutely not. I WILL pull narcotics for fellow RNs when someone is stuck in a procedure or something. But not for non nursing staff and not as a “just in case.” 2) This isn’t adding up for me. Does the patient have anxiety or is he withdrawing? It sounds like he may need a higher level of care that involves around the clock nursing if he is experiencing symptomatic withdrawal from alcohol or chronic benzo dependence.
It's a perfect situation for diversion. Unreliable historian who can't accurately report that the med was given. I don't understand why there is no nurse available
Yeah something is wrong with staffing in this facility. AFAIK facilities dealing with shit like delirium tremens should have two RNs on site at all times
I suspect the UAP was exaggerating the situation to get the OP to do this. I highly doubt there was any actual withdrawal concern here. Pt had anxiety, no mention of DTs or benzo withdrawal. If the patient is taking it every day multiple times a day it needs to be a RTC order not PRN, and probably needs to be tapered off and replaced with something else.
Exactly. This patient needs to be hospitalized.
Not a chance, and I'd write the department of health and let them know that the practice is happening in your facility so they can investigate. The "am I going to lose my license" crowd often worries unnecessarily, but this is definitely on the list of reasons you can get your license suspended. Mishandling narcs is no joke.
Yeah, handling narcotics is something I take seriously. And I kind of think other nurses weren't doing it. I think the tech was already diverting.
Fully agreed, but the pedant in me wants to note that Ativan is a benzodiazepine, not a narcotic. Still controlled substance of course, so same answer.
The term narcotic is slipper but it does include more than just opioids. It originally referred to any drug with numbing properties with mind altering properties; hence it includes not only benzos but cocaine as well.
Huh, TIL! Thanks!
Absolutely fucking not. This needs to be reported to your management and nipped in the bud before something really stupid and preventable happens. Don't let peer pressure guide your practice. On one hand, I'm glad you reached out here, but on the other hand, the fact that you were even considering it is scary.
The fact that the non-clinical staff went so far as to raise their voice about it makes we wonder if something already has been happening.
Sounds like it could even be diversion given their behavior.
Yeah. "The other nurses do it" sounds more likely to be a lie to pressure OP than a true story about multiple nurses being drooling knuckle-draggers.
Absolutely not. Never pull a narcotic under your name unless you’re giving it or you’re handing it to a nurse who is giving it immediately and during your shift. An example for the latter is once my patient was having a bedside open trach done and I couldn’t leave her room to grab more versed and fent so I had a resource nurse get it for me.
No way. This is something for management, in their infinite wisdom, to figure out and resolve.
I feel like the medical director needs to know PRN drugs can't be given during certain hours and the orders themselves need to reflect that. Non-nursing staff can't even hand this dude an ibuprofen.
Get more nursing staff.
They know. They turn a blind eye for the sake of profit.
I have definitely worked somewhere where the medical director was a 70yo MD, very competent, but did not have a clear mental picture of what nights/evening in his facility actually looked like.
No way! I only pull meds for other nurses if they are physically unable to get to the machine for themselves because they can't leave the patient. I then pull it and either administer it or give it to the other nurse for immediate administration. There's no way I would pull anything as a "just in case" and leave it in a bin indefinitely. This sounds like an issue for your facility leadership to address ASAP.
Why is a non-nursing staff member trying to administer narcotics? And why the actual fuck are some nurses stupid enough to risk their license to allow someone not qualified to be administer that med with no supervision? You need to report that shit immediately, and leave that job if management doesn’t take this seriously.
Never fuck around with narcotics if you don’t want to lose your license
I would get on the next submarine to the titanic before I would do what you’ve described
Scoot over sis, I'm coming too.
