Nurses Diverting Narcotics.

[NurseCalamity]

Today I caught a fellow coworker diverting narcotics.... she's an RN with a past history of doing this, but it couldn't be proven, not even with a pop up Urine screening. She had patients complaining about not being given the correct pain pill.... she's basically busted now.... so my question is, have you ever turned a fellow Nurse in for diversion of narcotics and how did it all turn out?

[Altra, BSN, RN]

Statistically, the addiction rate among nurses is the same as the regular population - 10%. And this includes nurses like myself who never diverted but are alcoholics.

Anecdotally, most of the nurses in my monthly monitoring meeting, the rehab I attended, and in an AA for healthcare professionals meeting I like who got nabbed for diverting were diverting wastes. Folks who divert from patients get caught pretty fast.

Not everyone who diverts also uses which can make UAs useless -- or they are diverting because the legitimate script they have isn't enough.

Excellent post.

[NutmeggeRN, BSN]

In 2012, rad tech David Kwiatkowski infected 27 Cath lab patients with Hep C at Exeter Hospital. He diverted drugs by cultivating relationships with the female staff and by making a big production of helping the RN put on her lead apron and thyroid shield. When the RN's back was turned from the tray he switched out the syringes of versed and fentanyl with contaminated syringes. Both he and the RN were contract travel workers. The Cath lab RN was exonerated after an FBI investigation.

I have no empathy at all, none, for people who knowingly involve their coworkers in a criminal act.

He was eventually caught in NH...what a shame it took so long!

[amzyRN]

I meant that I don't trust them when it comes to diligently counting the narcotics.

Where I work, all my coworkers are trust worthy. I've never worked at a place where diversion of narcs was common. At least not amongst staff. I don't think it's offensive to actually witness wasting, not because of distrust, but because that's what we are supposed to do, because it's not helpful to support that type of behavior which is detrimental to all involved.

The tone of your post seems to be that of disdain rather than compassion, that you are somehow morally superior. At least that is how it comes off to me. I do not support diversion and addiction but I have compassion for people with addictions because I know that it is a real disease that the person might not have control of. It is very unfortunate and something that I would want to help someone overcome and that is why I would report suspicious behavior. Perhaps that is the sentiment you share and maybe I am misinterpreting. I don't like the callous attitudes many people have about people who suffer from addictions. I believe of approaching it from the heart with compassion and empathy.

[NightOwl0624]

I had to report on a colleague once. I didn't suspect any diverting behavior and really liked the person, but the Pyxis activity was so strange one night (following the nurse) and the emr did not make sense. Reported it to the manager, that was the extent of my involvement. He was walked out the next day, and admitted he had been diverting for months.

i didn't feel bad about what resulted, but I did actually feel bad for the nurse with the problem. Addiction is nasty business and I wouldn't wish it on anyone.

[brownbook]

I was the night supervisor....I forget a lot of the details..but I was called to a unit, the narcotic sign out log was blatantly altered, I think she even tried to use white out? Of course my first thought was "what do I do...what do I do....who do I wake up at 2:00 in the morning...how do I deal with this!"

(I get so self centered in a crisis....how will it affect me...will I do something wrong...geeze!)

I don't remember any details, I guess she was just asked to go home pending further investigation? I know I didn't get a urine sample, call the police, etc. I think it was all left for the next day, for higher ups to deal with. I remember her, she was a good, nice, nurse, and I wonder what happened to her and wish the best for her.

[NursesRmofun, ASN, RN]

I had to report on a colleague once. I didn't suspect any diverting behavior and really liked the person, but the Pyxis activity was so strange one night (following the nurse) and the emr did not make sense. Reported it to the manager, that was the extent of my involvement. He was walked out the next day, and admitted he had been diverting for months.

i didn't feel bad about what resulted, but I did actually feel bad for the nurse with the problem. Addiction is nasty business and I wouldn't wish it on anyone.

This story jogged my memory about a co-worker from a while back. She was very pregnant and "sick" with I don't remember what and wouldn't write here her r/o diagnosis anyway, if I remembered it...but her symptoms were vague...and she was getting narcs as a patient on our unit. That same nurse, when working, frequently had odd things happen surrounding Pyxis issues...and I suspected she was at the center of it...but there was no proof as far as I was concerned. What I saw, the people auditing saw...not sure whatever happened. I left that job within a few months.

