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!!!

[Jolie, BSN]

I personally will not engage in this enabling behavior or prioritize the drug addicts needs over anybody else's.

So, again I ask: Did you report your observation of the nurse who you suspect of being an addict "jumping into the Pyxis" on the day that 3 fentanyl went missing? Did you attempt to call her behavior to light, while at the same time protecting the innocent nurse who is being asked to explain the missing drugs?

[heron, ASN, RN]

I do not know how getting a DUI is the same as diverting narcotics at work, working impaired and potentially ruining the careers of other RNs

"If you lie down with dogs, don't be surprised if you get up with fleas."

OK, now we get to it. I don't think anyone here, recovered addicts included, has advocated keeping active addicts on the job. I certainly don't. In fact, I see blowing the whistle as being both an advocate for my patients AND the best thing I can do for the addicted nurse.

So ... what did you do about the incident you witnessed?

And are you under pressure to cover it up?

Is there anything we can do to help in this situation?

[JennieO]

Dear Heron and Jolie,

I am not "covering uP" anything. This is exactly the inappropriate nursing behavior I have written about. It was not I who jumped into the Pyxis or diverted narcotics.

As my previous post reads, I have put myself in this position of reporting the addict before. Thanks, but these people are not worth the stress to me and that is MY choice. Many people are conditioned to feel sorry for the addict without any mention of the stress the person who reports it goes through. If an innocent coworker appears to be in trouble I will step forward. The person that was accused of taking three fentanyl is probably the biggest enabler on our unit by protecting and making excuses for employees. She would be the first one to offer her unconditional support of this person if it was not her that was being affected. It will be a hard lesson for her.

As for the NM, again, this person is seriously befriending her and making sure everyone knows. Fine.

I am a good nurse and will continue to be. I have many friends on the unit. This will play out among the key players--I am making certain I am not one of them.

Unfortunately, this unit is notorious for protecting those who do wrong and chastising those who point out the problems. A key management person has even said she grew up in a dysfunctional alcoholic home. Her behavior in the past is evident of this. I've lived and I've learned.

Also, if I have seen things, believe me others have, too. But again, the bad person is the one who reports wrongdoing on this unit. This environment was fostered by many of the same people who I am sure have their suspicions, but now, don't dare come forth. I am not going to change it. I have my own life problems, as we all do, and don't need anymore. No, I do not feel guilty and will not be brainwashed into feeling that way.

Remember, it is this very forgiving view of the the addict that fosters the behavior of people not getting involved. I am in no way responsible for this person's behavior, she is. If she wants help, SHE will come forward. If not, she will go down a different road.

In this state, now when you get caught, they videotape you and you do prison time. This problem will go away, eventually.

[MIcrunchyRN]

Dear Heron and Jolie,

I am not "covering uP" anything.

If she wants help, SHE will come forward. If not, she will go down a different road.

In this state, now when you get caught, they videotape you and you do prison time. This problem will go away, eventually.

Wiat i'm confused.. IF you did NOT report her then you ARE covering it up...

IF you did NOT report her.. then YOU are also creating an unsafe work environment for yourself, your patients, other staff members.

If she wants help she will come forward?... most addicts don't.. its someone saying they need the help that opens their eyes... Should a patient have to die before it opens her eyes that she needs help? I seriously hope your answer is no...

And... if you didn't report what you seen and someone else knew you seen it they could report you...

[leslie :-D]

as many of us already know, sometimes it just doesn't pay to be the hero, the good guy.

rather, it ends up biting you in the butt.

if op works in such an environment, i don't blame her in the least for not speaking up.

it's called survival.

leslie

[heron, ASN, RN]

Dear Heron and Jolie,

I am not "covering uP" anything. This is exactly the inappropriate nursing behavior I have written about. It was not I who jumped into the Pyxis or diverted narcotics

I did not accuse you of covering up ... I asked if you were under pressure to do so and offered support if you were.

From the rest of your post, you clearly feel pressure to keep quiet. You also made it clear that blowing the whistle involved consequences that you are unwilling to endure.

From your last post, it seems that there is a culture of covering up and "making nice" regarding problems on the unit. There may well be no way to address the issues short of dropping a dime with the BON, DEA, Board of Pharmacy ... any outside enforcement authority able to do an independent investigation.

And you're right ... the consequences of doing so can be devastating. But sometimes we, as professionals, are put in the position of having to face those consequences or face the fact that our inactivity is allowing patients and coworkers to be harmed, sometimes badly.

As a nurse, I must report patient abuse even though the abuser may come back at me with threats, lawsuits, even physical violence. That's what being a mandated reporter means.

I don't know what your state BON says about reporting impaired nurses and drug diversion. If you are mandated by law or BON regs to report, you may be d---ed if you do and d---ed if you don't. Truly a carpy position to be in.

Once again, please post or PM if there's something we, or I, can do to help figure out a solution. Heron

[leslie :-D]

i agree w/heron, jennie.

and, it couldn't hurt you to make an anonymous report to the BON.

you can do it online, and share all pertinent data/details.

leslie

[embarrasingfield]

Jennie:

I agree with what you are saying.

Nurses who are impaired do not belong at the bedside at all.

Thats why i said there should be conditions placed on the license.