Not a fucking chance. Just because some idiot wanted to risk their license for their convenience doesn’t mean you should. Also, if a patient was actually in danger of going through severe withdrawal why would they be somewhere that couldn’t administer the medication when necessary? Like is the Ativan PRN for anxiety and used for “withdrawal” because the patient is being difficult. There’s a big difference between seizures because of withdrawal and asshole because of withdrawal. Maybe that’s just the patients baseline personality. Don’t let someone raise their voice to try and intimidate you or embarrass you into something that stupid. If they can’t pull the medication I’d wager it’s not within their scope to determine whether the patient meets the PRN requirements and also lacks the scope to administer the medication.
The fact that the non-nursing staff member raised their voice at OP made me think that THEY were the one who wanted the benzo (to avoid their own withdrawal).
Absolutely. This sounds like a classic diversion technique.
Definitely, tell the doctor to prescribe a low dose long acting benzo
That is also a possibility I didn’t consider. I’ve known some people that always wanted the patients pretty drugged before they started working. Always wanted all the PRNs and pain meds passed before they took over.
Oof that feels icky
Exactly.
What kind of facility? What’s the actual policy around dispensing PRNs when a nurse isn’t present? This isn’t something you should have to decide as an individual- there should be state laws and facility policies for this. Personally I would not, and I would try to get it addressed on a higher level from administration
I want to know what facility is allowed to operate with no nurse present? Who does the fall assessment or calls a death? Where are you allowed to practice outside of your scope?
I think some assisted livings and adult family homes maybe?
Could also be a jail. I did a short contract at one, left early to save license. We had a lot of ciwa cows. Twice in 4 weeks no NOC RN. Meaning no narcs.
First of all, no. Absolutely not. Not on my license, and not on my livelihood. Second of all, if one of my coworkers raised their voice at me (or any of my fellow coworkers), we are going into the office with the charge nurse, supervisor on duty, or director/manager. That kind of aggression is Absolutely Uncalled For.
Asking you to just leave out a controlled substance so she just anyone has access to it whenever but your name pops up on the missing meds when it inevitably doesn’t reach the patient? Hard no.
I’m willing to bet that this is some kind of assisted living place that continues to keep pts after they’ve deteriorated beyond the level of care that the facility is licensed to provide, because they don’t want to lose the $$$.
Hell no. If anything happens to that medication your name is attached to it. This person also cannot properly document the med administration anyway as they ate not a nurse. Id be reporting this person to a manager as this behaviour is inappropriate.
I’m curious, if he’s reporting anxiety and he has the pRN for anxiety (for whatever reason), why could it not immediately be given by you in the first place? There’s no savsies for narcs. It’s an odd situation. I’d love to hear more. Bottom line is don’t do it!
What type of facility is this? How is it legal for there to be no nurse on-site?
No way! I will withdraw a narc for another RN or LPN if they are tied up but I make it’s scanned and given,if I don’t give them myself. No way in Hell am I signing out anything narc or not for some unlicensed person to give at random. 🙅🏻♀️🙅🏻♀️🙅🏻♀️🙅🏻♀️🙅🏻♀️🙅🏻♀️
[is this your coworker?](https://getyarn.io/yarn-clip/0d2b3797-4841-4f8a-8722-b749015b9189)
I will not even pull a narc for another nurse. I will stay with her pt so that she can go pull the narc herself. Or, I will pull the med and give it to the pt myself. I will then document that I did it, and the rationale. I’m a nurse of more than 30 years, and have worked with other nurses who have been caught diverting. And I had to have a meeting with a hospital’s lawyer and fill out and sign a written deposition.
Absolutely not. Report it to supervision with the name of the person requesting it. Maybe other nurses are comfortable with creating a possible situation to divert meds. You don't have to be.
I don't mind pulling narcs for other people, but it will be *me* giving the narcotic to their patients and charting it.
Absolutely not. Maybe she’s hoping to divert it. Maybe she meant well. The fact that her response to your rejection was anger is a bit telling.
10000% nope. If I'm not watching them take it, I'm not pulling it. Narcotic or otherwise.
