New York Nurse Steals Narcotics from Cancer Patients

[J.Adderton, BSN, MSN]

I am alarmed other "safeguards" were missed. A nurse diverting medications on 81 patients (most likely more) over a 6 month leads to additional questions:

1. Did the nurse have altered behavior or performance issues that were not addressed?

2. Had supervisors ect. discussed suspicions with nurse but did take concern through appropriate chains?

3. Were patient/family complaints regarding the nurse adequately followed up on?

I am not lessening the nurse's responsibility or accountability as there was absolutely wrongdoing. However, I suspect there is failure to safeguard patients from several different levels in this situation.

[Leader25, ASN, BSN, RN]

I find the article depressing and shocking with the stats of one in 10 having addiction issues.In Nowhere, USA, regional hospital there have been cases of rns caught stealing for personal use and as well sale.There was one rn that was a big user of alcohol,a nd other drugs but not stealing.I must say I was clueless as I did not notice any altered behavior,she was caught after becoming very sick from a infection that almost killed her.

One guy I did notice a sharp change in a usually mellow personality,he was using and selling.Travel nurses have had the most incidents,some passing out high, right at work in the ER.

Drinking seems to be mentioned by many as "when I get home Im having wine "etc.

Coping with all the stress and 100% perfect press ganey /H-caps scores will unravel the best of us.

What did nurse did to those ill patients is unforgivable,to cause pain and suffering like that,disgusting.

SMH - dont know what else to say,sooo sad.But if it was a loved ones med,I would be seriously pissed off.

[subee, MSN, CRNA]

While an addiction is running its course, the job is the last thing to go, so most nurses are detected late un the disease. At Roswell Park, nurses handle narcotics like water. They are all around them and pain management is high priority and the goal is ASAP. What makes this case more distressing than most is that the nurse diverted narcotics from the patients. Most nurse addicts get caught before they are compulsed to steal from patients. She will not be able to enter the peer assistance program because she caused obvious patient harm which will disqualify her from getting her license back. Hospitals are often reluctant to allow outreach lecturers in (who's in denial now?). This us a particularly sad case and I just hope she gets treatment before she suicides.

[goodnightopus4, BSN]

I've been a nurse for over a decade and I'm reluctant to divulge too much detail on this forum. However, I think that's part of the problem...we don't hear from both sides of the table often enough. Thank you for posing this question to those who are addicted as well. My post is going to be really long, but I hope you stick with me.

I am a recovering addict and alcoholic. And I'm a nurse. I didn't know I had an issue with drugs or alcohol until long after I became a nurse. I thought I was normal...all of us nurses were stressed and needed a little liquid assistance in winding down, right?! I realized I was different when I tried to get my drinking back under control, and couldn't. I have always been strait-laced, well behaved, hard working. To a fault. No one would have ever guessed that I was that 1 in 10.

The thing that I hope anyone who encounters someone struggling with substance abuse understands is that this is a disease. There is an element of choice, and of loss of control. For me, looking back I can see where I had an opportunity to get help but didn't. I had a choice at that time, but I couldn't see the forest for the trees. When things got really bad, I chose to stop. But here's the kicker...I couldn't. I was terrified because I have always tried to do the right thing, and I simply couldn't do it. No matter how hard I tried. Logically, this should have been when I asked for help. But it wasn't. I had convinced myself that I had to figure this all out by myself.

Here's how my diseased brain decided I should "figure this out"...

I had gotten to the point where it was hard not to drink during the day. But I would NEVER drink at work, so I asked my doctor for a prescription for Xanax. I started taking Xanax at work to avoid showing up drunk. Can you guess how well that worked out? It didn't. I didn't have any more control over Xanax than I did alcohol. I do not remember taking more than 1, but when I woke up 16 hours later, I had taken 15, blacked out WHILE taking care of patients, got sent home by coworkers, driven to the store for alcohol, started having trouble breathing and was taken to the ER by a friend who found me at home. To this day, I have no memory of any of that. In that string of events, I made ONE choice: take one pill.

The next day, a coworker who witnessed all this showed up at my house. She told me that I had two choices. Call the board of nursing, turn myself in and go to inpatient treatment, or she would report me to the board herself. That was my bottom. I broke. I knew that me trying to figure out how to manage this on my own was officially done. I called, I was honest, I spent 2 years in inpatient and outpatient treatment, spent 4 years under a very strict monitoring program through the board. They didn't make it easy and I am so beyond grateful for that. I had to prove that I understood the gravity of what I did and was committed to the work it takes to recover.

I hope some of you have made it all the way to the end. Today, I am over 5 years sober. I've told every employer about what happened that day. I am upfront and honest about my disease. I never want to pretend I can do this on my own again and that honesty is one of many things that helps assure that.

