[Tweety]

cantoo, thanks for telling your story. I'm glad that unlike steelcityrn (who certainly is entitled to her/his opinion) that someone had some tolerance and that someone believed in you and now your are in recovering, an a productive member of the nursing community. Congrats on the promotion!

[Bipley]

Originally Posted by steelcityrn

I personally have a zero tolorence for a nurse who has stolen medication and or uses drugs and is able to keep a nursing license.

We ALL have our issues in life and nobody is exempt from that. Nobody. For some it is drugs, for others it is something different.

Perhaps you don't happen to have an issue with drugs, cool. But just as everyone else you have an issue with something and maybe it involves patient care more than you realize, maybe it doesn't.

Sticking to hard and fast judgments of people or groups of people doesn't really do anyone any good. Mostly, it's just not productive.

[Dalzac]

I am on the Peer group here in my state I mean I am on the committee. I have worked with addicted and recovering nurses. Here if you self-report nothing goes on your license that you were even in peer, but if you are mandated to go to Peer it is on your license.
I was diverting drugs about 19 yrs ago and I quit nursing for about 3 yrs just terrified I would divert drugs again I just thought that getting away from them I could stop. I was wrong. I missed nursing so bad it ached. My family intervened and I went to treatment after I got out of treatment I got my license back. AMazinly I had nothing on my license. I hve been drug and alchohol free since 1986. I volunteer at the BON to help others just like me because I know it can be done. Nurses are NOT addicted forever. they go to AA and NA and stay clean.

[SmilingBluEyes]

I am so glad to hear from those of you who made a clean life and were able to get back on track. You are proof we can't draw an absolute hard line in situations like this-------good people who earnestly want to rehab, should be allowed to. Nurses are no different than the general population; we are just as vulnerable to addiction issues and their consequences, and should be allowed the same chances as anyone else to redeem ourselves and move on.

[ZASHAGALKA]

I was very interested in your comments, Bipley about how the pyxis machines work. Most times, I just figured that not only is every screen monitored, but that there is prob a video cam somewhere in the vacinity.

But, you know, quite often, I go back through my patients profile to see when I gave something to chart after the fact. I normally do that a few times per each of my pts per shift. And sometimes I do it to see if I can give the med again. I guess now I wonder how that looks to pharmacy.

You know, my biggest concern was always if pharmacy would bother to match up my non-narc withdrawals to how close I actually gave them to normal administration times. . .

I always figured that if pharmacy was REALLY interested in diversions, they could just set up a program that monitors the average number of narcs all nurses pull per unit and develop a bell curve and see who are the outliers. That wouldn't be proof mind you, some nurses are more sensitive to monitoring and treating pain than others, but I bet the diverters would be extreme outliers.

It's hard to imagine that anybody could beat the system for long if it were truly monitored.

~faith,
Timothy.

[Zoey65]

Gianna, Good Luck. I hope you are able to stay with your children. I think a lot of us have the potential to become addicts, and have no idea how we keep from it. I had the experience when I was weekend supervisor at a LTC facility of a nurse coming to me to tell me that she was sick and had taken one of the pts phenergen. I don't know if she was wanting help? I felt bad for her (she was a good nurse and a nice person), but I had to tell someone. I gave her the opportunity and she turned herself in and was allowed to just quit her job. I don't know what happened after that. I hope she was able to get straightened out.

[Bipley]

Originally Posted by ZASHAGALKA

I was very interested in your comments, Bipley about how the pyxis machines work. Most times, I just figured that not only is every screen monitored, but that there is prob a video cam somewhere in the vacinity.

But, you know, quite often, I go back through my patients profile to see when I gave something to chart after the fact. I normally do that a few times per each of my pts per shift. And sometimes I do it to see if I can give the med again. I guess now I wonder how that looks to pharmacy.

You know, my biggest concern was always if pharmacy would bother to match up my non-narc withdrawals to how close I actually gave them to normal administration times. . .

I always figured that if pharmacy was REALLY interested in diversions, they could just set up a program that monitors the average number of narcs all nurses pull per unit and develop a bell curve and see who are the outliers. That wouldn't be proof mind you, some nurses are more sensitive to monitoring and treating pain than others, but I bet the diverters would be extreme outliers.

It's hard to imagine that anybody could beat the system for long if it were truly monitored.

~faith,
Timothy.

No, nothing like that would be monitored, lots of nurses do that. They usually do random reports on people/pods. Or, let's say the NM believes Mary Jones, RN is diverting. Mary won't be told she is suspected of anything, instead pharmacy will be notified and they will set the computer to do auto reports daily. They don't even have to be done manually on a daily basis, the computer will be set to add Mary's report along with all the other daily reports the Pyxis sends out anyway.

Someone in Pharmacy will go through all the reports and upon seeing Mary's, that report will either be giving to the person who handles that or the dept head. (When I was a pharmacy tech going through those reports was my job.) They will monitor and see what kinds of screens Mary is looking at. Is she looking to see all the patients on her pod that are on MS04 10mg syringes? How much time does she spend on narcotic screens? Is she pulling reports for patients she isn't taking care of? They can monitor every single keystroke, they can see every single screen Mary saw, they can essentually duplicate every action Mary took while she stood at the Pyxis. For some nurses that can be 50-100 pages for one day alone.

