The Struggle: When A Nurse Diverts

[Thunderwolf, MSN, RN]

We often read and hear about nurses, physicians, and pharmacists getting caught diverting drugs in health care facilities. Some have wondered after the fact, how could this go unnoticed? And how could this go unnoticed for so long? When it actually happens to a colleague, I would think the normal response would be picking your jaw off the floor. But, it does happen. That is a major reason why health care facilities employ monitoring programs.

The intent of this post is to share an experience about a former colleague, a colleague who diverted and was eventually caught. This situation happened several years ago. This colleague had been a nurse for a very long time, in her 50's, and married. Both made good money, and lived in (what I heard was) a beautiful home. At work, for the most part, she was very helpful in lending a hand, often smiling, and advocating for her patients. Life appeared good for her. And for the most part, she was a most excellent nurse. She looked after her patients, often speaking of them fondly.

However, in a relatively short period of time (let's say, over a period of a year), her baseline behaviors began changing for her. For the most part, it went fairly unnoticed and that all these behaviors were in fact connected.

1. Calling in every day off and offering to work extra if needed. If she was called in, after about a couple hours of work, she would then beg to be sent home (not feeling well).

2. Entering patients rooms not assigned to her or reading their charts/notes.

3. Offering to medicate patients for other nurses not assigned to her.

4. Getting into heated debates over the phone with physicians because she believed that her patients were not being medicated enough or properly, asking (if not demanding) more potent pain killers.

5. Offering to change a PCA machine medication for a patient not assigned to her.

6. Being absent for periods of time or needing to frequent the bathroom.

7. Complaining about her assignment at times, especially if there were not enough chronic pain or surgical patients under her care.

Now, this list of behaviors, in and of themselves, are not too terribly shocking. By themselves, we as nurses have often witnessed them in our colleagues during the course of our careers. By themselves, none raise up a "ding, ding, ding...red flag, red flag...something is happening here." However, when lumped together over a period of time, a picture does seem to develop. Often times, this picture only becomes apparent after the fact, after the colleague is suspected and caught. After picking your jaw off the floor, you may have a tendency to want to kick yourself for not seeing it while it was happening. Then, a normal response would be, "well, who else is doing it in the facility?" It is then that you come to understand why monitoring programs are in place and are necessary.

It does shake your confidence some as a nurse. It can also make one feel angry...for it almost feels like betrayal. A betrayal as to why that nurse was in the facility in the first place (an access to drugs), a betrayal to you as a colleague and as a professional (hmmm, how many times was I lied to?), and betrayal towards the patients under the care of that nurse (how many patients actually did not receive pain medication who actually needed them?).

Feelings of self abasement can often be experienced. "I should have seen this. If I had, I could have at least prevented this from happening or been instrumental in pointing that nurse towards help." Having mixed emotions about this occurring on your unit is often common. Our entire nursing staff was floored, if not devastated. When a nurse diverts, it hurts. It ends up hurting many persons around them...patients, as well as colleagues.

My ex-colleague who appeared as a model nurse got busted during a routine random urine screening. When asked for a urine sample, we had heard that she had declined. When pressured, she bolted. After nearly running over a hospital security guard with her car, she was apprehended in the hospital parking lot. When she and her car were searched, it was reported that they had found more than drugs on her person. In her car, she had various hospital supplies ranging from IV tubings and bags to small equipment. The last I heard about her was when I saw her name on a list of nurses who had lost their licenses (in my board of nursing's bulletin). She dropped out of sight then after.

Now, when I look back and think about her, I feel sort of sad. It still leaves me asking questions, however. How could this have happened to her? What initiated her drug use and how did it snowball into what it became? Why didn't she get help for this if it were available? Questions, always questions. I may never know the answers. In the end, when I think about it, it just leaves me feeling incredibly sad.