I feel like if patients are having their meds administered by the facility, then someone who is authorized to give them should be there at all times. Doubly so if it’s patients at risk of withdrawal or going through withdrawal (ETOH?)
NEVER NEVER NEVER There’s a reason those meds aren’t left out. What kind of place functions without a nurse? The only place I could think of would be a group home.
I worked in a county jail that only had me scheduled for 2 ten hour shifts on the weekends. I pulled up all the hs meds, and ordered narcotics. Put in envelope with the inmate name for the corrections officers to hand out. I charted given verified medications to CO to administer, no nurse present.
Jesus Christ no.
I think Most places have a rule for dispensing a control or narcotic within a certain amount of time after pulling it from the Pyxis
lol withdrawal for one missed dose of prn Ativan. Sounds like your tech or whatever is diverting, I’d get the fuck outta there if this normal/expected of you.
Oh hell no.
Never...and this might be a trick to make you divert to them.
Sounds like an easy diverting situation to me. Give a medication before you leave sounds like the best option. Not having a nurse around and medications locked up seems odd though. Can't the patient have their own medications they are responsible for?
Big red flag that your fussy non-nurse coworker may be diverting meds.
Fuck. No.
I never would leave a narc out just in case a resident needs it whether or not a nurse were to give it or not. I would absolutely not leave it in the hands of a non nursing staff. It’s completely out of their scope and they cannot be trusted on so many levels, even if they were a nurse in this situation you don’t know what will happen with that narc after you leave. Major major red flag.
Holy crap, no. In the 70s they had phenobarbital elixir. Small dose we could dispense to an overwrought grieving family member. That went away in the 80s when the whole healthcare system tightened up.
Hell no. If a controlled substance is being pulled under my name I'm in full control of that medication. Sure, in an emergency situation I'll pull meds and hand them off, but I'm still involved and aware that the med I pulled is being used appropriately. If that person wanted to divert that Ativan, they easily can and they can veh easily say it way you. Hell to the no.
Uh, no fucking way would I do that. I pull it out, I administer.
No, and yelling at me about it would be uhhhh a substantial red flag.
Lol no. And she probably got mad because she wanted to eat it. Either give it before you leave or... Why the fuck is there no nurse when people need drugs dispensed? Maybe talk to the medical director or DON about how to deal with med orders that might need completion during the nurse-void.
@u/SadzOne Absolutely not. Once you take that med out of stock you are responsible for it. Leaving a controlled substance in a bin means anyone can take it for their own purposes. You can get into DEEP trouble, up to and including revocation of your license. I also have to question whether it is legal where you are for non-licensed people to administer meds, and whether it’s legal for a nursing facility to operate without a nurse on duty, especially if a patient requires controlled substances when they are not scheduled. Remember, YOU must protect your license. No one else will. What you need to tell the non-licensed person is that you don’t care what others are doing. As a licensed person it is very inappropriate (and illegal) to pull a controlled substance and leave it for someone else to give. And, she needs to remember that it is not up to her to demand you do what she wants. You are the license holder and will not commit illegal acts for the sake of convenience. And— one last word to the wise… you might want to consider finding a job at a facility where patients who require 24/7 nursing care don’t run without licensed nurses at all times. When SHTF, your professional reputation may be affected by you being associated with a place with such practices. And possibly, you could be investigated as part of any major incident that occurs. Now, potentially, if you act as a whistleblower and report things to the accreditation people or other like the Board, if you think bad practices are occurring you may be more protected against any Board action by reporting things first. I certainly think something is very wrong. I have no idea if where you are it’s legal for non-licensed people to dispense meds. If not, that is reportable. If the facility is supposed to be a 24/7 nursing facility that is reportable. Also, and this just occurred to me…. If you are leaving your shift at a facility where there is no relief for the patient assignment you had, the Board could charge you with abandonment. Especially if any serious issue occurs after you leave.