They will look to see how much is being wasted. If a doc orders 6-10mg MS04 is the nurse pulling 3-2mg syringes or 1-10mg syringe for a 6mg dose? During the beginning of the war many hospitals were running out of Morphine and the nurses were told to only pull what they needed. If it was 6mg, use 3-2mg syringes vs. 1-10mg syringe. Then we looked to see who was witnessing the wasted drug, was it the same person each time? Was it witnessed at all?

This is done over a long period of time. If things look weird then they usually pull a drug screen on the nurse, or they start putting management in there to do floor work for a few days to see if Mary will have the same exact behaviors. Same waste, same reports, same everything.

Then they pull charts and see if people are complaining of pain more on Mary's shifts than they are on everyone else's shifts. They pull ALL the med error reports for Mary, it's actually quite comprehensive.

There is a lot of stuff inbetween all the above but that's a general run down. It's really common sense stuff.

There are no hidden cameras in Pyxis that I am aware of, but many hospitals will have cameras on the really busy Pyxis machines, but they are obvious. There are some things that obviously, I'm not going to write about here but suffice it to say, it's amazing what computers can do today and what kinds of reports can be pulled and what extremes some hospitals will go to, to catch someone diverting. Lesson for all of us here, just don't take the drugs.

Keep in mind, they will do the same thing for non-narcotics too. If a certain antibiotic (especially the expensive ones) come up missing, even though it doesn't require a witness to fix the inventory, it still shoots a report to pharmacy. When Mary Jones pulls one Zithromax tablet and the next nurse comes along and discovers there are 6 fewer Zithromax than what should be, it sends a report to pharmacy. Usually nothing is done about this other than a report. But the computer can be set to notify staff if this is a regular issue. It's AMAZING how many antibiotics, BP tabs, statins, etc. come up missing from the Pyxis. Lots and lots of nurses use the Pyxis in place of Walgreens or OSCO. It's stealing and I've seen nurses fired for that too. Not all Pyxis machines permit you one tablet of a given drug only. Sometimes you have to count the rest and key it into the screen.

Another issue is when you pull the drug vs. when you give it. It has to be set manually to auto report that but it can be looked up at any time. It usually isn't an issue unless there is a problem or if it is all narcotics that are not given on time. If you pull Morphine out 2 hours before you give it, that can be a problem.

[talaxandra]

I haven't had much experience with drug addicted nurses, but I can see how easily it could happen. I've had frequent headaches (several times a week) since I was at school; before I started nursing I couldn't swallow tablets, and you have to really want to take something if you need to chew it! I got my first migraine a few months into my course, and between that and a concern about becoming one of those can't-swallow-pills patients, I learned how. And once I could, I started taking analgesics for my headaches. And then, knowing that a couple of Panadeine Forte (500mg paracetamol and 30mg codeine/tablet), which I was prescribed for migraines, would get rid of a headache, I strated using them for headaches too. It never became a problem, but only because my unit started treating patients with rebound headaches (due to overuse of analgesica and anti-migrainoids) and I saw my future.
It gave me a much better insight into at least one route to drug use, and I think has made me a better nurse. If I judged fellow nurses, I would also be judging all drug-dependant people, and I think that would be wrong.
As others have posted, we're people as well as nurses, and therefore at least as subject to the frailties of the rest of our race.

[boysmom32]

I am new to this site as of today and I found it by searching for info on drug addicted nurses. I would like to share my story and see if anyone has any advice on what I can do next.
I have been an ED nurse for 3 years and I had back surgery in2004. This past May I began to have excruitiating pain and my FNP prescribed Dilaudid tablets for me. I knew the first time I took one that I should never take another because it made me feel so much different than the narcotics that I had taken in the past ( Lortab & Percocet).. When I finished the prescribed amount I was at work one night and I felt like I was going to die. The pain and physical symptoms were overwhealming. Looking back, I can honestly say that I thought I was going to die that night. I went to the drug cabinet and got injectable Dilaudid and took it. The next morning I reported what I did to nursing administration. I was fired for stealing but not reported to the police. I contacted Tennessee's Peer Assistance Program that day and went for assessment the next day. I was assessed and told that I had to go into a 90 day Impaired Professionals Program the next day or I would be reported to the state board. The cost of the program would be approx. $30,000. I no longer had insurance and I share custody of my 2 children and had to provide half of their support. I made the decision to search for another job and went to a private A & D counselor for 2 months until I could no longer afford it. I have not taken anything stronger than Ibuprofen since then. I had not been contacted by anyone from the board or TNPAP. The job I got was also in an ED. I never had an urge to take any narcotics but I found that each time I went to the OmniCell to pull a narcotic, I froze and began to panic. This caused me to pull an incorrect med one day. I immediately pulled the correct narcotic and gave it. The problem came when I didn't immediately return the incorrect med. I was suspended for keeping the med on me for several hours and was terminated. I have been contacted by Peer Assistance that the hospital reported this. I am at a loss of what to do. I was and still am willing to go to treatment for addiction. I no longer want drugs, but I can see how easy it would be to lapse back into it. I know that I will have to agree to TNPAP's contract or lose my license, but I cannot see that my only option was the $3,000 treatment. I will have to lose my license and seek a non-nursing job. I am a good and competent nurse with over 12 years experience. My experience with TNPAP has been that the program sounds good and the intention to allow rehab and return to nursing is great, but the requirements are rigid and do not take into account the financial and personal obligations of the nurse. I would appreciate hearing from others who have been involved with Peer Assistance and any advice on what my options are.

[Darlene K.]

gianna2111 I'll keep you in my prayers.