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

  1. 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 work settings where availability is certain, frequent, and a sure thing every shift they work. Oncology is the most desired setting for obvious reasons, but when needing narcotics, any setting where they are given is good enough.

    The addicted Nurse receives his/her assignment, even "bartars" with his/her peers to "switch" patients so that she receives the ones who have orders for narcotics. She/he starts his/her shift by "reviewing" his/her patients med sheets to identify sources of obtaining addictive drugs. This Nurse looks in particular for poly-pharmaceutical orders so he/she can "bait and switch" at his/her own behest. The Nurse then "assesses" the condition of the patients and determines which ones are "confused", which ones are deeply sedated, which ones would be the least likely to know meds were being played with.

    The Nurse then takes the narcotic, signs it out, and intends to use it for himself or herself. If the same patient has some other drug like Benadryl, Vistaril, Ativan, that is what is given in lieu of the narcotic. If a patient is on a Morphine or Demerol infusion the Nurse goes to the room, removes the 50cc syringe, having already emptied out a 30cc vial of 0.9normal saline for injection bottle, withdraws the drug, injects it into the empty saline bottle and replaces the 50cc syringe volume with the withdrawn 30cc of saline so the volume remains the same. The same technique is used with 50cc bags of narcotic infusions.

    Nurses who are "stockpiling" narcotics for their own use come to work wearing a Lab coat, smock, or longsleeved, deep-pocketed smock. Morphine, Demerol, and Dilaudid carpujets are easily hidden in clothing, under the arch of the foot in the shoe, or in any body orifice that will accommodate them.

    The Nurse often "forgets" to document the narcotics supposedly given, on the patient's med sheet in the chart. The Nurse who is an advanced stage of addiction diverts narcotics and uses them while on duty. They are injected in the thigh muscles on a trip to the bathroom at break times or anytime that's convenient. A bandaid or two over the injection site assures no blood leakage onto the pants uniform.

    Pill forms of addictive drugs: Vicodin, Valium, Ativan, Xanax, Librium, Oxycontin, Oxycodone, MS Contin, are easily "palmed" and dropped into the pocket and taken later on that break to the bathroom.......or stockpiled, and hidden at home later.

    Clothing with pockets also serves as a hiding place for needles, syringes, tourniquets, vials, carpujets, if needed at home or on the bathroom break. On a busy, shortstaffed, highly stressful unit, all of these things are easy to come by, and easily hidden.

    In late stages of addictive disease the Nurse is NOT thinking about his/her illustrious career, the consequences that are inevitable, let alone how it will affect family, career, - or the patient and the people with whom they work. This Nurse needs that "high" and will go to any length to get it. The addicted Nurse is NOT necessarily the "most suspicious" looking one of all, but is more likely to be the most admired, most excellent Nurse on the Unit, and in fact is the least likely Nurse expected.

    Addiction is no respector of person, position, race, color, creed.

    There are few, if any, State Boards of Nursing that do not offer a diversion/rehabilitation program for such Nurses. However, if it is discovered that the Nurse is diverting for the purpose of sale and distribution solely, or along with personal use, that Nurse is NOT eligible for these programs according to the law.

    Bonnie Creighton,RN, Minnesota
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  2. 41 Comments

  3. by   JNJ
    Bonnie: Interesting information, thank you. Makes me think back to oncology units I have worked in . . .

    If the nurse, as you say, 'forgets' to sign out the drug, isn't this caught at the count at change of shift?

    What prompted you to post this?
  4. by   Tweety
    A nurse on another unit opened his locker (which he doesn't lock) and found a stash of narcotic syringes, most empty but some had some in it. All kinds of good stuff like morphine, demerol, and ativan. The whole unit will probably have urine testing.

    Recently a nurse on the same unit diverted and took 500 mg of Demerol while on duty. By the end of her shift she was stoned drunk it was scarey. Needless to say she could not longer work without going for treatment.

    Drug addiction is a serious, and scarey problem. We all have our tales.

    Interesting article.
  5. by   Rustyhammer
    Yeah, yeah, yeah.
    We have all seen the abusing nurse go down in flames at least once. It's not a pretty picture is it?
    We know the nurse who gives all the prn's on her shift and nobody ELSE seems to have that patient in pain.
    We can see when the same nurses count is always a bit off "I dropped one and no one was around to see me waste it".
    It's sad.

    -Russell
  6. by   WriteStuff
    In response to questions and comments by those of you who have replied:
    Sorry if I confused you somewhat regarding the conveniently "forgot" part.......what I believe I said was that the Nurse who is diverting for her own use (or to sell), conveniently "forgets" to chart that the narcotic was "given" on the patient's med sheet, thinking wrongfully that because she/he didn't chart it as "given", no one will notice or care. (The drug is floating around in the Nurse's brain instead.)

    To answer "JNJ" and the question: "What prompted you to post this?"

    For whatever reason, recently I have received private e-mails from members of allnurses.com who are new members who have posted, and who read one of my entries over a year ago when I shared about my own personal journey into the hell of addiction as a medical professional. The most frequently asked question was: "How do Nurses divert drugs anyway?" A legitimate question and one no one likes to ask.

    On August the 8th of this year I will celebrate 8 years of continued total abstinence from any addictive drug (including alcohol since that was where it all began for me in the first place), and it's a topic that is near and dear to my heart. I was most fortunate to have an employer who understood this as a "dis-ease" and saw to it that I got the help I desperately needed at that time. My employer effected an intervention that resulted in my being restored to sound mind, body, and spirit. I self-reported to my Board of Nursing and entered the Diversion Program that was available. I reached out to all and whatever help was available and as a result of all of that help, from many many people......professional and non-professionals alike........I am living a new way of life I never dreamed could be possible. I never lost my license, I never faced criminal charges, although the possibility was very real at the time. The statistics we have available for a Nurse recovering from narcotic addiction are grim indeed, and we rarely hear about the "successes." I continue to practise my profession today without restrictions because I believed in the hope that was held out to me and RAN for that help!!

