Tired of impaired nurses

[epipusher]

Ok...I have been a nurse for almost 20 years and thought I had seen it all. My current employer seems to be a becon for impaired nurses. We currently have 3. The latest one is causing loads of issues. She was a great nurse that worked with us for 1 year. It was found out that she was removing approximately 40 percocets per shift for patients she was not assigned to. Management aproached her and sent her for a drug test. Since she had a personal prescription for the drug, nothing was done. Many of the staff were very uncomfortable when she was around. (She was not signing the MAR--you had to look in the pxysis for the last dose given) Management pushed the issue and she up and quit. Well 6 months go by and she is back (rumor has it that she was terminated from the last place). I questioned my manager about this and she said there would be stipulations. I see none. Her first day back was today and I snooped around in the pxysis. She gave 10 percocet in one shift and once again failed to sign them out on the MAR. None of these patients are alert enough to report that they had not gotten the medication.

What can I do? Does any one know what actions I can take if management continues to turn a blind eye? I know we are short on RN's, but this is crazy. We already have a tough enough job without worrying about team members stealing drugs! A group of us are really upset and not sure what steps to take next. Help!!!

[sissiesmama, ASN, RN]

Should drug addicted nurses be allowed to return to practice when their rate of relapsing is incredibly high?

Should they be allowed to potentially harm pts. and compromise the careers of innocent RNs in their attempt to place blame for their behavior on others?

Perhaps it is time to start hoding people accountable for their behavior and not allow them to hurt others anymore.

Hello JennieO. My name is Anne and I am an addict. But, I am also a loving wife, a stepmother, a daughter, a cousin, a niece, and on and on. But I am also a NURSE!! I tried to think carefully before responding to your thread. I wasn't sure if maybe you have had a problem with a co woworker, or former one, or if something else had happened for you to feel like this about "US." I believe everyone is entitled to their opinion, so I just wanted to throw in my .02.

Now, when "WE" are caught, or turn ourselves in, or whatever, we are in contact with our state BON. I voluntarialy told them what I did, which was diverting from work, and entered treatment. I went inpatient for 30 days to a really strict facility run by our state. Upon d/c, you are re evaluated and have to follow up with state approved addictionologists, and are in the RNP for a minimum of 3 yrs, if this is their 1st offense. We submit for drug screens randomly, attent AA/NA meetings and have to send in a signed calander showing the meetings we attend. We also go to weekly meetings just for health professionals, also required.

I completed our state's 3 year program and in August will celebrate my "other" birthday on August 16th and have 9 yrs. clean and sober. My dh, who is also a nurse and recovering addict will celebrate his 9th year this month. I am glad that by the grace of God, I guess, SOMEONE who met me gave me a chance to prove myself. My dh did also. If those people shared your views that we should not ever be allowed to return to nursing, I guess we would be working at McDonalds trying to feed our 2 children and 3 dogs. I guess what I am saying that I feel that as long as a nurse is held responsible for the mistake they made and goes to rehab and can prove to themselves and the outside world that we are worthy, we should be allowed to return to nursing practice. We don't just "fly by the seat of our pants", we answer to a LOT of people. We have support systems that we are in close contact with.

I think of during the past 9 years, and am glad I that someone was able to allow me to prove myself and return to the field. I have had great experiences, and have been able to help guide younger nurse/addicts that I have met.We do deserve a second chance, as long as we are honest and accountable for our actions.

Should maybe a young man that is in college and gets a DWI NEVER be able to prove himself, admit his mistake and be able to drive later, or does 1 DWI mean that he can never be trusted again to drive a car? I know it is a farreaching comparison, but I hope you understand my point.

WE are human and make mistakes. We, however, do deserve the chance to correct it and go back, as long as we do what we are supposed to. Just my .02 thrown in there. Maybe it will give you something to think about, I hope. Like I said , we all have opinions, but this is mine.

I hope that you never heve to find out from experience.

Anne, RNC

Yeah! 9 years on "the wagon" in August! :paw::paw::paw:

[**All Heart RN**]

So, just out of curiosity:

Viewing addiction as a mental illness, and knowing that many people who face addiction relapse several times and still many more continue their life without ever finding sobriety...

