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Nurse addict?

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banker321 banker321 (New) New

My wife is an RN and recently I've become more concerned about certain things I've found around our house. I'm not in the medical profession but thought maybe someone in this forum could offer me some advice.

A little background - my wife graduated from nursing school in 2000 and for the last year has worked the night shift in the critical care unit of a busy, major metropolitian hospital. She isn't happy at work for a variety of reasons and has had difficulty adjusting to the night shift (she has trouble sleeping during the day).

A few months ago I found two little IV viles of lorazepam in the butter compartment of our fridge. When I ask my wife about it she said that during patient emergencies she sometimes inadvertently put the partically used viles in her pocket and accidently took them home (she said they were marked as "waste" on the paitent's chart). I asked her why she just didn't throw them away later. She said it just seemed like a waste to do that. I didn't question her any further on it and didn't find anything else in the fridge after that.

Since then I've found two syringe caps on the floor in our bedroom. Recently I found two more viles of lorazepam (one in a "carpuject" form) and one vile of midazolam in her sock draw (yeah, I snooped). I'm reluctant to confront her on this because she's lied to me in the past about other non-work related issues.

Might I be just making a big deal about some innocent mistakes she's made or do you think there is more going on here? The only other hospital drug I've found around the house was a vile of oral dose morphine by the telephone. Any advice is greatly appreciated.

no you are not on the wrong track. you don't accidentally take stuff like that home and hide it around the house. she needs help!!!!!!!!!

WOW, you definitely need to talk to her.

Bringing a wasted med home is possible, but I don't understand why she would hang on to the narcotics--in the fridge, dresser? :o

If she is abusing she needs help before she hurts herself, her patients, loses her job, loses her license, goes to jail, ruins your marriage, do you have kids?, need I go on....

I wish you and your wife the best of luck. She is not alone if she is using, employers offer assistance to impaired nurses.

I hope this is a awful coincidence, but it sounds bad.

how is bringing home a waste so possible when you are supposed to have two people sign that it was wasted. i mean i know it is possible but i think only purposefully.

I haven't accidentely brought home a waste myself, I'd be the one to pull it out of my pocket while walking to the car talking to my manager!! :eek: :D :D

But I've worked with a few nurses who have actually brought it back the next day and say that they kept it on them because they were sure the patient would need it again.....? :confused:

Where I work the 'narcs' are in a computerized/locked cabinet "PYXIS" (sp?) your signature is a short username and password, much like logging onto the BB! Everyone is busy, types in their username and password then turns around, never witnessing the actual waste. A flaw, yes I know. :rolleyes:

i don't understand how you can bring it home if it is not on purpose. why would you stick it in your pocket instead of trash, etc., unless you want it??????? don't all places require two signatures for wasstes?????????/

I've been in AA for 7 years. Call Naranon or Alanon, groups for families/supporters of addicts. You can confront her, but you cannot make her change. She will have to hit her bottom, and will most likely drag your and your family with her. She has an illness - like cancer. The treatment is recovery. Get her a Narcotics Anonymous schedule and let her decide whether or not to go. Naranon, will help you stay sane (if that's possible) while staying in this relationship. Addiction is a system problem, it involves the whole family. If you care about the relationship, you will invest in your own recovery. You could do the tough love thing and report this to her employer. They probably have an employee assistance program, and may give her a chance to clean up her act before they fire her. Remember, she is risking the lives of your children, and the patients under her care. Her judgement is impaired while she's using. Don't wait. Take action.

Good luck. Craff1@yahoo.com

P_RN, ADN, RN

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89. Has 30 years experience.

Your wife has a problem.

One: if it IS inadvertant or ISN'T it is still DRUG DIVERSION. She knows that it is wrong.

Two: You can't get out of orientation without knowing you have to have a witness actually SEE you squirt the stuff out. Somebody else is enabling her by signing without actually witnessing.

Carrying home a syringe or alcohol swab is innocent enough. You take them back the next day. USING them at home is something else.

You need to talk with your wife.....and possibly get a lawyer.

Being labelled as a drug thief will stay with her forever.

I didn't see where you are from but go to your state board of nursing web site and there will probably be a LONG list of nurses who have lost their licenses.....for the world to see.

Please talk to her and get her help. And please don't leave her alone until you do.

Tiger----

Ok, here's what I've observed..

Nurse gets out med, ex: needs 2 mg morphine which is supplied in 4mg/2mL. Computer asks 'Do you plan to administer entire dose of Morphine 4mg/2mL' Nurse says 'No' then the computer ask for another username/password which would be the second 'signature' The second nurse steps in enters her username/password and hits 'continue' draw opens automatically, after that you enter the beginning count into the computer, get out the 4mg/2mL of morphine, close the draw and draw up what you need and if you do it like it is supposed to be done you waste the 1mL you do not need. At this point the second signature is supposed to be watching you squirt the rest down the sink, but in some cases the nusre is long gone. I never keep a waste quoting myself from before:

I'd be the one to pull it out of my pocket while walking to the car talking to my manager!!
If I'm wasting I ask that the other nurse watch like the law says.

