[suprnurse]

Would you report a nurse to management who diverted a non-narcotic medication? I did so, & am being asked to sit down with this nurse and the nurse manager. It was a bizarre situation. The medication was a prep for a procedure, & this nurse removed it from the patient's room, then took the medication herself. I just wonder if, when we do sit down, this will be treated as a conflict between 2 employees, rather than what I feel it is. Meaning, questionable practice by a nurse. Any ideas?

[mattsmom81]

Very interesting thread.

Jen, I sure can relate to your story as there was a time I was in severe pain and still trying to work (I was waiting for a herniated disc to heal..80% do..so I hung in there) I was afraid to take narcotics for pain..and in retrospect suffered needlessly for too long before I finally had surgery to correct the problem.

Nurses with chronic pain are exposed to a lot of suspicion as soon as the drug count is off, unfortunately. But the use of vicodin or other narcotics for treatment of pain does NOT make an impaired nurse, nor does it make a drug diverter.

I know a nurse who wears a low dose Duragesic patch for untreatable pelvic pain (adhesions.) She functions well and her life is semi normal due to proper pain control. She does home health and does a great job.

If I have chronic unrelenting pain (that cannot be cured), and I am healthy and able/willing to do my job safely, and a narcotic makes it possible for me to be productive and enjoy a normal life...then I should be able to receive pain control, IMHO. And without raised eyebrows or funny looks, suspicions from coworkers. (Be careful who you share this type of info with, I've found)

I believe pain and pain control is easily misunderstood. Particularly chronic pain ..."She doesn't LOOK like she hurts."...

I believe too many health care professionals still undertreat (vs overtreat) pain. Due to recent patient rights laws, we now have a 'right' to pain control and I am glad to see this. Yes, analgesic use should be monitored closely for proper use, potential abuse...but proper use of analgesics is NOT abuse.

I agree with everyone who felt laxity in narcotics wastage can contribute to medication diversion. It should be like a 'standard precaution' to witness each other draw up the proper dose and waste the remainder right then....keeps us all honest

I have worked with 4 excellent nurses who are recovering alcoholics or CD's and they all were upfront with coworkers, and asked us for our support. They got it..and are doing well in their sobriety. My hat's off to them and they're all good nurses in my book.

[fab4fan]

I also have a chronic pain condition and am on daily meds for it. You would never know it to see me; in fact, if I did not take my medication I would look questionable.

If monitored closely, needing to take pain meds for a legitimate reason should not preclude someone from working. However, I sure would not show up for work with pus running out of my ears...that's a huge risk IMO.

[montroyal]

The problem with abuse and habitual use of narcotics in nursing is widespread. I am amazed though that most of these post are looking at this problem from the nurses point of view only. Anyone who deverts drugs, is stealing from a patient! Addiction is a medical problem but does not relieve a person from being accountable for the actions. We can treat the addiction but we are also patient advicits and must watch out for the patients rights to be upheld. If my family member was in pain because of deversion, I would make sure the person responsible was delt with by the law, and aren't we supposed to treat our patients with the same level of care and respect. As far as habitual(daily) users of narcotics,even if perscribed by a physcian, we must look at this problem from several different prespectives. In most states in this country, if you are a daily user of a narcotic, even if prescribed by a MD, you are not allowed to have a drivers liscence. Most states BON require a medical review of each case, were strong evidence must be presented to support the nurses intention that they are "okay to work". Finally, the patient and their family have the right to know if their nurse is taking a narcotic and be giving the opportunity to decide for themselves if the nurse can work in the role of caregiver to them. Patients and their families pay large sums of money for their care and have the right to expect competent care without the influence of a narcotic, no matter what the dose or reason for the use.

How many of us know coworkers that take ativan, xanax, valium, restoril, or any other narcotic on a daily basis and then watch them climb behind the wheel of their car at the end of the shift and say nothing. How many of these coworkers have not reported the use of their drugs to the state Board of Nursing in order to go the the process of ensuring they are competent to care for their patients? How many of our coworkers inform their patients that they take a narcotic on a daily basis, allowing them their right to make an informed decision?

There are people who can take narcotics and work safely, but that is why there are rules governing this. Anyone who aviods these procedures are placing their patients, themselves and their coworkers at risk.

