URBANDALE, IA — The Iowa Board of Nursing has issued a warning to a licensed practical nurse following allegations that she misappropriated patient medications from an Urbandale care facility, according to state regulatory records.
Rachel Blair, 35, of Windsor Heights, was working at an unidentified long-term care facility on December 3, 2024, when staff discovered discrepancies during a routine medication count, as reported by the Iowa Capital Dispatch. The facility identified one missing fentanyl patch during Blair's shift, regulators allege.
During that same work period, Blair collapsed to her hands and knees and had difficulty standing, according to the board's allegations. Emergency medical personnel responded to the scene and administered Narcan — a medication used to reverse opioid overdoses — to Blair, state records indicate.
The Iowa Board of Nursing charged Blair with misappropriating medications belonging to a patient or facility. Rather than pursuing formal disciplinary action, the board reached a settlement agreement that includes an official warning. Under the settlement terms, Blair must participate in the Iowa Practitioner Health Program and comply with all program requirements, according to regulatory documents.
Blair's nursing license remains active without practice restrictions as a result of the settlement.
Prior Disciplinary History
This incident marks the second time Blair has faced charges from state nursing regulators. In 2020, the board filed charges against Blair stemming from her conduct while employed at a county correctional facility, as reported by the Iowa Capital Dispatch.
According to board allegations, Blair worked at the Polk County Jail in April 2019 when she engaged in personal telephone conversations with an incarcerated individual. Regulators alleged that some of these calls contained sexually explicit content.
Jail officials terminated Blair's employment after she allegedly provided treatment to an inmate without a physician's order and admitted to having romantic feelings for an incarcerated person, according to the board's case file.
Law enforcement records indicate that another inmate reported to jail staff that a nurse, later identified as Blair, had been providing tobacco, drugs and sexual favors to an individual known as "Casper." A search warrant application filed by the sheriff's department stated that Blair acknowledged providing unauthorized massaging treatments to this inmate approximately 15 times over a four to six week period in a private treatment room, according to court documents.
An examination of recorded jail phone calls revealed communications between Blair and the inmate that included sexual content and references to a personal relationship, the warrant application stated. Investigators also discovered 199 text message exchanges between Blair and the inmate, including 21 photographs of Blair, according to law enforcement records.
The warrant application further alleged that money had been deposited three times into the inmate's account by someone using the name "Clare Loren" — with Loren being Blair's middle name and the name associated with the text messages, according to the sheriff's investigation.
Blair allegedly admitted to destroying potential evidence during the initial investigation, according to the search warrant application.
Following that 2020 case, the Board of Nursing suspended Blair's license pending completion of a mental health evaluation and required her to complete educational coursework on professional boundaries. After the suspension period ended, regulators placed Blair's license on probation for two years.
Medication Diversion in Healthcare Settings
Federal regulations require healthcare facilities to maintain strict controls over controlled substances, including detailed documentation and regular inventory counts. The Drug Enforcement Administration mandates that facilities implement security measures to prevent medication diversion by staff members.
When medication discrepancies occur, facilities must conduct investigations and report findings to appropriate state and federal authorities. Licensed healthcare professionals found to have diverted controlled substances typically face both regulatory action from their licensing boards and potential criminal prosecution.
Many states have established practitioner health programs designed to help healthcare workers address substance use disorders while maintaining public safety. These monitoring programs typically include treatment requirements, random drug testing, and practice oversight.
Resources for Families
Families concerned about medication management or quality of care at long-term care facilities can contact the National Long-Term Care Ombudsman Resource Center at 1-800-677-1116. Ombudsmen serve as advocates for nursing home residents and can investigate complaints.
The Iowa Department of Inspections and Appeals oversees health facilities in the state and accepts complaints about care quality, safety concerns, and regulatory violations. Families can also report concerns directly to local law enforcement if they suspect criminal activity.
Healthcare professionals who witness potential diversion of controlled substances have a legal obligation to report such incidents to facility administrators and appropriate regulatory authorities.
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