Drug addicted nurses

ZASHAGALKA, RN · Nov 14, 2005

I was very interested in your comments, Bipley about how the pyxis machines work. Most times, I just figured that not only is every screen monitored, but that there is prob a video cam somewhere in the vacinity.

But, you know, quite often, I go back through my patients profile to see when I gave something to chart after the fact. I normally do that a few times per each of my pts per shift. And sometimes I do it to see if I can give the med again. I guess now I wonder how that looks to pharmacy.

You know, my biggest concern was always if pharmacy would bother to match up my non-narc withdrawals to how close I actually gave them to normal administration times. . .

I always figured that if pharmacy was REALLY interested in diversions, they could just set up a program that monitors the average number of narcs all nurses pull per unit and develop a bell curve and see who are the outliers. That wouldn't be proof mind you, some nurses are more sensitive to monitoring and treating pain than others, but I bet the diverters would be extreme outliers.

It's hard to imagine that anybody could beat the system for long if it were truly monitored.

~faith,

Timothy.

Zoey65 · Nov 14, 2005

Gianna, Good Luck. I hope you are able to stay with your children. I think a lot of us have the potential to become addicts, and have no idea how we keep from it. I had the experience when I was weekend supervisor at a LTC facility of a nurse coming to me to tell me that she was sick and had taken one of the pts phenergen. I don't know if she was wanting help? I felt bad for her (she was a good nurse and a nice person), but I had to tell someone. I gave her the opportunity and she turned herself in and was allowed to just quit her job. I don't know what happened after that. I hope she was able to get straightened out.

Bipley · Nov 14, 2005

I was very interested in your comments, Bipley about how the pyxis machines work. Most times, I just figured that not only is every screen monitored, but that there is prob a video cam somewhere in the vacinity.
But, you know, quite often, I go back through my patients profile to see when I gave something to chart after the fact. I normally do that a few times per each of my pts per shift. And sometimes I do it to see if I can give the med again. I guess now I wonder how that looks to pharmacy.
You know, my biggest concern was always if pharmacy would bother to match up my non-narc withdrawals to how close I actually gave them to normal administration times. . .
I always figured that if pharmacy was REALLY interested in diversions, they could just set up a program that monitors the average number of narcs all nurses pull per unit and develop a bell curve and see who are the outliers. That wouldn't be proof mind you, some nurses are more sensitive to monitoring and treating pain than others, but I bet the diverters would be extreme outliers.
It's hard to imagine that anybody could beat the system for long if it were truly monitored.
~faith,
Timothy.

No, nothing like that would be monitored, lots of nurses do that. They usually do random reports on people/pods. Or, let's say the NM believes Mary Jones, RN is diverting. Mary won't be told she is suspected of anything, instead pharmacy will be notified and they will set the computer to do auto reports daily. They don't even have to be done manually on a daily basis, the computer will be set to add Mary's report along with all the other daily reports the Pyxis sends out anyway.

Someone in Pharmacy will go through all the reports and upon seeing Mary's, that report will either be giving to the person who handles that or the dept head. (When I was a pharmacy tech going through those reports was my job.) They will monitor and see what kinds of screens Mary is looking at. Is she looking to see all the patients on her pod that are on MS04 10mg syringes? How much time does she spend on narcotic screens? Is she pulling reports for patients she isn't taking care of? They can monitor every single keystroke, they can see every single screen Mary saw, they can essentually duplicate every action Mary took while she stood at the Pyxis. For some nurses that can be 50-100 pages for one day alone.

They will look to see how much is being wasted. If a doc orders 6-10mg MS04 is the nurse pulling 3-2mg syringes or 1-10mg syringe for a 6mg dose? During the beginning of the war many hospitals were running out of Morphine and the nurses were told to only pull what they needed. If it was 6mg, use 3-2mg syringes vs. 1-10mg syringe. Then we looked to see who was witnessing the wasted drug, was it the same person each time? Was it witnessed at all?

This is done over a long period of time. If things look weird then they usually pull a drug screen on the nurse, or they start putting management in there to do floor work for a few days to see if Mary will have the same exact behaviors. Same waste, same reports, same everything.

Then they pull charts and see if people are complaining of pain more on Mary's shifts than they are on everyone else's shifts. They pull ALL the med error reports for Mary, it's actually quite comprehensive.

There is a lot of stuff inbetween all the above but that's a general run down. It's really common sense stuff.

There are no hidden cameras in Pyxis that I am aware of, but many hospitals will have cameras on the really busy Pyxis machines, but they are obvious. There are some things that obviously, I'm not going to write about here but suffice it to say, it's amazing what computers can do today and what kinds of reports can be pulled and what extremes some hospitals will go to, to catch someone diverting. Lesson for all of us here, just don't take the drugs.

