This is "how" Nurses divert drugs for their own use. - page 3

This is the "how" Nurses divert drugs for their own use. The extent to which this goes on depends on availability. In the hospital setting, Nurses who are in advanced stages of addiction pick ... Read More

  1. by   Agnus
    Question, R/T my last post.

    Since my employer is not responding to concerns about inaccurate counts, drugs strangely multiplying, and just writting off inaccuracies in count including missing drugs; and pharmacy insist on overstocking for her personal convenience etc. Some of us have voiced concerns and written up concerns.
    Pharmacy does complain when non narc drugs come up missing (which happens daily ) pharmacy feels they are not making any error on this so it must be nurses are doing something wrong. The point is non narc drugs are disappearing or not acccounted for daily. However they way pharm distributes them from the pharmacy shelf there is no way to proove they did or did not put the drug out. As they just pull them from pharm shelves and do not record every dose that is pulled or where it goes. Yet nurses do record this on thier end as all you have to do is check the MAR.

    If something is missing when pharm is present you just go in pharmacy they hand you the drug and never record anything. This means there is no running count on most drugs in the pharmacy.

    Anyway, my question is if the facility is not responding to concerns about possible divertion who can I report it to? What is the governing body for this? This is an acute care Hospital.

    Pharmacy techs are left alone in pharmacy. Every nurse has access after hours. Other people wander in and out of pharmacy and the med room at will. Only the narcs are locked in the med room because the door to the room has a lock but that lock is never used. The pharmacy is frequently unlocked when the pharmasist is in the building and no one is in pharmacy.
  2. by   mario_ragucci
    Responses here are so gracious and I learn the easiest from allnurses.com. Perhaps a RN can hide a pain med addicition, since actual anxiety and depression are controled with pain meds. It's actual pain.

    Rememeber in Cool Hand Luke when he had to spend a night in the box when his mom died even though he didn't do anything wrong? An emotional response is always expected at the death of a parent, I guess.

    Thank (love) you for letting me chime in as I learn from reading your responses about pain meds and I am learning in RN school.
  3. by   mario_ragucci
    Originally posted by ITSJUSTMEZOE
    Im a FIRM BELIEVER for random drug testing of ALL employees...
    I want anyone that I work with the be as clean as possible for patient care.
    Just my thoughts
    Zoe
    Zoe - you have to be willing to go all the way, and not stop at random or drug test. Let's find out your genetic profile, and zap you prior to any illness. Survival, right?
  4. by   Sally_ICURN
    Originally posted by Agnus
    Sometimes I give more than other nurses. I am very conscious of patient pain the need and right of the patient to have it relieved. Also I am aware that those adicted actually require more of a narc for pain relief than the rest of us and they are entitled to relief.
    I so totally agree with you. Nothing, NOTHING gets to me more than when I get an assignment that includes, for example, a patient who's been on the unit for weeks, is lightly sedated, on a vent, has an open thorocotomy wound that gets bid dressing changes, but hasn't had any pain meds all day!!!!!! And they wonder why, despite giving the prn pressure drugs or maxing out a drip, the pt's pressure is still HIGH, or they're bucking the vent, or thier HR is high!! I will say though that if our patient's are sedated, they will usually have a fentanyl drip right alongside the sedation...but not always.

    Most times our patients cannot verbalize their pain and a really good assessment of nonverbal clues needs to been done, and done frequently. It bugs the crap out of me when a nurse charts "unable to assess" when it comes to pain. If a patient's face scrunches up or their body stiffens with the slightess stimulation, or their vitals are questionable, or they're restless, you better believe I'm giving something for pain and giving it as ordered prn around the clock. I strongly believe in this. Why would it be ordered otherwise? One would find that I do give prn narcs frequently when previous shifts have not...so does that put me under the magnifying glass?

    I certainly don't mean to minimize the fact that nurses do divert drugs for their own use. It's such a sad situation for both the nurse and the patient, they are suffering equally but in different ways and nurses such as the original poster in this thread are heros and true leaders in my eyes.

    Addicts, a lot of times if they are in recovery, have to be convinced that it's alright to allow us to treat their pain. How scary that must be for them!