[June59]

a few years ago i worked with a nurse that in all appearances exhibited appropriate behavior in the sense she did not exhibit the signs of substance abuse. however, two issues raised a red flag for me. one was when i would take over care of another nurses patients, it was her initials on the medication administration record of the patients who received narcotic analgesics. apparently, despite the poor nurse-patient ratio on this unit, she always had time to help her colleagues with prn medication administration. the other sign was when i took over care of her patients it was obvious that many interventions were not conducted that should have been during her shift. i would find patients that were admitted four hours earlier with nothing more than a brief nursing note and the ten page admission packet would be passed on for me to complete. also, i found patients with empty iv bags, and ceiling lights used to hang iv bags due to “lack of time to get an iv pole to properly hang the iv. she was not able to complete her work, but had plenty of time to assist with medicating other nurses patients.

initially, i asked my patients about the receipt of their pain medications on the previous shift and if the medication adequately resolved their pain. none reported not receiving the medication nor did they claim to receive better pain relief at different times of the day. i spoke with the dayshift charge nurse about my concerns and asked if anyone else had the same concern. she denied any behavior problems and found the nurse to be an excellent employee that just wants to be of help to her colleagues and overwhelmed herself with trying to do too much.

eventually, she developed behavioral problems similar to the ones your co-worker exhibitted. this facility did not routinely drug test. rather they tested for suspicious behavior or patient complaints of inconsistencies regarding pain relief. she also declined a drug test, but submitted in the end as she would have been reported to the board. she was positive and referred rehab in accordance with recommendations by the texas state board of nursing. if she refused rehab, she would have lost her license. after about 3 months she returned to work with restrictions, but soon manipulated access to a pts meds by offering to help a student nurse. i wasn't sure if she had the priviledge of being offered a 2nd chance at rehab, but approx. 6 months later i read that she had her license taki away.

i agree, these are very sad situations. i wonder if the increased stress of today's health care environment leads a person to substance abuse.

[Ruby Vee, BSN]

years ago, i was working straight nights in the ccu. "linda" was our charge nurse. every night, as soon as it got late enough that the visitors, management and the majority of doctors had left, she'd take her seat in front of the monitors and doze off. she'd stay in that chair dozing most of the shift, occaisionally rousing to answer a call light -- but not consistently. and she counted the narcotics more frequently than most charge nurses. (some of you may remember a story i told on this board about a charge nurse who slept and drooled all night. that was linda. we used to place bets on how long the string of drool coming out of her mouth would get before it broke off, and were often standing around her measuring the drool with a yardstick while linda slept on.)

linda and i carried identical coach bags, and one night i went into the break room to grab a tampon out of my purse and accidentally opened linda's bag instead. it was full of drugs! not drugs in prescription bottles with her name on them, but drugs in unit dose packages and syringes. i had no idea what to do about it, but figured making an appointment to speak with my manager was a good first step. she wasn't in the next morning -- it was sunday, but on monday morning i asked to speak with her. she told me i could wait, but she had "a situation to deal with" so it would be better if i came back later. when i came back later, linda had already been fired. (i hear she landed on her feet, as director of nursing at a ltc facility.) what absolutely amazed me was how my co-workers rallied round her, all of them absolutely convinced that linda would do no such thing, and it must be a horrible mistake. they took up a collection to make the payments for her brand new sportscar for her while she was out of work. (i was driving a tired old beater, so i didn't feel compelled to help linda make the payments on her brand new sportscar. besides, i knew it wasn't a horrible mistake.

you'd think i'd have learned from that experience, but a few years later i was in a job where drugs were disappearing by the boxful. none of my co-workers exhibited behaviors like linda's. it was before pyxis, and only the charge nurses carried the narcotic keys. the charge nurses were investigated by the fbi and the dea. i'll never forget having agents come to my home to ask me questions about my co-workers, my drug use (none), etc. etc. it was frightening and humiliating, especially when i saw them going door to door and ringing my neighbors' doorbells so they could ask about me.

it was sheerly by chance that another nurse and i encountered the boxes and boxes of morphine syringes in our manager's desk drawer. i don't remember what we were looking for, but it was something mundane like the key to the janitor's closet, or the spare cable for the co machine. we opened the drawer, and there were all those drugs. he landed on his feet as well, with a job in staff education and a brief stint in rehab.

unless you know a colleague well, the clues that they're diverting can be so subtle that they're missed. or misinterpreted. i remember a co-worker who suddenly started taking a lot of bathroom breaks -- new onset of ulcerative colitis. or the co-worker who drifted off to sleep while i was giving her report. new allergy medication. or the co-worker whose med count was always off. her math "skills" got her fired for giving the wrong dose of one too many medications, but her tox screen was clean.