[HM7380]

If you're dead set on reporting them, make SURE they're actually diverting. I was just fired (I live in Atlanta) because we got a new don/adon and both are black, which is great. Except every single person I work with hates white people. They proceeded to create paper trails of write ups for all the white nurses until they were fired. We went from having 85% white nurses to 1 white nurse - they will only hire white staff for housekeeping and laundry, and the black nurses are EXTREMELY under qualified. Two of the extremely racist black nurses who worked my cart (there were 4 nurses who worked it total) set me up (one worked 7-3, I worked 3-11, and the girls best friend worked 11-7) They stole several narcotic CARDS and the sheets to go along with them, and both went to the DON and told them I did it. (I did NOT.) Thankfully, I have a pain dr I go to after I fell 35 feet out of a tree on to rocks, so I have an rx for all my meds, but the point is, THEY TRIED TO GET ME FIRED AND TAKE MY LICENSE. They constantly told the mngmt that I was a pill thief, and it got so bad, and because they had no proof of anything other than these two hateful womens words. I could have lost everything because of someone who decided to lie and do their best to besmirch my name. And just for the record... I'm the most non-racist person I know. I'm an excellent nurse and have received accolades wherever I've worked. But just coming from someone who got thrown under the bus by hateful nurses, be careful who you report unless you are 100% sure. You could destroy someones livelihood just because you have some sort of inclination that could possibly be very wrong. Thankfully, they failed at trying to get me pinned for the narcotics, but because they constantly wrote grievances against me, I lost a job a love, in LTC where the people were like my family.

[NursesRmofun, ASN, RN]

If you're dead set on reporting them, make SURE they're actually diverting. I was just fired because we got a new don/adon and both are black. They proceeded to create paper trails of write ups for all the white nurses until they were fired. Two extremely racist black nurses who worked my cart (there were 4 nurses who worked it total) set me up (one worked 7-3, I worked 3-11, and the girls best friend worked 11-7) They stole several narcotic CARDS and the sheets to go along with them, and both went to the DON and told them I did it. (I did NOT.) Thankfully, I have a pain dr I go to after I fell 35 feet out of a tree on to rocks, so I have an rx for all my meds, but the point is, THEY TRIED TO GET ME FIRED AND TAKE MY LICENSE. They constantly told the mngmt that I was a pill thief, and it got so bad, and because they had no proof of anything other than these two hateful womens words. I could have lost everything because of someone who decided to lie and do their best to besmirch my name.

Assuming this is true and giving you the benefit of the doubt, that is horrible. Why would you want to continue to work there? Yikes. I know we all need to feed ourselves....but I definitely would *try* to find another job....but maybe the benies are too good or something?

[Mavrick, BSN, RN]

If you're dead set on reporting them, make SURE they're actually diverting. I was just fired (I live in Atlanta) because we got a new don/adon and both are black, which is great. Except every single person I work with hates white people. They proceeded to create paper trails of write ups for all the white nurses until they were fired. We went from having 85% white nurses to 1 white nurse - they will only hire white staff for housekeeping and laundry, and the black nurses are EXTREMELY under qualified. Two of the extremely racist black nurses who worked my cart (there were 4 nurses who worked it total) set me up (one worked 7-3, I worked 3-11, and the girls best friend worked 11-7) They stole several narcotic CARDS and the sheets to go along with them, and both went to the DON and told them I did it. (I did NOT.) Thankfully, I have a pain dr I go to after I fell 35 feet out of a tree on to rocks, so I have an rx for all my meds, but the point is, THEY TRIED TO GET ME FIRED AND TAKE MY LICENSE. They constantly told the mngmt that I was a pill thief, and it got so bad, and because they had no proof of anything other than these two hateful womens words. I could have lost everything because of someone who decided to lie and do their best to besmirch my name. And just for the record... I'm the most non-racist person I know. I'm an excellent nurse and have received accolades wherever I've worked. But just coming from someone who got thrown under the bus by hateful nurses, be careful who you report unless you are 100% sure. You could destroy someones livelihood just because you have some sort of inclination that could possibly be very wrong. Thankfully, they failed at trying to get me pinned for the narcotics, but because they constantly wrote grievances against me, I lost a job a love, in LTC where the people were like my family.

