Narcotic Diversion in Nursing

[Bugaloo]

I just received my state board of nursing newsletter. As I was browsing through it, I couldn't help but think, "What were they thinking?". It never ceases to amaze me that nurses put their livelihood in jeopardy for activities such as narcotic diversion. What is the point of putting yourself through the stress and financial strain of nursing school, only to throw it all away? We have nursing professionals diverting narcotics for personal consumption, being put on probation or worse, losing their license all together.

When I went back to school to get my RN degree, the first year students had already elected a class president. She was in her early 30's, seemed extremely motivated and often expressed her dream to further her education and become a nurse anesthesiologist. "Wow, those are awesome goals!", I thought. Six months after graduation, she was put on probation for diverting narcotics at the hospital she worked at. Just a few months later, while working at a local nursing home, she took a Fentanyl patch off of an elderly patient and used it for herself. She lost her license. Apparently, this nurse had had a drug problem in the past, was known to "doctor shop" for different prescription drugs, and that this was common knowledge to some of the other nursing students and also the faculty of the nursing school. I did not know this until she lost her license. So basically, a student with a known substance abuse problem was allowed to attend nursing school, was elected class president, and had the opportunity to further her education so that she may have access to the more potent drugs used during surgery. She had not been to rehab before, during or after nursing school. They took her word for it that she was reformed. She filled a seat in a program with a waiting list that might have been better filled by someone who really wanted a nursing career, not just handy access to drugs. This was a case of someone who went into nursing for the sole purpose of diverting narcotics. Sad, isn't it?

Let me tell you about another nurse I knew. She was a pretty, petite woman in her late 30's , married and the mother of three daughters. She had put herself through nursing school while a single parent, working and going to school full time, never getting more than four hours of sleep a night for two years. Two years after earning her RN degree, she began to divert narcotics. I worked with her on night shift at a local hospital. At the time, I was an LPN. Often times, she was the only RN working with me. Therefore, she was the only one who could give my patients their IV narcotic medications. I had no idea that she was diverting. I didn't follow her to make sure that the meds were given. I trusted her, just as I did all my co-workers. Apparently, nursing management suspected her, but continued to let her work with LPN's pushing their pain meds, being a charge nurse and accessing the Pyxis. When she was finally confronted by management, she denied the charges, refused rehab or help of any kind. She was fired and turned into the state board of nursing. Instead of trying to turn her life around, she voluntarily surrendered her license. She now works at Walmart. When I first found out she had been fired, I simply could not believe it. I could not believe I had not seen the signs. But as my co-workers debriefed ourselves, we realized the signs had been there all along. She was alternately exhausted and then bursting with energy, she was having serious family problems, and she had wild mood swings. She was often angry or distracted. The other nurses had seen more ominous signs than I had. At one point, one had found a used syringe in the staff bathroom and blood splattered on the wall.

Now, with a lot more nursing experience under my belt, I trust my instincts. I get along with my co-workers, but I never overlook something that seems suspicious in their behavior. Nurse that spend more time than anyone else in the med room, who always offer to give your patient's pain meds for you, who act nervous when they are alone and you walk up on them unexpectedly. Those are some of the things that send up a red flag for me. Of course, other nurses who divert are very smooth, and their is no way of knowing what they are doing.

If you suspect someone you work with is diverting medications, keep your eye on them. When you are sure that they are diverting, speak to your supervisor about your concerns. The main priority is to protect the patients in their care.

If you are a nurse and you are diverting medications for you or someone you know, stop now. There is help out there. It is not worth losing your license out there. Narcotic addiction is an illness, but diverting medications could land you in real hot water. Accept help from those who offer it, accept that what you are doing is not right, and learn from your mistakes.