This is the "how" Nurses divert drugs for their own use.
The extent to which this goes on depends on availability. In the hospital setting, Nurses who are in advanced stages of addiction pick work settings where availability is certain, frequent, and a sure thing every shift they work. Oncology is the most desired setting for obvious reasons, but when needing narcotics, any setting where they are given is good enough.
The addicted Nurse receives his/her assignment, even "bartars" with his/her peers to "switch" patients so that she receives the ones who have orders for narcotics. She/he starts his/her shift by "reviewing" his/her patients med sheets to identify sources of obtaining addictive drugs. This Nurse looks in particular for poly-pharmaceutical orders so he/she can "bait and switch" at his/her own behest. The Nurse then "assesses" the condition of the patients and determines which ones are "confused", which ones are deeply sedated, which ones would be the least likely to know meds were being played with.
The Nurse then takes the narcotic, signs it out, and intends to use it for himself or herself. If the same patient has some other drug like Benadryl, Vistaril, Ativan, that is what is given in lieu of the narcotic. If a patient is on a Morphine or Demerol infusion the Nurse goes to the room, removes the 50cc syringe, having already emptied out a 30cc vial of 0.9normal saline for injection bottle, withdraws the drug, injects it into the empty saline bottle and replaces the 50cc syringe volume with the withdrawn 30cc of saline so the volume remains the same. The same technique is used with 50cc bags of narcotic infusions.
Nurses who are "stockpiling" narcotics for their own use come to work wearing a Lab coat, smock, or longsleeved, deep-pocketed smock. Morphine, Demerol, and Dilaudid carpujets are easily hidden in clothing, under the arch of the foot in the shoe, or in any body orifice that will accommodate them.
The Nurse often "forgets" to document the narcotics supposedly given, on the patient's med sheet in the chart. The Nurse who is an advanced stage of addiction diverts narcotics and uses them while on duty. They are injected in the thigh muscles on a trip to the bathroom at break times or anytime that's convenient. A bandaid or two over the injection site assures no blood leakage onto the pants uniform.
Pill forms of addictive drugs: Vicodin, Valium, Ativan, Xanax, Librium, Oxycontin, Oxycodone, MS Contin, are easily "palmed" and dropped into the pocket and taken later on that break to the bathroom.......or stockpiled, and hidden at home later.
Clothing with pockets also serves as a hiding place for needles, syringes, tourniquets, vials, carpujets, if needed at home or on the bathroom break. On a busy, shortstaffed, highly stressful unit, all of these things are easy to come by, and easily hidden.
In late stages of addictive disease the Nurse is NOT thinking about his/her illustrious career, the consequences that are inevitable, let alone how it will affect family, career, - or the patient and the people with whom they work. This Nurse needs that "high" and will go to any length to get it. The addicted Nurse is NOT necessarily the "most suspicious" looking one of all, but is more likely to be the most admired, most excellent Nurse on the Unit, and in fact is the least likely Nurse expected.
Addiction is no respector of person, position, race, color, creed.
There are few, if any, State Boards of Nursing that do not offer a diversion/rehabilitation program for such Nurses. However, if it is discovered that the Nurse is diverting for the purpose of sale and distribution solely, or along with personal use, that Nurse is NOT eligible for these programs according to the law.
Bonnie Creighton,RN, Minnesota
