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My employer says Iím required to pass controlled substances without authorization, and threatens me when I refuse to do so. What should I do?

Wednesday December 21, 2011
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Dear Nancy,

The facility at which I work is asking me to pass controlled substances to new admissions without authorization from a doctor or pharmacy to keep the patient and family happy. I am being threatened and told if I do not do this, I will be transferred or worse. My administrator tells me she can authorize controlled substances, but she is an RN herself. I keep refusing to pass them and getting in trouble for it. Also, the latest facility memo stated we must contact the administrator and ask permission to call a patientís doctor because the company loses money every time a patient goes back to the hospital. This is taking away the patientsí and the doctorsí rights and potentially causing further harm to my patients. What can I do? I know what agencies to contact, but I am aware reporting to them likely will get me fired. I cannot lose this job because I am a new nurse with about nine months of experience, and it is difficult to find a job with less than a year of experience. Do I need to seek legal counsel?


Nancy Brent replies:

Dear Hallie,

Although it is understandable you are concerned about not having a job, continuing to work in this particular facility with the requirements it places on you is very risky legally. You know to pass any medication, including controlled substances, you need an order from a licensed healthcare provider authorized to order those medications. An RN, whatever his or her title, is not one of the people authorized to do so unless he or she is given special authority under the nurse practice act, rules and statutes and other applicable laws. It would be highly unlikely he or she has that authority.

There are two issues here for your consideration: reporting the procedures to the proper authorities and continuing to work there. The two are not mutually exclusive. You can blow the whistle on goings-on in the facility and continue to work there, if you decide to do so, for example. However, continuing to be employed by the facility will create licensure issues for you if someone else reports to agencies outside the facility, which is a real possibility. Keep in mind your nurse practice act may mandate a nurse licensee report unethical or illegal conduct to the appropriate authorities.

Moreover, the administratorís decision for you to call or not call a physician is very troubling. The decision to call should be based on your assessment of the patient and his or her need for that call to be made.

You may want to share your concerns with a nurse attorney or attorney in your state who can help you sort out the legal risks of staying in this situation. Your attorney also can help guide you through the process of reporting to specific agencies.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.