We are taught to be compassionate towards our patients. Even when they don't make the logical choice...over and over again. Even when their illness brings pain to those they love. They stop taking their meds, they chose not to seek treatment, they lie about their diet, how much they smoke, how much they drink. We are human. All of us. If you see a fellow nurse who is struggling, look at what's happening head on. Ask them what's going on...they very well may brush you off or push you away. That's fine. Somewhere in the back of their mind, the seed is planted. If they do something that seems off and flags are raised, confront the issue by talking to them, reporting them, whatever it takes. They might feel betrayed. That's fine. They might be angry at you. That's fine. They may never work in healthcare again. That's fine. This is a person, with a disease that distorts reality. You can see reality even if they can't. So be honest. Be forward. Be loving. Turning and looking the other way is dangerous for patients and for the person struggling with substance abuse.

[2BS Nurse, BSN]

Thanks for sharing goodnightopus4. We work in a high stress environment where PTSD is not recognized or treated. The work is piled on until we reach our breaking point. A patient dies and we internalize our feelings and take them home with us. I'm so glad you sought out and received help.

I have chosen to remain in the outpatient setting because it allows self care and a good work/life balance. As nurses, we are taught to feel guilty about caring for ourselves. I have learned to set boundaries and say "no" to picking up extra hours.

[NurseBlaq]

@goodnightopus4 Thanks for sharing your story and glad you're on the right path again. Good luck to you on your journey.

As to the article, that's just cruel and horrendous. Don't care if someone has a drug/alcohol problem or not, to divert much needed pain meds from cancer patients is a tragedy.

I used to work with a nurse who diverted drugs, found one of her stashes and turned her in. Did management do anything about it? Nope, because she was in their clique. I've had classmates who say they've turned in addicted nurses who had become hazardous to patients and other staff members only to be harassed themselves for speaking up or fired for stupid reasons for telling on the favorites. I've seen some of these people get away with what they're doing because they're always willing to work overtime, of course to have additional chances to divert drugs, but management only notices they have holes in their schedule filled. It's all bad.

On the flip side, I've seen addicts get help, improve and stay clean a long time. Many say it's hard but when you have a great support system it's very much doable. Knowing that I don't trash addicts, but I don't look the other way either. Almost always, speaking up is what's the best thing to get them the help they need and can save their lives.

[kbrn2002, ADN, RN]

One in ten nurses has a substance abuse problem? If that's a true statistic that's terrifying. I work with more more than ten nurses, as do most of us I am assuming. I haven't had any reason to suspect any of them of diverting. None have shown up to work in the morning appearing hung over, smelling of alcohol or with any signs of being impaired by drugs or alcohol. I don't spend a lot of time with them out of work but I have no reason to believe any of them are abusing any substances off the clock.

My question is how does anybody know that one in ten statistic is anywhere near accurate? Not like most addicts just flat out admit to having a problem and I doubt that one in ten nurses have been caught impaired on the job or diverting. If that were the case it would be much bigger news than an article on AN.

I don't want to be that nurse, full of suspicions and involved in a witch hunt looking at my co-workers trying to figure out which one is having trouble with substance abuse and might be diverting. Sure, we have a few nurses that are always actively looking for OT, but isn't it a much more reasonable assumption that they do it because they want or need the income rather than jumping right to assuming they are an addict and might be diverting meds?

[subee, MSN, CRNA]

7 hours ago, kbrn2002 said:

One in ten nurses has a substance abuse problem? If that's a true statistic that's terrifying. I work with more more than ten nurses, as do most of us I am assuming. I haven't had any reason to suspect any of them of diverting. None have shown up to work in the morning appearing hung over, smelling of alcohol or with any signs of being impaired by drugs or alcohol. I don't spend a lot of time with them out of work but I have no reason to believe any of them are abusing any substances off the clock.

My question is how does anybody know that one in ten statistic is anywhere near accurate? Not like most addicts just flat out admit to having a problem and I doubt that one in ten nurses have been caught impaired on the job or diverting. If that were the case it would be much bigger news than an article on AN.

I don't want to be that nurse, full of suspicions and involved in a witch hunt looking at my co-workers trying to figure out which one is having trouble with substance abuse and might be diverting. Sure, we have a few nurses that are always actively looking for OT, but isn't it a much more reasonable assumption that they do it because they want or need the income rather than jumping right to assuming they are an addict and might be diverting meds?

You can have your addiction attenae turned on without being on a witch hunt. Since most addiction occurs in nurses who are experienced, well-educated, married, etc. they walk among us without getting a second look. Staff have to be proactive about spotting people who are suffering from this problem and get them off the floor before they hurt others or themselves.

[MsQueensRN, LPN, LVN]

This is sad for all parties involved. Those hem/onc patients who experienced undue pain, infections, and prolonged hospital stays; the nurse who obviously needed help; and the facility that will now be smeared and lose the respect of many individuals who could potentially benefit from the care provided there. Honestly, I can't point a finger at coworkers who didn't notice or should have noticed, because let's be honest the fact that we work with and want to be able to trust our coworkers does cast a veil over our ability to see one another in such a negative way. Also, from my experiences in the workplace, we often do not notice that something is wrong until it has been ongoing and the nurse in question has obviously lost control.