[whodunit]

Once in a LTC place I worked, we experienced a big drug problem and the FBI and state guys got involved and yes it was both scary and embarassing. Actually the problem was discovered months earlier and nothing much was done.What happened was that a Agency nurse called me to a med rm in the facility after discovering meds were tampered with. Someone {with a lot of time apparently }had taken all the vials of morphine and demerol apart, emptied them and replaced them in the box.{It was common practice just to look in the locked cabinet and count the tips of the syringes that stuck out of the boxes instead of taking each individual syringe out to examine it}.They were also slitting the bottom out of the envelopes of fentyl patches etc and removing them so unless you actually picked up each envelope and examined it you would not have known.I called all the appopriate people and there was an investigation and for a while we were all subject to random drug tests{which no one failed so am pretty sure the stuff was being taken out and sold}.Anyway while that was going on, pain patches started disappearing off pts and a hospice nurse was caught trying to draw the gel out of a pt's patch with a syringe, and she got the whole investigation going.I remember the men in black waiting to talk to me and I was mortified and scared to death. I quit that place shortly thereafter !

[NT]

Sad state of affairs. I know that many states have programs in place to help these professionals recover. But sometimes that is just not possible. What a loss for the profession and for this person individually.

NurseTim

[RNDreams]

I am hopefully going to be a nursing student very soon and the main reason (besides finances) that I didnt follow my dream and become an RN sooner was becasue my mother WAS an RN and I looked up to her VERY much. I started finding tissues in our home restroom when I was getting ready for school that had blood on them and then I started to finde needles wrapped up in them. For a while I gave my mother the benefit of the doubt and thought she had diabetes or an illness these meds were prescribed for her ligimitelly by a Dr. but she hadnt told the family (or maybe just us kids) about the fact she has to give herself these injections becasue we were kids and she didnt want us to worry. After a little while going by I started to make sure that I was the first one to use our restroom first in the AM so I could see what she did that morning and there became more and more sloppiness on her part and more and more used syringes, bloody tissues, and then finally little empty med bottles that were all just thrown into the trash with a slight attempt to cover them up like 2 sheets of toilet tissue over it. I told my father because I didnt want to give her time to plan a story or lie becasue she is really good at that and as her family we wanted to believe her. My father loved her so much that I knew without directly showing him that there was the possibility he wouldnt believe me.

I showed him and he didnt want her to lose her job, but he wanted her to obviously stop so he called a couple of her friends from nursing school, that curently worked with her, that had become very close friends and friends of the entire family.

My father didnt know at the time that one of these so called friends had a falling out with my mother becasue she thought her fiance was interested in my mother, or whatever female drama they were having at the time. My mothers "frined" went directly to the hospital with everything myself and my father had told her in confidence hoping that she could talk to her as an Rn and get her to stop, but she did the exact opposite. She got my mother in a lot of justifiable trouble with the hosp, suspended and required to go to counseling.

My mother promised everyone that she was "clean" and that she was ready to have her licence reinstated and it was.

To get away form all of the fallout and start fresh the family had to move form up north to Florida (which I loved) but history repeated itself there and it wasnt long before I started to find things ( by them I was snooping ans she was so far gone that she had gotten very sloppy with her hiding techniques & she would leave an open used syringe on the bathroom sink where my little sister also got ready for school and she was 8 at the time.

Needless to say that she eventually lost her license forever. The only work she could get was as a pheblomotist on the red cross van. making 1/100 of what she did as the supervisor of the floor she had worked on for 10plus years all to throw it away just like that.

When she no onger had access to drugs she switched to becomming a chronic alcoholic and my senior yeear of HS my father asked her 9finally) to quit drinking with him or else he wanted a divorce. She opted for drinking and I havent spoken with her sonce about 14 years ago.

I know that having 2 parents as alcoholics, druggies that I have to be very careful not to become eaddicted or an alcie. myslef. I am very concientious of that.

Her actions kept me from going after my dream of nursing for many years becasue I was scared I would do what she did.