I don't see your point here. These nurses did not make any kind of "mistake" by reporting you. They did it intentionally and maliciously.

You have to report what you know and you won't know it all. A proper investigation will find out the rest. Diverters will be secretive and not want to give themselves away.

[icuRNmaggie, BSN, RN]

Although I have been absolutely been made a fool of several times by drug diverting nurses, I have noticed some patterns and behaviors that suggest diversion.

One is the "quick waste" when everyone is very busy. The nurse will demand a witness and try to rush the nurse who is the witness. I heard a story about a very rude and intimidating endo nurse who did this and she actually had a secret pocket inside her scrubs. Ask to see the medication before you log on to the pyxis, every single time.

Never pull medication from the pyxis for someone else to administer during an endoscopic procedure. If a procedures nurse knew she did not have access to the pyxis in your area and expects you to just hand over versed and demerol for concious sedation, that should arouse your suspicions. Don't be a pushover.

If the patient is jumping off the table in the Cath lab, or any other procedure, despite repeated doses of concious sedation, suspect diversion.

Another is the nurse who volunteers to medicate your patients for pain, or change the PCA, ativan, versed or fentanyl drips. Diverting waste is supposed to be the most common method of diverting drugs.

If your Ativan, Midazolam, Fentanyl, hydromorphone and morphine drips run dry but the pump says the volume to be infused should have lasted for hours, and the amount infused is not consistent with the rate, report it. Check this at the start of your shift. Also check the port on the bag for a hole or drips. Report inconsistencies or pharmacy may suspect you for another nurses diversion. Also be alert to coworkers, patients and visitors who want the curtains closed. This gives them an opportunity to use a syringe to withdraw from the IV bag.

I worked with a nurse who volunteered to go on every transport and who would withdraw an excessive amount of sedation and analgesia carpujects from the pyxis to take on the transport. She was caught when she overdosed at work.

Frequent discrepancies with po meds in the pyxis and a particular nurse who volunteers to correct the discrepancy with you as her witness, and can do that with very quickly as if she's had a lot of practice doing so. If something feels off, trust that feeling.

Patients who are in distress or under sedated despite repeated documented doses of sedation and analgesia or high rates of IV sedation and analgesia.

An attitude of indifference, mood swings, irritability, sarcasm and defensiveness, chronic lateness, falling asleep, sloppy appearance, disappearing from the unit, and a deterioration in the quality of work, and doing the bare minimum while leaving an excessive amount of taskwork for the next shift - all of these signs point to diversion.

[dishes, BSN, RN]

An attitude of indifference, mood swings, irritability, sarcasm and defensiveness, chronic lateness, falling asleep, sloppy appearance, disappearing from the unit, and a deterioration in the quality of work, and doing the bare minimum while leaving an excessive amount of taskwork for the next shift - all of these signs point to diversion.

I agree with the all the paragraphs in your post except for the last paragraph about the behaviours being signs that point to diversion. I would not make assumptions based on those behaviours, as they are just part of human nature and are not necessarily related to substance abuse, addiction or diversion.

[icuRNmaggie, BSN, RN]

You are correct but these are all changes in behavior which I have personally seen and experienced working with nurses who were drug addicted, caught diverting and even using at work.

It angers me that I have encountered so many impaired nurses who divert from patients and deceive everyone around them.

It angers me that an end of life care patient who is opiod naive can be wide awake while on a Morphine drip set at 30 mg/hr.

It angers me when the Cath lab or Endoscopy nurse says "I couldn't sedate him, he's an alcoholic" and when I look into that I learn that nothing could be further from the truth.

The nurse who was ordering fentanyl drips, and having other people sign for them and then cancelling the order was someone whom I thought of as a friend and a trusted colleague. It is really disturbing to be duped by someone that I believed was worthy of my trust.