Keep in mind, they will do the same thing for non-narcotics too. If a certain antibiotic (especially the expensive ones) come up missing, even though it doesn't require a witness to fix the inventory, it still shoots a report to pharmacy. When Mary Jones pulls one Zithromax tablet and the next nurse comes along and discovers there are 6 fewer Zithromax than what should be, it sends a report to pharmacy. Usually nothing is done about this other than a report. But the computer can be set to notify staff if this is a regular issue. It's AMAZING how many antibiotics, BP tabs, statins, etc. come up missing from the Pyxis. Lots and lots of nurses use the Pyxis in place of Walgreens or OSCO. It's stealing and I've seen nurses fired for that too. Not all Pyxis machines permit you one tablet of a given drug only. Sometimes you have to count the rest and key it into the screen.

Another issue is when you pull the drug vs. when you give it. It has to be set manually to auto report that but it can be looked up at any time. It usually isn't an issue unless there is a problem or if it is all narcotics that are not given on time. If you pull Morphine out 2 hours before you give it, that can be a problem.

talaxandra · Nov 14, 2005

I haven't had much experience with drug addicted nurses, but I can see how easily it could happen. I've had frequent headaches (several times a week) since I was at school; before I started nursing I couldn't swallow tablets, and you have to really want to take something if you need to chew it! I got my first migraine a few months into my course, and between that and a concern about becoming one of those can't-swallow-pills patients, I learned how. And once I could, I started taking analgesics for my headaches. And then, knowing that a couple of Panadeine Forte (500mg paracetamol and 30mg codeine/tablet), which I was prescribed for migraines, would get rid of a headache, I strated using them for headaches too. It never became a problem, but only because my unit started treating patients with rebound headaches (due to overuse of analgesica and anti-migrainoids) and I saw my future.

It gave me a much better insight into at least one route to drug use, and I think has made me a better nurse. If I judged fellow nurses, I would also be judging all drug-dependant people, and I think that would be wrong.

As others have posted, we're people as well as nurses, and therefore at least as subject to the frailties of the rest of our race.

boysmom32 · Nov 23, 2005

I am new to this site as of today and I found it by searching for info on drug addicted nurses. I would like to share my story and see if anyone has any advice on what I can do next.

I have been an ED nurse for 3 years and I had back surgery in2004. This past May I began to have excruitiating pain and my FNP prescribed Dilaudid tablets for me. I knew the first time I took one that I should never take another because it made me feel so much different than the narcotics that I had taken in the past ( Lortab & Percocet).. When I finished the prescribed amount I was at work one night and I felt like I was going to die. The pain and physical symptoms were overwhealming. Looking back, I can honestly say that I thought I was going to die that night. I went to the drug cabinet and got injectable Dilaudid and took it. The next morning I reported what I did to nursing administration. I was fired for stealing but not reported to the police. I contacted Tennessee's Peer Assistance Program that day and went for assessment the next day. I was assessed and told that I had to go into a 90 day Impaired Professionals Program the next day or I would be reported to the state board. The cost of the program would be approx. $30,000. I no longer had insurance and I share custody of my 2 children and had to provide half of their support. I made the decision to search for another job and went to a private A & D counselor for 2 months until I could no longer afford it. I have not taken anything stronger than Ibuprofen since then. I had not been contacted by anyone from the board or TNPAP. The job I got was also in an ED. I never had an urge to take any narcotics but I found that each time I went to the OmniCell to pull a narcotic, I froze and began to panic. This caused me to pull an incorrect med one day. I immediately pulled the correct narcotic and gave it. The problem came when I didn't immediately return the incorrect med. I was suspended for keeping the med on me for several hours and was terminated. I have been contacted by Peer Assistance that the hospital reported this. I am at a loss of what to do. I was and still am willing to go to treatment for addiction. I no longer want drugs, but I can see how easy it would be to lapse back into it. I know that I will have to agree to TNPAP's contract or lose my license, but I cannot see that my only option was the $3,000 treatment. I will have to lose my license and seek a non-nursing job. I am a good and competent nurse with over 12 years experience. My experience with TNPAP has been that the program sounds good and the intention to allow rehab and return to nursing is great, but the requirements are rigid and do not take into account the financial and personal obligations of the nurse. I would appreciate hearing from others who have been involved with Peer Assistance and any advice on what my options are.

Darlene K. · Nov 24, 2005

gianna2111 :crying2: I'll keep you in my prayers.

Balder_LPN, LPN · Nov 24, 2005

I'm not sure of the prevalence of drug addiction in nurses. Easy access to narcotics makes it very tempting for the addict.
A couple of them have found healing and recovery after getting caught.

I found this at the wesbsite healthcare.lycos.monster.com/articles/drugabuse

"Studies show the addiction rate among healthcare workers mirrors that of the general population. “The normal rate (of addiction) for the public is one out of 10,” says Connie Mele, MSN, RN, CCAF, CARN-AP, program administrator of substance abuse services for Mecklenburg County, North Carolina. “But I think people have the expectation that a nurse would certainly know better.”

and another source http://www.duke.edu/~mageorge/Papers/Substance%20Abuse.pdf#search='healthcare%20workers%20drug%20addiction says

"Healthcare workers are in a unique position to acquire and abuse prescription drugs. While many offenders steal drugs while working, others steal prescription pads or write illegal prescriptions for friends. Of the 250 felony arrests made by the Cincinnati Police Department’s Drug Diversion Unit in 1999, almost a third involved healthcare workers, including doctors, nurses, and hospital workers.