    ~Sally

    p.s. I think random drug testing would be a terrible idea.
    Last edit by Sally_ICURN on Jan 20, '03
  5. by   Dr. Kate
    Mario made a comment that he wouldn't know what to do if he saw someone actually using drugs. I would hope that he, and anyone else who witnessed such a thing, would have the courage to let the unit manager or supervisor know immediately. People who are diverting drugs tend to be very careful. It seems that when they get caught it is often because they "want" to get caught, and get some help they don't have the courage to ask for directly.
    It isn't always easy to say something when it will impact a peer negatively. We have a duty to each other as well as to our patients.

    Great thread on a difficult and sometimes touchy subject.
  6. by   mario_ragucci
    Dr. Kate, I was honest. I have never been in that predicament, but your remark causes me to think about it more in a theoretical sense. I'd say "WTF are you doing?" and "I want to help you" and "Lets go right now and get help." Try to ease their anxiety by telling them exactly what I would do immediately. I wouldn't let it go. I would address this immediately, 100% up front.
  7. by   RED_ALERT37
    I placed myself in a profession that if asked to take a random drug test I would at anytime. If I have anything in my system it is there with a script behind it. If its a medication that possibly would inable me to be at the top of my game then I would avoid it while I was working. Thats just the way I am. I worked too hard for my license to allow a medication take it away from me.
    Its just my opinion I am by no means in the majority and I know that. Its ok , but I will toss my opinion out there if its saves someones life from a mistake in judgement.
    Zoe
    PS I just realized Im logged in under Reds name. Im at her house on her computer so I will have to adjust that but those who know me know its me .
    Zoe
    Last edit by RED_ALERT37 on Jan 20, '03
  8. by   Agnus
    Zoe, I understand what you are saying. I am with you and share your feelings.

    And there is something else to consider as we look at this. Take the case I already mentioned. A nurse who has a perscription, she rationalizes to herself that the perscription means she is not an addict.

    I worked with a nurse on a restricted license post rehab for marijuana. This nurse was required to do periodic urine tests. This nurse was very aware that the urine test would be done monthly. (this was a requirement of the SBON not the facility) Low an behold the employer reacieved a call from the SBON that this nurse had shown positive on the latest urine test, and they were pulling the nurse's license. Early on this nurse admitted to me the knowledge that marijuana is detectable up to one month after a single joint. I was angry with this nurse for the self destructive act of using with full knowledge that being caught was inevitable.

    Then there was the alcoholic. She drank herself into a coma and had to be vented. But she,"doesn't drink." Her symptoms were so classic that even I was able to recognize them from day one. She was very dangerous in her nursing practice. She was eventually fired for "excess absence" related to her drinking and not reported to BON. She is now out there as a traveler.
  9. by   WriteStuff
    All of you, too numerous to name individually have given such excellent input, insight, feedback on this ugly subject. And I couldn't agree more.......one that we don't even want to discuss.

    Just a few comments to add in response to it all:

    1. Sloppy Pharmacy administration is no excuse, and being transparent one more time.......I diverted narcotics for three solid years, fudging the numbers, doctoring the count (which can be done) at the same place I worked for 8 years, and Pharmacy personnel ........where were they? What kind of "auditing" were they doing, is a question I asked myself over and over toward the end.
    2. Impaired Nurses from, whatever the substance might be, working while impaired, cause a great deal of stress for their peers. There is not only the "moral" issue, but the legal and safety issue as well. Today, if I suspected a colleague was diverting, I would go to my immediate Supervisor first without hesitation. I say this because as the one who was once addicted, I was in horrible inner turmoil, horrible mental, emotional, psychological and spiritual pain, and the denial I was in kept me from "reaching out" for the help I desperately needed, not to mention the fear that was eating me alive. I kept "believing" that my colleagues would "turn me in" for sure because there were so many "red flags" -they could hardly be ignored. And several of my colleagues were personal friends. However, I now understand the feelings THEY were having, and fears as well, and I of course do not "blame" them at all. But, in the final outcome, "someone" had the courage to report me because an intervention did take place. To this day I will never know who it was, but if I could, I would thank that person profusely.

