Why do I feel so horrible.

[cptluciejensen]

unfortunately I was put in the position where I had to tell my manager about someone I though was diverting.. I feel horrible like I have betrayed, she is a good nurse MSN we all look up to her. She was an instructor at a couple of nursing schools and taught some of the girls on my floor. over the past couple of months I noticed that she "gave" pain meds to pts that were not hers. most of them disoriented, however one time I went to the pyxis to get a med out for a pt in pain and I saw she had taken it out 30 min ago, the pt denied getting anything. I thought that was a fluke and sometimes when you go in and give an IVP med and strike up a conversation the pt may not be paying any attention to what you are doing, so I gave her the benefit of the doubt. I then saw where she started taking narcs on pt's that were to be discharged (like within minutes) these pt's were not even hers either. I had a chest pain pt that was getting dc'd and had denied any chest pain since the stent was put in and I saw where she took out ivp morphine twice for this pt and I had taken out the IV several minutes prior. she took out 2 doses 15 min apart when it was ordered q 4 hrs.

sometimes on my ward I start discussing topics in nursing, I started to discuss diversion and what we should do about it, in a generic. after report, 2 of these nurses came up to me and said, they noticed the same thing. well we all knew that all of us knew and HAD to report this because last week the diversion was so obvious we all couldnt help but notice.

since we all knew we were obligated to report because of Bon policy. We all did report to the manager and since I am the sr RN I had to go first... I had hoped it was a test by administration to see of any one would notice, I told the mgr my suspicions and told him to please tell me that I am wrong, I really wanted to be wrong and maybe her pain mgmt skills were so much better than the rest of us. He said he would look into it.

The next day when I saw the mgr I said please tell me I was wrong or it was just a test, he said we were probably right.

I feel horrible, I feel like I have betrayed a friend and co-worker, On the other hand I would also feel horrible if she overdosed as well. I havent slept in the past few days (at least not for more than an hour or so at a time) I am the one that feels guilty. She is supposed to start a new position this week being the director of palliative care, she said she would be in a different division and wouldnt have access to the pyxis when she left the ward position. so in theory she wouldnt have had any more access to the pyxis. there are 6 others that reported after I did, they all feel just as bad as I do. She was so careless the last week she was there it was just so obvious, most of us take out 4-8 narcs off per shift, she takes out 25-30 and most are not even her pts.

Was I right in turning her in? What can I do to be supportive of her without her hating me or the rest of us. We are a federal facility and have a union, maybe she can do rehab and keep her job? I really want the best for her, yet I am also angry with her for putting us in this position. What can I do to keep from feeling like such a *itch?

thx

[weirdRN, RN]

Ack! 4-5 12 hour shifts in a Row? With few breaks during the shift?

I worked in a hospital once where I had a difficult time getting bathroom breaks let alone a full lunch. I was routinely scheduled for 3 12's but never more. I had five to six patients at a time. It was horrible.

My goodness! I can't imagine doing 4/5 of those kinds of shifts. That is a sucky job if I ever heard of one! No matter how well paid you are.

[martysmiles]

You did her a major favor as a nurse and a friend. I wish just one of my friends had approached me out of care and concern for me and my patients. She doens't know it was any of you. Now comes the real test. Call her and reach out to her. She feels ashamed and isolated.

[jackstem]

As health care professionals, we constantly tell our patients and families to be aware of early signs of chronic, potentially fatal diseases. The earlier a disease is recognized and treatment begins, the better the chance for remission and keeping the disease in check. Diabetes, coronary artery disease, cancer, infections, etc. all have better outcomes than if we wait until it can no longer be ignored.

And yet, when it comes to addiction, we do none of these things. We wait until the signs can't be ignored anymore. Or we wait until a tragedy like a death from an accident or an accidental overdose happens. We actually believe things like, "An addict has to hit rock bottom before treatment will work", or "Treatment doesn't work. Look at all the relapses that happen."

The truth is, this disease IS treatable. Long term recovery IS possible. Unfortunately, we wait until the disease has advanced to the late stages before we do anything (DUH!). The treatment that most addicts receive is too short and there is sporadic follow up, if any. And then we're surprised when someone relapses. The treatment community is in the process of changing their entire paradigm from an acute treatment model to a chronic disease, long term recovery treatment model.

