A Nurses Responsibility: Report Possible Narcotic Diversion

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    Chemical dependency and narcotic diversion from the workplace has become more common. Nurses need to know their responsibility if there is an alcohol and/or durg problem on their unit. Education is needed for all staff members.

    Drug diversion from the workplace, specifically a hospital or surgery center, is becoming more common every day. The specialty of nurse anesthesia has a near 10% of practitioners who may face a chemical dependency. It is important to know that every nurse has a responsibility to report any suspicion of drug diversion. If the drug count is always incorrect after a certain nurse works, it should be reported. Drug addiction and alcoholism are true diseases, and these individuals are sick. Don’t be afraid to report possible drug diversion. In the long run, this will help the individual get help.

    Most facilities have a policy regarding intervention of an employee, but many employees do not want to get involved. Fear of retaliation, from the employee or other co-workers, they look other way. Properly planned interventions, which may include a counselor from a treatment center, will facility a road to wellness. If the employee agrees to go to treatment and follows the recommendations of the licensing and/or rehabilitation board, the job may be secure. Once the employee returns to the unit, it is important for all co-workers to provide support and assist with accommodations that must be made. Standard accommodations that may be implemented for a variable time period are:

    • The impaired nurse cannot administer any controlled substance or carry narcotic keys.
    • The impaired nurse may not be allowed to work 12 hour shifts or overtime.
    • The impaired nurse will attend an assigned support group which may require other coworkers to cover part of a shift.

    The staff should be educated regarding the restrictions of the impaired nurse and notified of any additional responsibilities the staff will need to cover. It can be helpful if a coworker volunteers to cover the assignments that are restricted. The returning nurse will be afraid regarding what their peers may think about their disease. The staff should be educated that chemical dependency is not about morals, it is a disease.

    Many specialty associations have members within the state that are available to answer questions and assist with helping a person find appropriate treatment. The American Association of Nurse Anesthetists has a Peer Assistance Advisor for each state and a Wellness Committee. There is an abundant amount of information on the website with a variety of useful links. More information regarding how to deal with drug addiction, alcoholism, and other topics can be found at http://www.AANA.com.

    Connie Whitesides MSN, RN, CRNA
    Last edit by Joe V on May 19, '11
    merlee, zephyr9, and cherryames1949 like this.

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    About clebius

    Connie Whitesides is a CRNA and the AANA Peer Adviser for Maryland.

    Joined May '11; Posts: 2; Likes: 3.

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    16 Comments so far...

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    This problem affects all of us - the patients, the coworkers, the families. I have seen it all through my career. It seems easier to be silent. By being silent we enable. That is not helpful for anyone. It just perpetuates the problem. Nursing boards are aware of the problem and are supportive. Employers have treatment programs. This is a problem that cannot be ignored and needs to be taken seriously. It affects our integrity as a profession. It destroys trust with patients. The longer the behavior (drugs, alcohol, or both) goes on the harder it is to change. This problem is not going away. Attitudes have to change. The silence has to be broken.
    zephyr9 likes this.
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    The first time I witnessed/discovered drug diversion by a fellow nurse, my first instinct was to ignore it. I could not believe the obvious. A nurse, who I liked and considered a friend, was taking narcotics signed out for a pt. There had to be a mistake. There was a logical explanation. She wouldn't do that. I was mistaken. How could I think that of my friend? Of course when I questioned her about it she played on all of my own reservations and denied it.
    I didn't report it for 24 hours, and that could have cost me MY job.
    zephyr9 and cherryames1949 like this.
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    The rule for reporting drug diversion that you personally witness is pretty cut and dried. However, what about a situation where you overhear a conversation in which a co-worker tells another co-worker that they think someone is diverting? Or what do you do if the information is third or forth hand, like when someone says, that someone says that someone says that so and so is diverting?
    zephyr9 and cherryames1949 like this.
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    The IMPAIRED nurse must do this, the IMPAIRED nurse must do that....what a label!!! I thought "impaired" meant when one is actively under the influence.

    Frankly, I do not appreciate the BON's treatment in most cases of addicted nurses. What happened to the nurse's HIPPA rights? Why is everyone on the unit, and everyone they decide to tell, now aware of the nurse's "disease"? How can the board force someone into a support group, the majority of which are 12 step programs that say ABSTINENCE is the only answer to addiction? It just blows my mind that in this day and age, when science has proven a biological component for addiction, that so many still believe abstinence is the only answer. Diabetes is a biological disease, but no one would ever dream of telling a diabetic to go to 12 step group to control their need for insulin. What about medication for treating addiction? The idea that complete abstinence is the only answer stems from the belief so many have that addiction is a moral issue, a moral failing, a matter of willpower.

    Also, not all addicted nurses steal. Some of them actually have the decency to go out on the street and BUY their drugs. It's insulting to imply that all addicted nurses are at risk for diversion, there is a difference between being an addict and being the type of person to steal.

    So many old prejudices and discriminatory attitudes about addiction, even from educated people. It really surprises me.
    Last edit by Bhavana on May 20, '11 : Reason: spelling
    amybeets05, XXWeaponX, and tyvin like this.
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    It's a looooooong way down from that Ivory Tower.
    zephyr9, cherryames1949, imintrouble, and 1 other like this.
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    Thanks for a great article!
    Bhavana, this article IS the enlightened view! Your defensiveness calls for SELF examination. When it comes to this particular issue, it seems you are either very naive or in some kind of personal turmoil yourself!:redpinkhe
    Re: overhearing a conversation 3rd hand? I think I'd give a heads up to the higher up, maybe even remain anonymous. Tough situation which I've never been in myself.
    A nurse who is UTI and makes an error that harms or kills a patient, vs. a nurse who is simply caught/reported/comes clean re: pilfering meds, and is forced to submit to due process? BIG difference in outcome.
    Purple_Scrubs and cherryames1949 like this.
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    I've been around several nurses who were diverting. I consider myself pretty observant, but I had NO suspicion at all of any of them. Hindsight maybe, but not at the actual moment.
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    Well written response Bhavana; I see much compassion in your reply. I must agree with most of what you wrote.
    amybeets05 likes this.
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    Brava! I love the way you put compassion on the addict. It is a disease, one protected by the ADA, by the way. Being so, we as nurses should want to do whatever we can, to help the person succeed. We as healthcare workers want to eradicate drug addiction, and part of that is putting on our compassion, learning all we can about it and using what we learn to help those in need. These drug addicts are our mothers, fathers, sisters and brothers. They did not dream of one day, becoming an addict. One small change in your circumstances, and it could be you. OP, Thank you for this article! Peace!
    aw70, cherryames1949, and zephyr9 like this.

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