    3. It was a little bit disturbing to read one of the posts that indicated a person like myself should be condmened to hell, or words to that effect. People who become addicted to substances are not "immoral" people basically. In other words.....it was not because I had some fundamental lack of moral constrants in my personality that I was doing what I was doing. The addiction becomes set up because of the use.....and as the dis-ease progresses, it affects behavior at every level.......legal, common sense, otherwise "normal" ability to stop something that one knows is illegal, etc. The hallmark of addiction is DENIAL. The user denies it's hurting anyone, denies it's "wrong", denies every built-in feature of self-preservation out of the "need" to "feel ok" because of the drug effects.

    4. People who "fail" to recover are usually people who once sober again, and have no drugs affecting their thinking and feeling, are consitutionally incapable of being honest with THEMSELVES. Genuine, sincere, recovery effort is HARD work, because the "work" required is an inside job. And once sober, looking inside is not a pretty picture. The pain of seeing who I really was........lost, no self-esteem, a lifetime of emotional bankruptcy, no healthy boundaries, no spiritual mooring, isolated in every respect, was the most frightening stopping off place I have ever been in my life. I was 50 years old when I went into treatment. Recovery requires starting at "square one" and being willing to go to any length to begin all over again. It is a very personal journey, and few are able to head down that road, which is most unfortunate.

    We all work in a rich variety of settings, with administrators, supervisors and management styles which are just as varied in their "approach" to this painful subject. I firmly believe that Human Resources Depts. could do much much more in terms of educating new hires, or at the very least provide hard-core inservices for employees, that touches on this subject. It wouldn't take a Rocket Scientist to put in place a pro-active Policy and Procedure that allows employees to freely "report" all of the things you all have pointed out that are so disturbing in your work settings, and do so without recrimination, and with quick and effective action for the impaired colleague. Obviously I am today in favor of random urine, or blood testing for health professionals on the job. And any empoyee who is taking an addictive medication for a legitimate health reason should NOT be singled out, "suspected", when they have a prescription that is valid for the drug. Such health conditions for the most part are "temporary" situations and in no way render the Nurse "impaired" if she/he is using it as prescribed.

    Thanks again for all of your comments, thoughts, and honest feelings about this subject.

    Bonnie Creighton,RN, Minnesota
  10. by   eddy
    I have been "accused" several times. What complicates this is that I work agency. A quick voluntary UA or blood test always shows the truth. I have always suspected that these were the result of addicted nurses trying to find an easy scape goat (in comes the agency nurse... perfect). I insist on an immediate UA, and if they won't do one I'll go have it done on my own dollar.

    I am not for random testing, but a test conducted for any level of suspected diversion seems reasonable to me. However, this does make it possible for "setups". If an addict is desperate enough, they could easily put something in someones drink or food (say they went and picked up McDonald's for everyone). This could result in a false positive, and take the heat off of the real user. Also, this is a great way for that Nurse Mgr or admin to intimidate and bully you.

    However, we do work in an environment that is full of nifty drugs. I doubt anyone is allowed to exit fort knox without a pat down and metal detection. Drug tests are OUR form of this. I do value my privacy and that is why I don't support random testing. If I go to Amsterdam and smoke some pot LEGALLY (not saying I would, it's just to make a point), it's not the right of my employer to know or fire me for this upon my return. Jeez... now I don't know where I stand or why. Hence, the same reasons why it is so tough for most other people too.

    -eddy
  11. by   caliotter3
    Agnus: Have you tried looking up the DEA (Drug Enforcement Agency) under the govt heading in the phone book or on the internet? I would think they would have an interest in this (particularly at the pharmacy level) or just contact the narcotics unit of your local police dept. Just an idea.
  12. by   caliotter3
    Agnus: Of course, before you say or write a word, ask if they will honor your anonymity, otherwise, you may never work as a nurse again for the black listing.
  13. by   caliotter3
    I also disagree with the person who made the statement about condemning someone to he**. I have had personal contact with an addict whose mother was an alcoholic, as his father, and his brother committed suicide. Environment? What about genetics? We need to use some of the things brought out in these fancy "educations" we get. Why not do some research yourself? I researched the internet and that's how I learned about "serotonin syndrome". Knew somebody who came very close to dying b/c of "serotonin syndrome". Education hurts no one.

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