termination. What should I do?

I work in a small outpatient surgery center, usually on the afternoon shift. I usually close the center, but on this day I was opening the center and doing the morning narcotics count, which is in the PACU area. I finished the count and was concerned about a narcotic on the shelf that was outdated by several weeks. I saw the RN, who was covering for the manager who was on vacation, come into the center. I had taken the narcotic out to speak to her about it, but she did not enter the PACU area. I went to ask her about this drug and when we came back to the PACU, she found I had left the narcotic out and unattended. There were no patients or visitors in the PACU at the time, since we hadn't started cases for the day yet. She was furious with me and stated I should put this narcotic back on the shelf, since it was on backorder. This had not been shared with her staff previously. I found out several days later that this was grounds for termination.

You did not indicate if you were indeed fired, but the situation is an example of how important it is to handle narcotics as required by law and by facility policy. Diversion of narcotics from the workplace by healthcare providers, including nurses, is common when there are staff members who are currently using. A recent study of 55 nurses admitted to a residential outpatient treatment program in Chicago indicated that of the 55 nurses studied, 40 used substances that were available at their workplace. Of those 40 nurses, 26 were diverting drugs from their employer (Bettinardi-Angres and Bologeorges (2011), "Addressing Chemically Dependent Colleagues", 2(2) Journal of Nursing Regulation).

It is unclear why the outdated narcotic was still present on the shelf. Any outdated medications, including narcotics, should be returned to the pharmacy or handled pursuant to facility policy and documented as such on required forms.

The other issue your question highlights is the importance and requirement of having two nurses do each narcotic count at the beginning and the end of a shift. When only one nurse does the count, he or she is readily open to challenge in many ways, including the accuracy of the count, the handling of the narcotics (as in your situation) and if the count is off, an allegation that it was the nurse who took the missing drugs.

If you are concerned about the way in which this was handled generally, and certainly if you were terminated or were disciplined in some other way, you can take advantage of your facility's grievance policy to try to rectify this situation. If you have some concern that the RN's reaction to the situation was excessive or unusual (e.g., is she using?), you can share this concern with the manager when he or she returns, or speak confidentially to the chief nursing officer or other person designated as the one to whom these issues should be directed.