The bottom line is nurses and other health care professionals have no idea what they're doing when it comes to the number one public health problem in our society. We base our decisions on myths, misbelief, and misinformation. We react emotionally instead of scientifically. If nurses don't get this disease, how in the world can we ever expect politicians, law enforcement personnel, or anyone else to get it?

This is precisely the reason I started my consulting and advocacy business. If we are to make progress in dealing with this disease, nurses are going to be the ones to lead the way. After all, we're the front line forces dealing with the health care consumer.

Jack

[foraneman]

Would anyone feel bad about saving a drowning man?

[jackstem]

Just an example where medical issues and drug abuse issues might have some of the same symptoms.

Chemical dependence IS a medical "issue" (disease)! I'm not picking on anyone with this post. I'm pointing out how the language we use to discuss this disease points to one of the main underlying problems...addiction isn't seen as a "real" disease.

People with cancer, heart disease, diabetes, etc. are "diagnosed". Addicts get "caught".

People with the above diseases have times when they may require a change or more intense treatment if their disease doesn't respond to initial treatment or progresses after a period of relative stability. Whether it happens because they didn't follow their treatment plan or because the disease is more virulent, it's an expected occurrence and is dealt with by explaining the need to be more active and diligent in following their treatment plan. We don't judge them as "weak willed" or a failure.

The target organ for the disease of addiction is the brain. Because specific areas of the brain (learning, motivation, and pleasure) are targeted and altered structurally and chemically, we expect to see signs and symptoms of these alterations...increased motivation to obtain and use the "drug of choice" and decreased motivation to eat, go to work, have sex, and do the things that used to be pleasurable (hobbies, etc.), and failure to "learn" from the negative consequences of using the "drug of choice".

Addicts are seen as "failures", "disappointments", or "betrayers" if their disease progresses (usually due to inadequate treatment time and intensity, and a failure on the part of the addict to follow their treatment plan). Or they are "weak-willed" or simply "don't care" and is choosing drug use over everything else. Treatment is seen as a failure or worthless.

When we look at the current method of treating addiction and compare it to the way we treat other chronic, progressive diseases, it becomes clear why there is a high rate of relapse or "failure". We wait until the addict "hits rock bottom". They receive inadequate treatment, both in time and intensity (Studies continue to point to inpatient treatment for more than 28 days...preferably 90 days, as having the highest success rates) with sporadic follow up, if any. And health care insurance generally won't pay for more than one inpatient program, or will only cover "intensive outpatient".

If we treated diabetes in this fashion (waited until they were in a hyperglycemic coma, and treated with inadequate doses of insulin, no education regarding diet and exercise, and only one time inpatient treatment regardless of how out of control the blood sugar may be), there would be major demonstrations and rallies to get things changed.

If the health care community doesn't "get it", how in the world can we expect the criminal justice system, legislators, or the lay community to 'get it"?

Jack

[Nurseforatu]

I'll tell you this from the other side of the spectrum..I was that nurse who was turned in for suspicious Pyxis activity...I was also taking up to 800mg of Demerol a shift. The nurse that turned me in most probably saved my life. You should not feel bad in the least for 2 reasons: number 1: it's your duty to do so. Number 2: you probably forced that nurse to get help. I've been clean and sober now for 25 months but even in the beginning I could feel nothing but relief that it was finally over...so believe me, you did the right thing.

[martysmiles]

Nurseforatu, what a great testimony you have to tell. I would love to hear it all.

Please Im or email me. If you feel like sharing. I to have been down that road and in recovery a year June 10, 2009.

[michigooseBSN]

Nurseforatu, That was me too. I've never heard anyone else mention that overwhelming sense of relief that it (my nightmare of addiction) was finally over. I couldn't imagine how I was ever going to feel better though. And two weeks ago I celebrated 17 years of continuous sobriety and recovery. I don't have any idea who turned me in but I'm so very grateful that she did. She saved my life and protected my patients. After I got sober I continued to work in nursing and as a matter of fact, I just retired 6 months ago. I have a life "second to none". And all because someone had the courage to intervene in my addiction.