In the past month, I have spoken to four nurses fired from their job for diverting narcotics.
Each of these nurses has denied the allegations.
All too often, hospitals, nursing homes and long term rehabilitation centers do not adequately control the narcotics.
Many hospitals dispense their narcotics through a Pyxis machine. If a nurse is wasting a narcotic, another nurse will typically witness the wasting and acknowledge this by signing off on the wasting in the Pyxis machine.
Many of the calls I receive are from nurses who work at facilities that do not have a Pyxis machine. Typically, this may be a nursing home or long term rehabilitation center.
Many times nurses are accused of diverting because of a discrepancy in the narcotics count. In nursing homes and rehabilitation centers, it is not unusual for a nurse coming on duty to experience a discrepancy with a narcotics count.
I spoke to a nurse last week, who told me that two or three times per week, when she came on duty, there was a discrepancy with narcotics. It was typically one or two pills, generally dilaudid or percocet. The nursing supervisor would come down to where my client was performing a med count and then tell the nurse from the prior shift to sign the missing pills out to a patient who typically receives these narcotics. There was no attempt by the nursing supervisor to determine where the missing pills were. In these types of facilities, I think there is an increased likelihood that a nurse could be blamed for missing narcotics.
If you are accused of diverting narcotics and you did not do so, you should take a drug test immediately. Many facilities will not even ask a nurse to take a drug test; however, if you did not take the narcotics and you are not using drugs without a prescription, you should go to your own doctor and take a drug test the same day.
What often happens is that a nurse is called in by a nursing supervisor and confronted with medication activity records or patient charts and accused of diversion. The supervisor will not allow the nurse enough time to read the charts before the nurse is asked to respond to the allegations. These meetings often end up being a witch hunt.
Other times, when the facility has a Pyxis machine, you may be accused of diverting if the amount of narcotics you give is disproportionally higher than other nurses in your unit. In those situations, nurses are often confronted by a nursing supervisor and someone from human resources and told that they give out a much higher ratio than other nurses; however, the accused nurse is rarely given time to review the Pyxis printout and offer an explanation. Therefore, what the nurse is being asked to do without looking at charts, is to give an explanation of why they may have given narcotics to a certain patient.
It is best not to answer questions about the medications that you dispense without being able to look at patient charts and Pyxis printouts.
If you have been fired for diverting narcotics, your employer is obligated by law to report you to the State Board of Nursing and the State Office of Attorney General for a criminal investigation.
If you have been terminated or accused of diverting drugs, you should contact a lawyer immediately before answering any questions. If you are terminated for diversion, it may take several weeks or months before you are contacted by the State Board of Nursing or the Office of Attorney General; however, you will be contacted by both organizations. In my experience, it is rare for the State Board of Nursing or the Attorney General's Office not to contact you. Anything you say to either agency can be used against you in a criminal prosecution.
When a nurse contacts me after he or she is fired or accused of diverting narcotics, I immediately begin my own investigation. I interview potential witnesses and gather information. Often times, I will also request the nurse to take periodic drug tests.
A thorough investigation often will often result in the Board of Nursing and the Attorney General's Office declining prosecution.
During your nursing career, you should request copies of all job evaluations. If you are ever terminated for diversion, these evaluations are extremely important in proving you are a good nurse with a proven track record. We often find that once you are terminated from your job, most employers will not voluntarily give you a copy of your evaluations.