I now know that is not the case and that do I now only not take drige that arent prescribed for me, and take them as directed, and take as little as possible. More than that is the fact that I would never steal from my job, and expecially leave people in severe pain because of my selfishness. I can finally know that I wouldnt do that and that I am not her, I accept that those tendancies are there and always will be but I can be an RN and I will never do that, not in a billion years, but I will continue to monitor my actions and remind myself everyday that if I want to pursue nursing and I have my entire life that I will have to continually assess myself to make sure I am not starting to be temped to do what she did, I have to remind myself daily that I am not her and that I will create my own future as I have since I was 17 and she bailed out on our family to become a fulltime drinker.

I am so excited about my decision to finally put that behind me and know I am not even close to her and I have a wonderful husband and a amost 3 yr. old daughter of my own who I have to provide for and take care of for the rest of our lives and I am grateful for what she taught me not to do as a mother and I will now see first hand that I will not be the same person she was as an RN.

Sorry so long, this is my first time getting that out there since deciding just yesterday, and finay getting my husbands blessings (he thought nursing school would take me away from the family for a long time and it will but it is 2 years and then it is done, it is a short term sacrifice of time with my family for long term security, he is finally on board with me going and us struggling financially as I know we will greatly fo rthat 2 years, but it is just 2 years)

Anyway, I really posted to ask the definition of diversion becasue I know my mother was flat out stealing the meds, so can you please tell me what the difference between someone that does that is with someone that diverts to get the meds for thir fix.

Thank you for listening if you got this far.

Best,

Christine

:1luvu:

[10MG-IV]

Oncology Unit I had a patient call the desk " your nurse is passed out in here"

I (charge RN) ran in the room and sure enough, out on the floor,look listen feel, pulse present, slow resp. grunting, and there it was a IV INT lock in her upper rt arm with his empty Dilaudid Pain med syringe in it. I should have just called a code so all could see, but I pulled her out to the hall by her heels, called all supervisors, got her on a stretcher to the ER and put on a pot of coffee.

Oh, once I could not find one of the nurses for a hour or so. We had a rest room right out by the elevators and lots of us used it. I ran out there to partake of the facilities and look for my nurse. I pulled open the door and there he was sitting on the toilet pants around his ankles smoking a joint. GREAT! This was back in the day when yes believe it or not nurses smoked in the break room, and patients smoked in their rooms. HOLY COW. I think we ran our needles through cotton to see if there were barbs before putting them in the autoclave. HA!

[June59]

HI Christine, Good luck in your future endeveurs. You sound like you will do fine. Diversion is when you "divert" a drug from reaching the patient and take it yourself or sell it.

[Elizabeth, RN]

I once discovered a nurse taking Vicodin from the ER when I called to do a followup on a patient and asked if the pain medication was helping. She denied receiving any "to go" meds. After calling several other patients who had meds signed out as dispensed, we found out none of them had been given the pills. This nurse also phoned Rx's to local pharmacies and picked them up herself.

[Ruby Vee, BSN]

when i worked in boston in the 1980s, the housekeepers could always be located by the distinct smell of pot . . . seems they spent most of their shift in the linen closet smoking weed!

[diane227, LPN, RN]

We just had a nurse on our floor who was found diverting narcotics. Her behavior was interesting. She was just sort of spaced out, like she had something else on her mind. Even when reminded she would forget to do something. She worked 7am-7pm and rarely got out of there until 9pm because she had to finish her charting. As the charge nurse on 3-11 I told my manager that she might want to check her clock out times. She was getting an a lot of overtime. She was always in everyone's business so at first we thought she was just doing so much socializing that she could not get out on time. Then one night the night charge nurse looked at the Pyxis and saw a couple of discrepancies. She printed out a list of every narcotic that had been given and looked at the MAR to see if it had been given. The errors occurred with this particular nurse. The narcotics were not documented. She got so sloppy. So the charge on nights wrote the report and gave her copies of everything she had discovered to the our manager. The manager called this nurse in and she immediately admitted that she had been taking narcotics. They sent her out to a program offered by the BNE (State of Washington). It was very sad. Now she is out of work and her boyfriend was already out of work so they have no income right now. She told some of the other nurses that is did not matter if they put her through a program, she still had sources to get narcotics. I doubt very seriously that she will make it. I doubt that she will ever be successful at coming back into nursing.

[explorer13]

I struggle with the rationale of rehiring a person who has diverted, into a position where they may be tempted again. If a person stole money fron the bank would they get rehired I wonder?