I'm interested in hearing from others (without taking the Boards of Nursing into account), how many times should an addicted nurse in recovery be allowed to re-enter the nursing field?

[Harparia]

from patients perspective,

There should be, and maybe is I do not know, a registary that all hospitals can contact ONCE THEY HAVE HIRED A NURSE to find out if this nurse has a drug problem. They should not be able to know before hiring because this might cause them to not hire, illegal but happens. They they can continue the random drug tests previously innitiated.

This is a good idea in theory, but I think that hospitals would never want to take on this liability. It's better for them to plead ignorance. I can see the lawsuit now...."Hospital X knew that this nurse had a problem. Hence, they were grossly negligent for not watching this nurse better and they should be made an example." (translation = $$$ Cha-ching).

Also, I think that people make mistakes and sometimes move for a fresh start. People deserve second chances- Well, generally speaking, unless they are murderers, rapists, or molesters. (Some people may disagree, but I don't think that these three are ever recovered or recovering. Of course, there are exceptions.)

Thanks for your perspective as a patient. :nuke:

[MAISY, RN-ER, BSN, RN]

It's simple, with drug testing and counseling a nurse regardless of problem should be fine. If they fall off the wagon, I am not sure we can keep letting them come back. I'd imagine we'd need a set number of instances. Truthfully, if the drug availability is the trigger, I think the nurse will eventually refuse to come back-if not, like I said before other jobs without drug availabilty are in the marketplace. Telephone triage, flu clinics, occupational health, and I am sure a slew more.

Maisy

[ThatPoshGirl]

But it does make me cringe when they are diverting their patient's medication. Not only are they impairing themselves but they are directly harming the ones who are dependent on them. I have heard of nurses trading out saline for narcotics and this boils down to torture of your patient, regardless of your position on drug abuse.

So if a pt is harmed then I think the consequences have to be much more severe. Definite long term suspension if not permanent.

I think I agree with this. I have even seen former addicts here justify this by saying something like "the pt.s are usually perscribed more than they need." I think that's a terrible position to take. It's wrong behavior. There really is no justification.

[leslie :-D]

I think I agree with this. I have even seen former addicts here justify this by saying something like "the pt.s are usually perscribed more than they need." I think that's a terrible position to take. It's wrong behavior. There really is no justification.

no, there absolutely is never, ever a justified reason in taking a pt's meds.

don't let anyone tell you any different.

leslie

[roesseba]

We nurses are supposed to be perfect all the time, I had a positive UA for Methadone, had to go to treatment then outpt. tx. for 5 months. I thought I was ready to go back to work, therefore I did, for only 1 day. I was so nervous, shakey, embarrassed at work the first night back. I took an Ativan, no narcotics and it made me too sleepy, probaably because my tolerance had gone down over the last 6 months. I was fired immediately.

All the meetings I had been going to "be in Recovery" did not seem to help at all. Why? The professionals thought I was ready. It was horrible. I could not face the pressure of having to behave perfect at work therefore I told the BON to take my nursing license. I have not been so happy in 10 years, I am taking Buprenorphine for the opiate dependence. My depression that I've had for the last 20 years is gone. If anyone out there reading this is dependent on opiates. Try subutex.

[nickola]

Yes, I feel that nurses in recovery should be able to practice. This happened at my facility, and most of us welcomed the nurse back with open arms.

Who am I to judge?

It could happen to anyone- there are a myriad of addictions out there. As long as the person has sought help, they should be able to come back. There but for the grace of God go I.

[sissiesmama, ASN, RN]

I say if youre willing to work and stay clean while you're working and follow all rules and regulations within your institution then I am thrilled to have ya!! It makes me angry that so many of our fellow coworkers try to hold nurses to a higher standard than the rest of the world!!!

I do believe, however, that because of a drug addict's problems in the past, it might not be the BEST idea to be around controlled substances, kind of the same way an alcoholic shouldnt be a bartender.

I also think that there should be special rules in place for former addicts that return to nursing.

PiPi2004 - THANK YOU THANK YOU THANK YOU!!! I hope after reading your post on this subject that we as addicts (I have been clean and sober and nursing since 1999) that if we don't feel good about being around controlled meds or we are not allowed by our RNP f/u, there are nursing areas we can work in and still be productive. We have opportunities like clinics, MD offices, doing QA, working in social service positions arranging d/c plans and setting up home health. There are so many more areas than just being in a poosition where narcs are readily accessible.