[fab4fan]

Stating that one takes medication on a daily basis does not automatically mean that this information is being witheld from the appropriate people.

Some of us are responsible.

[fab4fan]

mattsmom: Kudos to you for having a compassionate and informed approach to pain mgmt.

[imn2nursing]

Gosh, I was searching for this very thread and Iam so grateful to have found it. Well, I see exactly in you guys as the rest of the world is: some judgemental, some not. My motto is, try not to judge anybody until you've been there and done that! I too was an impaired nurse. I worked on a med-surg floor and orthopedic floor for 3 years all the while diverting pain meds. It started out P.O. meds but as my addiction escalated I went on to the IM's such as Demeral and such and then on to IV. When I was intervened upon, (thank God, none of my patients had been hurt while I worked under the influence: though in the beginning I didn't) the hospital I worked at didn't press charges, and I was taking enough to be selling the stuff to be honest. Anyway, I refused to go to tx for the first 3 mo, and was buying Oxycontin off the street to feed my addiction. I finally went to tx in 1999-2000 for a total of 7 mo. I have been clean for 3 years and have a good recovery program and I'm being monitored by the state through drug screens and other recovery things. I haven't went back to nursing yet. Right now, I am trying to get a job, but I have to tell my potiential employer about my drug addiction and once they hear that, they can't seem to get past that, so I have been like so so down about this job thing. So, guys when you hear of addiction in patients or even co-workers have a little compassion. I have learned to think of it as a cancer. It will kill you if it isn't taken care of. And by all means, if you suspect a co-worker, REPORT them. If the DON doesn't do anything then go higher. You can go on line to your state board site and there is a site for impaired nurses. Did you know that you could get into trouble with your license if you know that someone is working under the influence and you don't report them? Thanks guys!

[RN2B2005]

I think any nurse who gives a patient NS instead of the actual analgesic should lose her licence, period. Diverting narcotics is one thing...diverting narcotics at the expense of your patients' well-being is downright evil.

I worked at a veterinary clinic where one of the techs was actually doing IM Demerol, plus buprenorphine, injectable oxycodone and Ketamine, a tranquiliser. She would replace the drug with sterile water. Record-keeping isn't as strict at vet clinics, and there's no Pyxis system, plus most drugs are in multiple-dose vials. It took us almost a year to figure out that the drugs had been diverted...dogs screaming in pain even after 3 or 4x the normal dose of oxycodone (sterile water) and dogs that stayed wide awake even after dosing with tranquilisers (sterile water). She put her co-workers in jeopardy--a fractious, biting dog that can't be sedated is a danger to everyone. Eventually, we bought a clue and she left before we could do anything like report her.

Anyway, since I'm still a student, I can't imagine a nurse doing that to a HUMAN patient. I think, though, that nurses who just divert 'waste' meds should definitely be given multiple chances to rehab.

[chicoborja]

I, like everyone else in this forum, oppose diversion of narcs from patients but possibly contrary to some in this forum, I don find anything immoral with pocketing wasted meds. It is the equivilant to saying that dumpster diving is unethical. With that said, it should be known that I realize that there is a difference between CNS stimulants/depressants and an old couch. I would like to pose a question though: Which nurse would be more damaging, the exhausted, overworked one with a splitting headache and an inability to concentrate adequately or that same nurse w/o pain but with a slight euphoria as a result of hydrocodone? I don't think there is a clear-cut answer to that question but feel it should be left up to those health professionals that have the ethical means (diversion of waste) to obtain those meds. After all, either way it is that person's license on the line, not yours. Oh, I am aware of the patient's life that is subject to the care of that professional but I must refer you back to my previous question regarding which of the two nurses would be more effective btw the one with the ha and stress or the relaxed euphoric one, like I said b4 I don't think there is a clear-cut answer.

[Dr. Kate]

Chicoborja you scare the h*** out of me.

In case you have some doubts, euphoria, whether drug induced or not, is a state of impaired judgement. A nurse with impaired judgement is a nurse without judgement and one who has no business taking care of anyone.

There really are clear cut answers. A nurse who is unable to safely perform the duties of his or her job, has no business being at work. A reasonable prudent nurse and his or her supervisor will get him or her out of the clinical area. Reasonable and prudent coworkers will understand and cope.

While legal and moral are not necessarily equivalent. We are bound by the law.