But I have seen nurses put the other 1 mL (to stay with the above example) in their pocket to use it in 3 hours because the patient is in horrible pain requesting the med as soon as it is available. When I was seeing this I did open my mouth about why the witness was not there, now I try not to be near someone who is doing it improperly, for my own sake. When I am the second signature on a waste I watch the waste happen I do not walk away after entering my username and password/'signature'

But just the other day I was in the medicine room and a nurse was talking about how she had just thrown away a med she had accidentely taken home. She thought that the patient would need the med again before the end of shift so she hung on to it trying to safe herself time (I guess) but the patient did not request the med after that and she forgot she had it until at home emptying her pockets...

It's not right that this happens and I do not let it happen to me. Maybe it's been explained clearly :)

like i said i know it's possible but more than likely if you end up at home with a controlled drug it is intentional. i have been doing this for 16 yrs and have never taken any drug home. and we are all very trusting of each other to waste what we sign for even if we don't actually witness it. i don't think i would forget that i had something illegal in my pocket when i got ready to clock out.

debbyed

Specializes in ER, Hospice, CCU, PCU.

Ok...I agree that she probably has a problem based solely on the fact that she hid these drugs.

Everything everybody said about wastes is completely true, however---and this is a big however, written standards are not the same as reality.

In most the ER's I have worked at, critical and code situations called for a little different stratigy, We frequently use multidose vials especially Ativan (10 mg. vial) Since you unofficially have a 1 mg prn for seizure activity until seizure activity stops that 10 mg. vial goes with you to CAT Scan, etc.

When intubating a conscious patient we always remove 2- 5mg. vials of versed from the Pixis because it takes so D@*n long to get the med out in the first place. Some times it only takes 2 mgs some times it takes the whole 10.

With acute MI patients you give morphine 2mgs every couple minutes until pain is under control. The tubex holds 10mgs. Again sometimes 2 mgs is enough, sometimes you need all 10.

Now in a perfect world when the critical incident is over you should empty your pockets and waste what is left. More often than not you are already involved in something else and you forget.

I have taken all of the above home a few times, but they went out on the dresser with the rest of the stuff in my pockets, to be disposed up properly the next shift I work. (No I don't have small children in my home, just hubby and me)

Originally posted by tiger

and please misty clarify that that quote is not from me!!!!!!!!!!!!!!!!!!!

Sorry not sure what you are talking about, is it this?.....

"I'd be the one to pull it out of my pocket while walking to the car talking to my manager!! "

What I meant here was that that is why I do not put waste in my pocket, I would forget and when I remembered and went to get it out of my pocket someone would see it and get the wrong impression of why I had it.

Hope that clears myself up :)

Thank you everyone for the advice you have given me, I guess I have a lot to think about. To answer misti_z question, no, we don't have any children. We are both in our late 30s and have been married for less than 2 years.

In regard to the drugs I mentioned -- lorazepam (mostly) and midazolam (once), I have another question. I've found out via the internet that both are sedatives, but are they the type of drugs a stressed out RN would want to steal? I'm very confused.

Several posters mentioned that two RN's are needed to declare a drug "waste". Is this true in all 50 states?

Thanks again for your help.

After being personally involved in three IV drug cases at work, I can say unequivically you should seek help. (Sometimes I really hate being Charge) The advice above seems sound. You alone know your wife and how she will react to any of the above situations. All I can say, is act now before something bad happens. I had the very unfortunate experience of saying goodbye to a colleage at the Pyxis at 0700. That was the last time I ever saw this nurse alive. She/He Od'd in the restroom one hour later. You will never know the depth of her problem until you confront her.

I wish you luck, and hope that things work out as best they can for you. You are in a potentially bad situation, but without action, it will only get worse. The person I mentioned above was only found to use IV drugs after they went anoxic in the employee restroom. So you may be in time to do some good.

NICU_Nurse, BSN, RN

Specializes in NICU.

Found on the Yahoo health topic:

Lorazepam (Ativan)-

Lorazepam is a benzodiazepine used to RELIEVE ANXIETY.

Pharmacology:

Studies in healthy volunteers show that in single high doses Lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems.

Indications and Usage:

Lorazepam is indicated for the management of anxiety disorders or for the SHORT-TERM RELIEF OF THE SYMPTOMS OF ANXIETY ASSOCIATED WITH DEPRESSIVE SYMPTOMS. Injectable lorazepam is useful as an initial anticonvulsant medication for the control of status epilepticus and fpr producing sedation (sleepiness or drowsiness), relief of anxiety, and a decreased ability to recall events related to the day of surgery. It is most useful in those patients who are anxious about their surgical procedure and who would prefer to have DIMINISHED RECALL of the events of the day of surgery

Warnings:

Lorazepam is not recommended for use in patients with a primary depressive disorder or psychosis. As with all patients on CNS-acting drugs, patients receiving lorazepam should be warned not to operate dangerous machinery or motor vehicles and that their tolerance for alcohol and other CNS depressants will be diminished.