I mentioned dui, because there is so much that is wrong in that whole area. I know too many professionals who blew a .08 and had their lisencse severely disciplined, so bad that it was financially and emotionally devastating, then they are branded as addicts by the poepl who do not drink at all and cannot understand what I am talking about. I know too many people who have been pulled over without just cause, maybe leaving a sporting event or similar, after having a two beers over four hours. They have never done any narcotic, and never been impaired in any way at work. But treated as such by Nursing Boards and Employers.

What I posted was not meant to trivialize. Cellphones statisically represent five times more accidents, and that = impaired. You can get a dwi (different but the similar) for swerving on the road and being on benadryl or really sleepy. However, alcohol has been made so stigmatized that it has become a Witch Hunt by people who believe any association with alcohol is evil.

I respect your stance but I maintain mine as well regarding disciplining nurses who get a dui and do not have a problem with alcohol.

[JennieO]

I appreciate all your replies. Unfortunately, I do not have absolute proof of this, so I will keep quiet at work on this issue. I will let someone with more "clout" on the unit raise the alarm. I am not obligated to report something on suspicion alone and I will ensure that I do not see anything that would put me in a position of obligation to report. Remember, I have already reported someone, when six other coworkers who were witness to the same behavior said nothing to anyone but each other. Most of you have never reported an RN for substance abuse, so do not criticize me as I have already had the courage to do so.

As a single mom of a sick child, it would be very irresponsible to jeopardize my job, and daughter's health care, ability to pay for medication, etc. In my situation, the right thing is to provide for my child as she takes a greater precedence to me than this situation. Again, I do not have positive proof so I am not obligated to report anything. I feel fortunate that what I have seen has made me suspicious and I will protect myself accordingly.

Back to the original post, I do not feel the rest of us should be under this kind of duress to accomodate someone who has already betrayed people's trust. We all have problems. The rest of us deal with our problems, but do not take casualties with them.

I like the analogy that someone made of would a recovering alcoholic taking a job as a bartender be the appropriate thing to do. No. Truly, it is the same issue with the exception that narcotic diversion and use at work as an RN are illegal and can effect coworkers legally. I do understand that as an RN the active/recovering addict makes more money than they would make taking a different job. Is this not selfish on the addicts' part to risk pts and other RNs careers so THEY can make more money? If they truly wanted to recover they would not work with narcotics, but the money appeals to them more than the risks to others. It may be hard for many to face, but I do believe that is the reason they return to nursing.

[heron, ASN, RN]

"Most of you have never reported an RN for substance abuse, so do not criticize me as I have already had the courage to do so."

Actually, I have, more than once. Fortunately for me, management was willing to deal with the problems.

"Back to the original post, I do not feel the rest of us should be under this kind of duress to accomodate someone who has already betrayed people's trust. We all have problems. The rest of us deal with our problems, but do not take casualties with them."

No argument there ... and many of us have said so, over and over.

"I do understand that as an RN the active/recovering addict makes more money than they would make taking a different job. Is this not selfish on the addicts' part to risk pts and other RNs careers so THEY can make more money? If they truly wanted to recover they would not work with narcotics, but the money appeals to them more than the risks to others. It may be hard for many to face, but I do believe that is the reason they return to nursing."

Nope, I have to call BS on this. Recovering addicts have bills just like I do. We all collect a paycheck ... I sure wouldn't do this job for free! If an addict in recovery is blocked from employment in the field for which she trained, how is she supposed to support herself and pay for the basics, let alone the costs of treatment? It sure won't happen on a minimum wage job! Welfare? Disability? You can't have it both ways, berating addicts for irresponsibility then faulting them for taking responsibility for themselves.

A final note, you are right about active addicts putting co-workers' careers on the line. When bad things happen, innocent bystanders get hurt. You, however, are not an innocent bystander ... you know what's going on and have chosen to do nothing in order to protect your income and your ability to care for your child. I do not walk in your shoes, so it's not my place to comment on the ethics of your choice. But you have made a choice. If your description of the circumstances is accurate, then it would be your choice to not report that endangers your license, not the diversion itself or the malpractice involved in the impaired nurse harming a patient. I say again, it's a carpy position to be in ... when it happened to me, I was beyond angry!

You are NOT responsible for the behavior of the addict or those who are covering for her. You ARE responsible your own behavior and the choices you make.

You have a child to support and protect. Some of us have offered suggestions about dealing with the situation that might deal with the impaired nurse and the management covering for her, without hanging you out to dry.

Take them or leave them ... it's up to you.

[BradleyRN]

I do understand that as an RN the active/recovering addict makes more money than they would make taking a different job. Is this not selfish on the addicts' part to risk pts and other RNs careers so THEY can make more money? If they truly wanted to recover they would not work with narcotics, but the money appeals to them more than the risks to others.

This method of rehabilitation would insinuate that a recovering alcoholic should never walk into a convenient store, grocery store, or even drive down the street! Does that sound logical? Recovering nurses are subject to numerous drug tests, so the risks that they pose are probably less than someone that is not in recovery.

[Shenanigans, RN]

My friend's brother is a nurse and he got kicked off the register for using dope. That was a few years ago now and he's never allowed to practice again. Given that we don't have medicinal marijuna in this country I don't see an issue with him being allowed a job.

Of course, the utmost care and secruity must be taken to ensure they don't find themselves alone with a stash of morphine or something to tempt them.

Yet, I think if they show up stoned or intoxicated they shoudl be out the door.