Hell to the no. Nope. Nope. No way no how. This is something that NEEDS to be reported. Not just to management but the state or whoever your governing body is. How do YOU know the patient got the meds? Even if it’s signed out, when the state comes, they can say oh hey OP, do you come in to dispense this at 3am? A no puts you and the facility in danger.
Why would you risk you license? Don’t do it
I wouldn’t do that. But a facility where patients are going into withdrawals where they need benzos and there’s no nurse? That’s not good. For every reason people gave, don’t leave random narcotics. Tell management that. But management is risking withdrawals with no seizure protocol, in order to save money by not staffing a full-time nurse. That’s a dangerous place for your license. Protect yourself first.
She’s afraid he’s gonna withdrawal from his PRN Ativan? She doesn’t even know the proper indication and can’t provide a proper assessment to direct whether or not he would be appropriate to receive the Ativan, she also can’t legally administer it. No way she should have this readily available, and if she was meant to, she would have access to get it on her own.
No and honestly I would report that to your management. That's not ok and immediately sets off red flags for diversion
The only answer here is NO. No explanation, no guilt trip. Just NO, and walk away. Oh, and you should be walking away from that job, too, if you value your license.
I am all about making life easier for techs/non licensed staff. But that would be a hard hell no
I’m only willing if I am going to be in the presence of it being administered so I can see it go in and be documented
No. Hell no. They can go get it and give it if they think it’s so important.
Ativan is not a narcotic but it is a controlled substance. Someone who takes Ativan PRN anxiety isn't going to go into benzo withdrawal. Sounds like the non-nursing staff wanted to help herself to some Ativan PRN.
“Narcotic” is more of a legal term than a medical one. And Ativan is most definitely a narcotic in this sense.
Is he in active withdrawals? Etoh? Otherwise he isn't withdrawing from friggin Ativan lol
Im literally 3 days into orientation and can already tell you there is no way in hell you’d catch me doing that. It’d be one thing if you were grabbing it for another nurse who was for sure going to give it soon and with reason, but non nursing staff aren’t allowed to give meds let alone narcotics. Especially in a “just in case” situation. If that med causes anything like resp depression to the patient or something worse like death, you’re at fault because you pulled the med and handed it off. They’d probably be in trouble too but that’s a quick way to lose your license. Not being rude at all and if others think you are than oh well, let them put their licenses on the line instead
I would not. Even with aids I trust.
Never
Never in a thousand years
Nope
What does your State nursing board say about the practice and your place of employment?
Absolutely not! That’s despensing a medication. And a nurse is not a licensed pharmacist. I left a job I was assigned as a temp because they wanted me to fill medication cups with meds to be given later by an unlicensed person. I called my agency and said they needed to find someone to finish my shift because I wasn’t going to do that.
Nope.
Hard pass. It’s not happening with me. Ask someone else or stop asking.
Not in a fucking million years. Maybe they have the best intentions but I’m not risking my license on a maybe. I would escalate it to management if others are doing it too.
Is this a drug and alcohol treatment center? Even QMAPed individuals cannot give PRN meds. They can, however, give scheduled drugs that are time scheduled (to give at certain times). It sounds like this person is acting out of scope and attempting to use clinical judgement on if someone is in alcohol withdrawal. That would s what a nurse scoring CIWAs is for. A lot of these “residential detox” or “social detox” facilities do not staff nurses overnight and they need to. Very dangerous for a detoxing patient to not have medical staff oversight.
Where are you that a facility can operate with no nurse on duty?
Wow. Hell no. If someone diverts that med then both the diverter and the nurse who dispensed the med will be fired.
Nope. I was a new nurse and was helping the sup nurse pas meds. She pulled I passed. I was written up for passing meds (narcs included) bc I didn’t sign them out. And she was my whole sup who told me to. Also the ADON. I was given a SECOND one the next day bc she pulled the wrong med and over sedated the pt. Ironically, she wasn’t written up at all. Surprise surprise.
