Listmates,
My post is intended as a way of "helping" us in our work settings to possibly identify a peer or colleague who might be actively diverting drugs. None of us wants to "rush to judgement" on such a critical issue as this. To accuse or even "suspect" wrongfully is a very hurtful place to go for everyone involved.
However, the reality is that our working environment is inherent with accessibility, and availability of addictive drugs that can become a source of temptation for the Nurse who is battling her own demons of addiction.
The "list" of red flags I am proposing is in no way all-inclusive. However, I submit such a "list" from my own experiences as the once impaired Nurse that I was, with the hope that if you see such similar red flags, they are "signals" that might not be ignored.
As Managers, Charge Nurses, and Teammates we never want to "believe the worst" about our colleagues. Addiction is addiction, whether it's played out on the street corner, or within our medical settings, and within our medical settings we find it far more difficult to "believe" this could actually be happening, but it does.
I also submit this information with the hope that, if you suspect a colleague has a problem with addiction, you might find the courage to take the necessary, and proper steps toward intercepting the diversion for him/her, because left unchecked , he/she is not only compromising the safety of patients, but contributing to the progression of the disease. By "intercepting" I simply mean reporting your observations, concerns to the person you believe will be able to help.
This list is not necessarily in any particular "order" of importance, it reflects behaviors that potentially portray an underlying problem, when seen on a consistent basis:
1. Volunteers, frequently, to work overtime, extra days.
2. Uniform consists of a lab coat with pockets or clothing that is loose fitting.
3. Often "disappears" from the unit aside from expected "break times" (meals, etc.)
4. "Nods off" at the desk, or frequently c/o "feeling so tired" lately.
5. Mood changes from quiet and subdued, to suddenly being animated, charming, engaging and confident.
6. Avoids being in the Med Room when others are there, and is observed being alone much of the time (in the Med Room).
7. When alone in the Med Room, and others enter, makes a hastey exit.
8. Often "forgets" to sign out scheduled drugs until the end of the shift.
9. Volunteers to be the one to "make out new narcotic sheets" for oncoming shift.
10. Volunteers to be the one doing the Narcotic Sheet count, as opposed to the cupboard's Narcotic Stock supply at change of shift.
11. Volunteers to give your "prns" for you.
12. Volunteers to go to Nurse's Lounge and make the coffee whenever needed.
13. Has a locker assigned, but rarely uses it.
14. Often has "bruises" on top of hands, and covers them with a bandaid.
15. Appearance of bloodstain (fresh) on uniform pants in thigh area.
16. Her patients who are in pain "never seem to obtain effective relief", or are "still agitated, uncomfortable and anxious" when she claims she has "just medicated" them.
17. Shops for orders for her patients relative to pain medication. i.e., "Dr. So-and-so....the Vicodin is not working for Mr/Ms "X", could we give something stronger" - when the Vicodin had been working all along.
18. Charting reflects having "given" a narcotic injection to a patient on the day of discharge.
19. Writes a T.O. order for narcotics, but never called a doctor.
20. Volunteers to be assigned the sickest patient or patients. (who have narcotic orders in abundance)
21. Frequently leaves out details required on Narcotic Sheets.
22. Is often late to work.
23. Calls in sick more than usual.
24. Ignores, even "jokes" about the necessity of and seriousness of policy and procedure surrounding narcotic dispension and documentation.
25. Pockets multi-dose vials of normal saline (10cc and 30cc).
26. Has a "ready supply" of syringes and needles in her uniform pockets.
27. Is known to never "empty" out pockets of such supplies at end of shift and before leaving the hospital.
28. Gives conflicting information about her patient's degree of pain to oncoming shift. (on "her" shift, the patient was in "great" pain and "needed" medicating either more often, or with larger doses)
29. "Forgets" to tell oncoming shift she "just" medicated patient with a narcotic, and conveniently "forgets" to chart same on med sheet.
30. Is known to "save" partial doses of narcotics (not used), because...."patient might need it later."
31. "Wastes" narcotics without a second witness, and asks you to "please sign" at end of shift - "I was in too much of a hurry and no one was around then."
32. Distances self from management, administration, and others in charge.
33. Rarely asks "for help" from peers with regard to patient cares requiring such help. (prefers to "work alone")
This is an example of what might be observed in behaviors. There are many more I'm sure. I cannot stress enough that delicate place of not rushing to judgement, but at the same time relying on your common sense, caring concern and what your heart and gut might be telling you. If you find yourself in such a position, the better thing to do is take your concerns to even one person you trust, who will know how best to address your suspicions. You have the right and need to express your worries over such serious matters in the work place. An impaired Nurse on duty places her teammates in a very uncomfortable, and compromising position. When handled properly, the outcome for the Nurse, colleagues and patients, can be positive rather than tragic.
Good Management knows the risks that are involved when an intervention is necessary, and should be prepared to deal with the risks. (one being suicide)
I hope this is helpful information. Over a period of three years, I exhibited all of those behaviors, and toward the end, I was screaming (internally) to those around me......."don't you see what I'm doing, please, please stop me; someone help me!" And they finally did, before I could take my own life.
Thanks for "listening."
Bonnie Creighton,RN, MHCA
Mental Health Consumer Advocate