[K+MgSO4, BSN]

It speaks so much to department culture. I started managing my unit soon after another job where a nurse had committed suicide with drugs they had stolen from their workplace. All narcotics and "medicines with the potential for abuse " are a double check out of the drug cupboard and to the bedside until administration to the patient. Combined with rotating rosters you are less likely to have a chance to divert due to working with different people all the time and a culture where patients speak up if they don't see 2 nurses with their pain meds...funny when I was the second nurse but dressed in funeral clothes for a colleague's funeral and they questioned me as I had no ID visable!

[JKL33]

20 hours ago, kbrn2002 said:

I don't want to be that nurse, full of suspicions and involved in a witch hunt looking at my co-workers trying to figure out which one is having trouble with substance abuse and might be diverting.

Ditto.

I think it is well-established that we have no reason to think nurses are somehow immune to these problems, but it is something else entirely to maintain a high index of suspicion just because we handle controlled substances.

The linked and referenced article from ANA is ridiculous; pretty much embarrassing. I just can't believe a professional organization would publish something like that with the cheesy fake conversations and über-stereotypical nonsense, and "What does a substance abuse nurse look like?"

? A "substance abuse nurse"??

***

On 6/18/2019 at 4:58 PM, Melissa Mills said:

Psychology Today reports that behaviors that should make you question what’s going on with colleagues include volunteering for shifts on holidays, weekends, and overnight because there is less oversight by administration during those shifts. You might also wonder what’s up if a coworker constantly has incorrect narcotic counts, reports wasting medications without a witness because no one was around, or they look for opportunities to be alone with pulling narcotics from the dispensing system. It’s critical to point out that doing one of these actions or having it happen occasionally isn’t reason enough to schedule a meeting with the unit manager to discuss your concerns. However, if you notice a coworker doing these actions consistently or if you have that “nurses intuition,” it might be best to discuss your observations with the manager privately.

[I appreciate that you did write that singular or rare occasions may not be enough to raise suspicions.] Aside from that,

1. Volunteering to work in situations that just so happen to usually have extra cash attached to them (not to mention more work = more money) is nearly meaningless with regard to the topic at hand. Even preferring to work when admin is not there is not independently suggestive of anything (other than common sense, some would say).

2. Wasting medications without a witness is not good and never was, but up until very recently it was not a rare thing. Yes, if someone was frequently doing it now it would signify some sort of problem (possibly but not necessarily r/t substance abuse).

3. No you should not have any private talks with management regarding your "nurses intuition." If everyone is expected, at baseline, to be constantly suspicious of everyone else around them (without any reason for such), then "intuition" becomes nothing more than a false confirmation of one's own unfounded suspicions. < I feel like I'm not explaining that very well, but think about any unfounded thing people say they "can just tell" (like "I can just tell she doesn't like me"). The person's own thoughts become their suspicions and also their (poor) "intuition."

I do not agree with the philosophy or ethics of addressing these situations in the ways I am commonly seeing and reading about. As far as how we should regard our coworkers this is quite simple: If someone appears to be having a problem at work, get help for them not knowing whether they could be impaired or be suffering from a different medical condition. Do your part to make sure their patients can be safely cared for. This tack does not require anyone to have any "intuition" or suspicion that a coworker is having a problem with SUD. Either they are appropriately taking care of patients, or they aren't. If they aren't, get help (report per usual procedure for basic situation of need. Let the supervisor take it from there).

I don't go to work to police my peers, and I don't desire to help create a world where everyone (especially those with very little power or authority) is always under suspicion of some sort of serious wrong-doing.

13 hours ago, subee said:

You can have your addiction attenae turned on without being on a witch hunt. Since most addiction occurs in nurses who are experienced, well-educated, married, etc. they walk among us without getting a second look.  Staff have to be proactive about spotting people who are suffering from this problem and get them off the floor before they hurt others or themselves.

It sounds like something easier said than done, and is a tall order I do not trust others with successfully accomplishing: Without actually being overly suspicious or being on a witch hunt, people are supposed to seek to proactively spot people who others may or may not find suspicious-looking? I just don't see that happening. All around our workplace environments are examples of people oversimplifying things and other people absolutely responding in unthinking manners as if these (often self-serving) overly-simplified directives and imperatives are either laws or major ethical tenets written in stone.

**

I think we are confusing issues here. There is a massive difference between not making excuses for the obvious even if it happens to appear where you didn't expect it vs. kinda suspecting everyone for the lame-o reason "it could be anyone."

Going overboard with themes "it could be anyone" and especially "its always the ones you don't suspect" is really problematic. It's wrong, IMO, and is very, very different than just empowering people to not dismiss obviously irregular behavior just because it may come from a well-respected source. Sometimes "the ones you don't suspect" haven't been suspected because they aren't doing anything suspicious or wrong. ??‍♀️