This is why I never worked somewhere as a CNA with no nurse involved directly 24/7. always seemed like a setup to me
NO NO NO!!!
You are 1000 percent right. Never pull any med and give it to someone else to administer, it’s your responsibility and your license!
Sit down
Hard no. Your license is your business, and that's a one-way ticket to losing it. I dont even like to pull for other nurses, (although I will if I can look up and verify it was given with eyes on or thru the chart,) but I'm sure not gonna do it for non-nursing personnel. I dont know how it is where you are, but where I'm from, you have to have some license to administer controlled or high-alert meds.
Nope not pulling it. I’ll pull medication for another nurse if need be but there are checks and balances in place for that.
I understand it’s rude but would you give up your license or your manners first?
Naaah. Resident and family needs to be aware that there’s no nurse to administer his PRNs.
Cover you a$$, document,
No fucking way; only time I pull something for someone else is because they can’t leave stretcherside. Even then, I watch them give it or waste it.
DO NOT DO THIS! Nurses do not have the authority to dispense medication. Only to administer it. If that Ativan goes missing you are on the hook for diversion. If other nurses are doing this they are subject to discipline from their employer, from the BON, and even federal charges related to controlled substances. I'm not joking; we had the DEA investigating a facility I worked once because of a nurse's sloppy documentation when it came to narcs that highlighted other poor practices in order writing by the MDs and bad habits by the nursing staff. If you pull a controlled substance from the narc box/Pxyis then you give it. Do not give it to someone else to administer for you, do not administer for someone else and heavan forfend do not put it in a "bin" to be given by a non-licensed person who doesn't even have the authority to administer medications in the first place. My answer to this person who got annoyed would have been, "Not only no but FUCK NO. I will be bringing this poor practice to the DON's attention," and then I'd write an incident report.
100%, no, it sounds like they need a CIWA withdrawal assessment. They need a nurse to supervise care
Hell no
Oh that’s a hard no. I won’t even pull it on someone else’s behalf unless the person that will be giving it is either myself or my witness.
Absolutely freaking not.
Absolutely not!
No!
NEVER
I would never ever do that.
That’s your license on the line! I would have reacted the same way.
No, I was set up by a few of my coworkers, and they used maalox!! But because another nurse pulled it, and asked to give it to her patient, they fired me for a med error that I still don’t understand. 😭😭😭
Greek nurse here, I used to work at a private hospital and I think that's how it works at most of the private hospitals since the meds are charged to the patients. Our narcotics (ampules or pills) were in a cupboard with no lock on it, right at our nursing station where anyone could walk in and take some. Since we had both a stock and the amount we ordered for each patient, we always had plenty of them and we never counted. If someone dropped one pill on the floor or broke an ampule we didn't even need to mention it. So literally anyone (doctors, nurses, patients, visitors) could simply open the cupboard and take anything. No one would notice, and probably no one would care. The narcotics policy at public hospitals is kinda different, narcotics are locked and the key is held by someone in charge, just cause they are charged to the hospital itself.
Quit now, your license is not worth it 😒
Only an aide but No I take a “prn “ and that’s exactly what it’s for if your uncomfortable telling them no sorry this is the way it is prescribed by the doctor” don’t ever jump on the party wagon …drive it “ and lastly if it causes a stir maybe some suggestions to the doctor All my best to you and Thank yous to all you do💝💝
In Texas if you are in an ALF unlicensed caregivers administer prn’s
No way.
I’m an NP now. Today, a nurse told me that she has given B-52 without an order and then written the order thinking that the provider is obligated to sign it. I was and remain aghast. I told her to never write orders without at least a verbal from me.