Thank you again from this recovering addict nurse!

Anne, RNC :paw::paw::paw:

[VICEDRN, BSN, RN]

I have actually seen a real life example of this situation.

A close relative of my ex husband's was caught diverting narcotics from her patients on a med-surg floor. Apparently, she had gotten to the point where she needed so much that she actually ended up needing more than just excess or unused portions and had to actually take from her patients. She even told her sister (also a nurse) that her "experience" as a nurse told her how much demerol a patient with oh say, a knee surgery would need and that it was okay to take the rest.

All of us, nurses and lay people alike, were disgusted and all of us were also left feeling very vulnerable. Imagine being in those shoes as a patient!

She was caught, went before her BON and has been restricted to working in places where narcotics are not used. She is presently working in a dialysis clinic.

I guess my point is: there is a balance here. I personally would be very uncomfortable working with or seeing a patient work with a nurse that had been caught diverting when narcotics are involved. On the other hand, I think a nurse who wants to keep their license will need to accept restrictions on their ability to practice. Its a position that requires a lot of trust and that shouldn't be taken lightly.

BTW, I agree that the relapse rate is...awfully high. This was certainly not her first time getting "caught." More like, the first she got "officially" caught.

[sissiesmama, ASN, RN]

Oh wow.....my 1st husband was an anesthesiologist with a prescription drug problem (Nubain, valium, others). He was asked to voluntarily resign (which he did), go through a monitored program (which he also did) and then was promised that he would be allowed to go back to work. Well, long story short, he never was allowed back at that hospital, decided not to persue it legally and began working locum tenens.

The sad part of this story is that his reputation in this (small) community was ruined, and when in town, he pretty much kept to himself (think "hermit"). He has since passed away (2004) from complications of diabetes, but I'm positive that this injustice done to him significantly shortened his life. Everybody thinks they know the story....but they have no idea.

iteachob - I am SO sorry to hear about the situation concerning your first husband and his demise. That is a horrible and possibly could have been averted if he had been treated differently. I have been to funerals for friends and ex co workers that were in the same situatioin and decided it was hopeless.

Bless you - Anne, RNC :paw::paw::paw:

[heron, ASN, RN]

OP - it's hard to judge tone in a post, but it sounds as if you've been burned by an active addict. If that is so, please understand that you are not required to "forgive and forget". An active addict will pretty much do anything to anybody if it means feeding the addiction ... you are not required to pretend that nothing happened or that the behavior is ok because they have a disease. If you've tangled with an active addict, the anger I perceive in your post is probably fully justified.

The posters here are mostly referring to addicts (and I include alcoholics, gambling addicts, et. al.) who are truly in recovery. This means that the individual is actively changing her/his thinking and behavior, not just avoiding a specific drug of choice. It is this active change process that allows the individual to remain sober long term. It is also the reason that many addicted nurses are able to return to work without relapsing (although it's always a risk for any addict). I think that sometimes they become better nurses because of the amount of self-awareness they need to stay sober.

One of the first steps an addict takes in the process of becoming sober is to acknowledge the harm they have done, accept responsibility and make what amends are possible. If they do not do so, they are not sober. AA refers to them as "dry drunks" - people who may not be using at the time but have done nothing to change the behaviors that triggered and supported their habits to begin with.

So, the question becomes, is the returning nurse in recovery or simply a "dry drunk" who has not yet hit bottom? Does our need to make sure that the "dry drunks" on the job do no harm justify blocking a nurse in recovery from gainful employment? Are our priorities on healing or on punishment/control? Where do we draw the line? And how do co-workers tell the difference? Short answer: darned if I know! Each situation and nurse are different ... I don't think there's any one answer that fits all.

PS: lest you think that nurses in recovery have "gotten away with it", bear in mind that recovery is lifelong and frequently very painful. It's also very expensive ... inpatient rehab, therapy, meds ... all costs money and many nurses pay out of pocket since they've likely lost insurance along with their right to work as nurses. Many diversion programs are quite rigorous in their monitoring and time commitments. Any nurse who is in recovery has paid a high personal and likely financial price to get there. They deserve all the support we can offer.