    Narcotic addiction for Nurses who are practising in the profession is a huge problem that continues to be "swept" under the carpet because hospitals do NOT want that kind of "publicity" (and rightfully so) and prefer to "get rid of" the problem in many instances by firing the Nurse, or bringing criminal charges, as opposed to recoginizing addiction for what it is: a cunning, baffling, and powerful dis-ease that destroys good people, who deserve the best in treatment if they would only reach out for it when it is offerred.

    Much progress has been made on the part of employers, but we have a long way to go toward embracing our suffering colleagues as the caring professionals they truly are and doing it with the intent of helping them recover.

    I was not a "bad" person who needed to become "good" again, I was a very, very sick human being, who needed to get well.........and I have, and am so grateful for all of the help I received when I needed it the most.

    I welcome any questions about my personal experience and if you so choose you can e-mail me privately at: bonnie_creighton@hotmail.com.

    Thank-you for your comments as I continually learn more, the further I travel down this road we call "recovery."

    Bonnie Creighton,RN, Minnesota
  7. by   EmeraldNYL
    Bonnie, thanks for sharing your story. Congrats on your continued success in staying sober.
  8. by   mamabear
    Bonnie:
    Thanks for sharing your recovery. Although we're supposed to be non-judgmental and compassionate, nurses are often among the first to look with disdain on anyone with an addictive disease.
    I celebrated 4 years clean and sober this past November. :hatparty: Congratulations on your 8 years, and keep coming back:kiss
  9. by   Agnus
    A hearty congratulations. And thank you. What courage you have in revealing yourself in this way.

    I am very naive about drug addiction. I remember as a student doing my psyc rotation. There was a patient who was a ER nurse hooked on vicodin. It was an eye opener to the fact that nurses are so fucused on careing for others that not only do we not care for ourselves but we don't care for other nurses.
  10. by   patsue53
    In 1996 my father was dying of lung cancer. The nurse at the cancer center called and asked my stepmother to please bring in my father's medications as she needed some information off the bottles. My step-mother questioned her as to why she couldn't obtain this information from the doctor or the chart, but the nurse insisted that she needed to see the label on the bottle. The MScontin had just been refilled. Because it was so expensive my stepmother counted the tabs when she had the prescription filled to make sure the pharmacy hadn't shorted him. She took the bottle to the cancer center where the nurse took it into another room to "write down the information." When my stepmother got home she recounted the pills and there were 13 missing. She immediately called the nurse and accused her of stealing the morphine. The nurse denied it....but offered to pay her for what was missing! My stepmother took the necessary steps to report this to the hospital administration and eventually the nurse confessed and was admitted to rehab. This hospital now has mandatory random drug testing for all employees.

    Yes, addiction is a disease and should be dealt with as such. But I still feel justified in being angry with a nurse who steals from a dying man. I do not believe that woman should have retained her position. Her actions were deceitful, unethical and illegal. If I were to relive this incident it would have been reported to the police before it was reported to the hospital administration.
  11. by   ERNurse752
    ...which brings up another interesting topic...

    Should all hospitals institute mandatory random drug testing for all employees?

    I can see where it could be good...impaired staff wouldn't be able to hide so easily, and hopefully the hospital would be open to providing them with rehab etc, instead of firing them. Would be better for patient safety.

    But I can see where it could be very difficult for others who take Rx meds for whatever reason, trying to constantly prove that they're legit.
  12. by   Agnus
    Originally posted by ERNurse752
    ...which brings up another interesting topic...

    But I can see where it could be very difficult for others who take Rx meds for whatever reason, trying to constantly prove that they're legit.
    The nurse I spoke of did not divert or steal her vicodin. She had a legal perscription. She had originally obtained it for a real physical pain. I don't recall if it were an injury or what. She continued with it to treat a psycological pain. She justified it to herself by saying it was a perscription and she was a nurse and knew what she was doing. She was not a low life who stole her drugs or stole money for them. So she couldn't possible be addicted. But of course she was very much addicted. I llistened to her story in group as a studend LPN and I realized we need to care for each other as nurses as it seemed to me that might have prevented all this for this woman.
    She was a good nurse and worked under a lot of stress and had no where she could go with that stress. etc. well you know the story as we are all there ourselves as nurses. this BB is my group therapy.:kiss
    Last edit by Agnus on Jan 18, '03
  13. by   mamabear
    I don't think random drug-testing is the answer. There are small, petty, vindictive people who could use it as a means of harrassment Also, having to explain why you take a particular medication or medications, in my case, opens you up to the whole "guilty until proven innocent" thing. My health issues are none of my employer's business, unless they interfere with my job performance.
    This is a very good thread, by the way.:kiss
  14. by   mario_ragucci
    Yesterday I used the pixis for the first time as a student nurse. There was a prototype finger recognition peripheral added to the pixis. Learning about drugs is pretty interesting, opioids and steriods. I wonder what a morphine buzz would be like? We use it as a tool to stop pain. Wouldn't a PT know right away if no pain med was given? And, messing with your prostiglandins and your nervous.sys is not good.
    If I saw someone shoot up in the wrist, like Dr. Carter did that time on ER, I would no know what I would do. Then again, you would have to drop a dime for your own protection.
    What does it mean when RN witness the destruction of a drug? Forget it, thats easy :-) Pretty much I feel other RN's would know if something was "not right."

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