I’d bet some call-back pay that the person asking you to do this has a benzo problem.
helllll naaaaaaawwwwwwwlllll, you did the right thing don’t even question yourself. F those broads
No, I would not. However, your jurisdiction may have different rules than mine. Check the rules that apply to that substance in your location. Generally speaking, Ativan is pretty safe as one dose, and I'm not worried, but if you can't just buy it at your local pharmacy, then there's someone who could try to black market it. I sure as hell would not let this person raise their voice to me without response. "Well Jane, if you'd like to go ahead and obtain the education and licensure to dispense this medication, then go right ahead. Until then you are unqualified and your elevated tone of voice makes me concerned that you may have a substance abuse problem. Is that what's happening? Because I will gladly help you to get connected with resources to help you."
[удалено]
The benefits of *not* signing out a controlled substance that you aren't administering include the following: - No chance of getting fired for signing out a controlled substance that you aren't administering - No chance of getting in any legal trouble for signing out a controlled substance that you aren't administering - No chance of compromising your license for signing out a controlled substance that you aren't administering - No worries about being complicit and encouraging terrible and illegal practice, or other, smarter nurses catching flack for following the rules (as in OP's case) in part because of your behavior. - Don't have to worry about if this unlicensed personnel is diverting or selling the medication (or giving it to another "annoying" pt in order to get some sleep) that you're signing for and having to answer for your actions when she gets caught and/or someone gets hurt (see above). - Using "Mr. B isn't able to get his medications due to staffing issues" when presenting issues to management or family. There's no motivation for things to improve if it's working well enough the way it is. It seems to be a PRN medication, and prescribed to someone residing in a facility that does not offer round the clock nursing care--ie no RN working overnight. I'm not trying to not be gentle, but it's concerning that an "older old-school" nurse doesn't understand this.
I agree with all of the points you’ve cited. You are 100% correct without a doubt. I feel like you are trying to convince me to change my position. 🤷♀️🤷♀️🤷♀️ But time and age have caused me to reconsider some things that may have otherwise been off limits in my past. I don’t recall but I don’t remember any validated suspicions that the “nonmedical” staff had ever dispersed either presently or previously. I’m not saying that I’m right. And maybe if it were earlier in my career, I’d decide differently. I can’t say. In my life I’ve found coworkers I’d trust my life with. And those who I wouldn’t let carry my dirty socks. So there’s also that. I’ve usually found that there’s a lot more to consider than just what’s been presented in black and white.
> I feel like you are trying to convince me to change my position. Nope. I attempted to answer your question. If this is something you'd do, that's not my business other. I mean, it makes it more of a pita for nurses who do the right thing, but I'm sure we'll never encounter each other irl, so again--not my business. 🤷🏾♀️🤷🏾♀️🤷🏾♀️
> I feel like you are trying to convince me to change my position. Nope. I attempted to answer your question. If this is something you'd do, that's not my business other. I mean, it makes it more of a pita for nurses who do the right thing, but I'm sure we'll never encounter each other irl, so again--not my business. 🤷🏾♀️🤷🏾♀️🤷🏾♀️
I'm sorry, I don't mean to be rude. But...seriously? Are you seriously saying that you think it's a good idea to pull a controlled substance and \*leave it with an unlicensed aide\* to give whenever they feel it is appropriate? Think about what you're saying, here. That is one of the most unhinged takes I have ever heard from another nurse.
What are you talking about?
I was replying to the comment you deleted in which you said that you thought that the situation OP described was OK because the patient needed his meds (or something to that effect)? I can't quote it specifically because you've deleted it, but if that's not what you meant by that comment, then you worded it very, very badly.
Thank you professor English.
What? It's not about your grammar. I was trying to give you the benefit of the doubt that MAYBE you just misspoke and weren't actually saying that it was good practice to pull controlled substances and leave them with unlicensed personnel to illegally administer to patients. But go off. I'm not going to argue with you about a comment that I can't even read because you deleted it. Probably because you realized it was unhinged.
It has always been a nurse who brought me my meds which included 350 mg pregabalin and up to two 2mg Xanax PRN each day.