Physical And Psychological Dependence:

Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (convulsions, tremor, abdominal and muscle cramps, vomiting, and sweating), have occurred following abrupt discontinuance of lorazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage-tapering schedule followed. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving lorazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.

Overdose:

In the management of overdosage with any drug, it should be kept in mind that multiple agents may have been taken.

Symptoms: Overdosage of benzodiazepines is usually

manifested by varying degrees of central nervous system

depression ranging from drowsiness to coma. In mild cases,

symptoms include drowsiness, mental confusion, and lethargy.

In more serious cases, and especially when other drugs or

alcohol were ingested, sypmtoms may include ataxia,

hypotonia, hypotension, hypnotic state, stage one (1) to three

(3) coma, and very rarely, death.

Midazolam (Versed)-

Midazolam is used to produce sleepiness or drowsiness and to RELIEVE ANXIETY before surgery or certain procedures. It is also used to produce loss of consciousness before and during surgery. Midazolam is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the STRESS of being in the intensive care unit and help the patients cooperate when a machine must be used to assist them with breathing. Midazolam may cause some people to feel drowsy, tired, or weak for 1 or 2 days after it has been given.

*****It may also cause problems with coordination******

***** and one's ABILITY TO THINK. ******

Therefore, do not drive, use machines, or do anything else that could be dangerous if you are not alert until the effects of the medicine have disappeared or until the day after you receive midazolam, whichever period of time is longer.

Do not drink alcoholic beverages or take other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness) for about 24 hours after you have received midazolam, unless otherwise directed by your doctor . To do so may add to the effects of the medicine. Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; other sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; medicine for seizures; and muscle relaxants.

You get the idea. My strongest prayers to you right now; the situation you are faced with is a tough one, but if you truly love your wife, you know what you have to do with this information. In Louisiana, two nurses are required to witness narcotic wastes; I agree with the above posters that while it does happen occasionally, it is HIGHLY UNLIKELY that this is an accident, especially considering that it has happened more than once (in other words, you've found it stashed around the house...you mentioned fridge and dresser?). The fact that she is hiding it rather than immediately (by the next work day) bringing it back to the hospital or even disposing of it herself at home rather than keeping it is in line with typical drug-using behavior. Nursing is an extremely intense profession; it is possible that she is experiencing emotions that she is not capable of dealing with in a healthy way. To care about someone, as unfortunate and painful as it may be sometimes, is to risk losing them; if you are afraid of making her angry at you or having her leave you or accuse you of not trusting her may scare you into INACTION. I beg of you not to do this. You care about her; otherwise you would not have been concerned to find what you've found. I suggest that before you confront her, make sure that you have evidence of your accusations and make sure that you have a plan to help her get treatment lined up. Legally, hospitals typically will provide rehabilitation and job security to drug-abusing and drug-using (but isn't it really the same thing?) employees; investigate this at once anonymously to find out if it is an option for you and your wife. She needs counseling, and possibly a change in career in the long run if it is indeed nursing that is 'driving' her to do this. Other possibilities would be trouble between the two of you (only you can examine this; I'm not judging, just suggesting...) or financial difficulties or difficulties with family. My point is that there is some issue, or more than one, somewhere, that is causing her to want to 'flee' her everyday life; it is too much for her to take, and so perhaps it is appealing to temporarily forget or relax via narcotic use. Examine all aspects carefully, know that you have people here you can talk to, and have faith that no matter what she says or does, you may be saving the life of the woman you love. Good luck to you.

Well Banker, good for you for coming to this post to ask other nurses what they think. I agree with the others that your wife has a problem. I understand it. She is working on a shift that she doesn't like, and she sleeps poorly. She has found help in a vial. As others have mentioned, now is the time to act before something happens to your wife. It's only a metter of time. It is far better for her if she goes to management and admit she has a problem before they go to her. Many hospitals have programs for nurses with durg and alcohol dependencies. You have a job on her hands

because she probably won't admit that she has a problem right away. And she may have a lot of denile to deal with also. Sure will be thinking of you and your wife. Please continue to keep us posted as to how you are doing.

Bigred

This was very hard for me to read, and to comment on. Sir, I am afraid your wife has a big problem. I am a recovering nurse who was addicted. My prayers are with your family. Be supportive and get her some help. Chances are, she won't admit she has a problem. God bless!

I've brought home empty medication vials in the past (mostly non narcotics as far as I can remember). So, that would be possible. However, I think it is a warning sign that she puts them in the fridge and hides them in a drawer. Best wishes to all of you.

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