Overall, the prevalence of substance use disorders in healthcare professionals (and nursesin particular) appears to be about equal to that in the general population (between 6 and 8%) (Blazer, 1995). In fact, healthcare professionals have slightly lower rates compared to certain other occupations, such as roofers and housepainters, and people who travel frequently for aliving.

Among healthcare workers however, there is a higher use of prescription opioids and benzodiazepines than in the general population (Welsh, 2002).

The majority of nurses who receive treatment for problems related to chemical abuse became addicted as students, and were academically in the top third of their class. A majority also hold advanced degrees. “It has been estimated that approximately ten percent of nurses are chemically impaired and most disciplinary problems that are addressed by Boards of Nursing are related to nurses in this ten percent. A recent report from the Idaho State Board of Nursing indicated that ninety percent of the nurses whose licenses were suspended or revoked from 1985- 1997 had problems associated with chemical dependency.” (Clark, 1999)

The American Nurses' Association (ANA) estimates that six to eight percent of nurses use alcohol or other drugs to the extent that they impair their professional performance (ANA, 2000). Emergency and critical care nurses are more than three times as likely to use marijuana or cocaine as nurses in other specialties (Trinkoff and Storr, 2000)."

Simba&NalasMom, LPN · Nov 24, 2005

I work in LTC and I'm a pretty new nurse, so haven't seen any problems as of yet; but it amazes me how easy it would be for anybody to have access to all the narcs facilities keep on hand. The only safeguard is that the narcs are counted at shift change; still, because we are working with a poplulation with individuals who cannot make their needs known, it would be so easy to sign out a narc, make it look like it was given, and then not give it; The individuals for whom narcs are intended are not always capable of saying "I didn't get my pain pill tonight." So not only are there probably nurses/med aides with serious problems not being addressed, but people are suffering pain as a result. Absolutely terrifying to say the least.

I look forward to the day where LTC facilities catch up with the technology that is found in hospitals.

boysmom32 · Nov 24, 2005

I worked in LTC for 7 years and you wouldn't believe the number of ways narcotics were stolen. I just joined this website today and this is actually the first time I've encountered the term " diverted" and I've been an RN for 12 years. I took medication from the hospital where I worked and I live everyday with the guilt that I "STOLE" medication. I became addicted after years of taking Lortab and Percocet for bulging disc pain without any problems. I was given Dilaudid and the changes that occurred in my brain were quick and frightening. I was aware that it was affecting me but I was helpless to stop it. The compulsion to get more was the most important thing to me even though I could tell myself that I was messing up. I was ashamed of what I was doing because I knew better. I reported myself and have gotten help. The one thing that stays with me through all that I am going through is that I reported it myself and took responsibility for what I did. I make no excuses for what I did, but I cannot describe the overwheaming compulsion that I had to get the drugs. I never would have believed that I wold crave something so strongly. The truth is that I had been getting medication for awhile before I actually took an unopened vial of Dilaudid and shot it into my vein. I was a well respected and well liked nurse in my community and I found myself digging into sharps containers for partial vials of Dilaudid that had been wasted and using it. It was when I ran out of this that I took the unopened med. I panicked and told on myself. I feel like that demonstrates the uncontrollable urge I had to take Dilaudid. No nurse in their right mind would do what I did. Looking back on it scares me to death. I know that it is only by the grace of God that I am still alive to tell my story. I hope that other nurses will realize that they need to be alert and aware of the things addicts will go through to get their drug. If you think something is going on where you work that doesn't seem right, go with your gut. Keep your eyes open and don't let your guard down. Your observations might help to save someone's life.

jerseyboy · Nov 24, 2005

I personally have a zero tolorence for a nurse who has stolen medication and or uses drugs and is able to keep a nursing license.

Have you ever done anything that you shouln't have?

rach_nc_03 · Nov 24, 2005

My best friend dated a nurse who stole IV narcotics from her facility for quite some time. she would bring syringes with her to parties and nightclubs, and she and her friends would shoot up whatever she'd been able to steal that day. She was caught, put on probation, and several years later is working on an unrestricted license.

on my old unit, it's common for nurses to keep vials or syringes of IV narcotics in the bedside drawer so they can mix drips on the fly. After 24 hours, these are supposed to be thrown away- i can't tell you the number of times i've found six or seven vials of morphine, fentanyl, versed, valium...you name it- drawn up in a syringe and left in a bedside cart drawer for days. i always wasted these with another nurse, because i feared i would be the one accused of diversion. nurses frequently carried these in their pockets. i'm sure there are people who just walked out with them after their shift....there's no way anyone would have known.

i've had multiple medical problems over the last two years, one of which required the daily use of narcotics. i currently take a combination of demerol and phenergan when i have acute migraines and am not working. the relief- and release- i feel from the demerol makes me understand how anyone could become addicted.

treetop · Nov 30, 2005

DALSAC you are an inspiration. I surrendered my license in 1988 b/c I too was worried that I would divert again. I have been in recovery all these years and obtained social work degree I now want to re-enter nursing but do not even know where to begin or if anyone would ever hire me again.