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

[lance197728]

If she was taking 25-30 a day, then she had a serious life threatning problem. So by reporting her you may have saved her and finally gotten her the help that she needed.

I'm sure it was a tough thing to do, but it was the only thing to do. And if she's not thanking you now, she will.

[catmom1, BSN, RN]

The reason you feel so horrible, cptluciejensen, is that you have your priorities out of whack. You are not causing the consequences that will be suffered by the diverting nurse. She has caused her own consequences. You would be doing her and her patients no favor by turning a blind eye because you don't want to face dealing with this situation.

More than one diverting nurse has ended up dead because his/her coworkers didn't have the intestinal fortitude to report them.

You did the right thing. Get ahold of yourself & stop the hand- wringing already, okay?

Catmom :paw:

[sissiesmama, ASN, RN]

You didn't just turn her in. This may not even be all of what you did.

You may have saved her life, if not now, what "if"

You may have saved the lives of another, her patients, a stranger she would met on the road after using

You may have saved the life of a patient that may have died needing and not getting their med

There are no limits, if you think about it to the numbers of people you may have saved

You also saved your own life well livlihood, because the BON could have really come through there if they desired to and fired everyone who knew if a patient had died and no one said anything to them until a complaint showed up.

Anne, RNC

[Magsulfate, BSN, RN]

First of all, I totally agree with the other three comments.

You did the right thing.

I am so proud of you. I know it is hard. Hard is not even a word to describe it.

Now you've got experience with a diverting/addicted nurse. It will happen to you again, probably... and maybe more than one time. This is way more common that you think.

Think about what would have happened if you had not told your manager? Everyone would continue to pretend that everything is alright. She would continue to get high and potentially kill herself eventually. She would require more and more narcotics as time went on. Maybe you just really started noticing it right now because she is requiring more now.

When a person is addicted to IV narcotics like this, there is a fine line between walking around normal and being passed out in the bathroom from too much. I'm sure she was taking way more than the legal dose. Heck, none of it was legal,, but she was steps away from taking a lethal dose. THink about how bad you would feel right now if you didn't say something,, and she was found in the bathroom, dead?

Or think about if you didn't say anything and a patient ended up having a severe reaction to a narcotic...... because a nurse AFTER this nurse ACTUALLY GAVE THE PATIENT the dose that was documented and was never given by this addicted/diverting nurse??

This is nothing new. It has happened in countless hospitals, on countless units. The reason you are bothered so much by it is because of many things.

She probably seemed like the super nurse, didn't she? She was probably nice to everyone, right? She probably was a really nice person that would go out of her way to help you and everyone else, right? She would stay late, come early,, sign up for extra shifts, right? These are all characteristics of the diverting nurse.

She has serious issues with herself and her home life and in NO WAY ARE YOU TO BLAME FOR ANY OF THIS!

Don't lose anymore sleep over this. As a matter of fact, you should be sleeping better after this. Get rid of your guilt. You did an honorable thing. And most importantly, you did what you had to do. Don't ever put your license in jeopardy over something like this. That's exactly what you would have been doing if you let this slide. So what if she was transferring to a new position and would not have access to narcotics. I seriously doubt that it would have lasted very long, she would have figured out a way to get her narcotics. She would have gotten another part time job, or eventually wiggled her way back into working overtime on a unit somewhere,,, or she would have gotten someone else's password. Or she would have started looking to buy on the street, from your friendly corner store drug dealer.

You cannot control this kind of nurse,, the ONLY way you can help them is to report the facts to your supervisor. I was always taught to never approach this kind of person and tell them they need help. They won't get it, and then they will run and hide from you and anyone that tries to help.

So, please, trust me when I tell you that you did the right thing, you did the only thing that you could do. You did what any good nurse would do.

Since you work at a unionized hospital, then most likely they will not fire her. She will go to rehab and get help. Then she will come back in a few months sober. She won't have access to narcotics for a while, and she will be drug tested frequently. She will be getting the counseling that she needs and the tools she needs to fight her addiction. Please don't shun her, she is only human, and she has a disease. IF she is strong enough to fight it, and has the courage to come back to work sober,, she deserves another chance.

[Tweety, BSN, RN]

You know you did the right thing, don't even ask that question.

It's also o.k. to feel bad and upset about the situation. It's a sad situation.

[SuesquatchRN, BSN, RN]

Sometimes it's hard to do the right thing. You did.

[jackstem]

Yes, you most certainly did the right thing. I gave a lecture last week at the nurse anesthesia program here in Cincinnati. I'll tell you what I told them.

Have you ever noticed how cancer, diabetes, heart disease, etc. are all diagnosed while those with the disease of addiction get caught?

When a chronic, progressive, potentially fatal disease is treated successfully, the person is in remission. Addicts are in recovery.

When someone's cancer comes back, we say the disease is active. When addiction becomes active, it's a relapse.

When the cancer continues to progress, most folks are saddened. When addiction continues to progress, everyone is angry or disgusted.

Even when a lung cancer patient was a smoker, we still don't become angry with them or "judge" them harshly. But everyone "knows" addicts do this to themselves, so what else should they expect?

My point is the stigma associated with the disease of addiction is embedded in our culture. The stigma is associated with the lack of understanding about the disease and how it adversely affects the brain, which leads to negative alterations in emotional and mental health.

Your reaction is the most common one experienced by those close to the person with the disease. You did exactly what needed to be done to save her life. Would you feel this way if you intervened if she were having an MI, seizure or stroke? Of course not, because we know those are legitimate diseases. You feel bad because of the negative attitudes permeating our culture. The more you read about the disease the less you'll feel this way. When I am involved in an intervention, I feel pretty good because I know I just may have saved this person's life. One of these days, we'll be treating addiction as we do other chronic diseases. It's just going to take some time and a lot of effort on the part of recovering individuals.

Believe me, this person will thank you once she get's some clean time and works on her recovery program. I know I sure was and still am!

GOOD JOB!!!!!!!!

Jack

[psalm, RN]

You didn't betray her, she betrayed you, the patients, her students, the BON and herself.

[BmichelleRN]

You absolutely did the right thing. The guilt is hard to deal with...but you have to be honest with yourself or the guilt will continue to lie to you. If you don't report cause you like the person or respect the person then do you only report those you don't like?? You know, that is guilt, irrational. Then there is the possibility of jeopardizing your own license if you didn't report and she's found dead on the floor from an overdose. Or how about the patient who is in pain and can't get dosed and must suffer because they are Q 4h and someone said they had the dose 15 mins ago.

Don't beat yourself up. Maybe this will be her rock bottom and she will get her life back to where I am sure she desires it to be!! And good for you for doing the right thing for everyone. My past instructor calls that a RN: REAL NURSE!

[cptluciejensen]

I am glad that I actually heard from those that had been in both positions. I know they are doing an investigation, from what I have heard thru the grapevine it is pretty big. I dont think she knows about the investigation yet because she comes up to the floor to say "hi". the unfortunate thing is that her daughter is also an RN and works on a different floor. some of the girls think that the dtr knows because she has been behaving differently lately. what a horrible place to be in, worse than mine.

on a lighter note one of the nurses that knew as well said her usage of the pyxis was so great that the machine should have rang bells, flashing lights should have gone off, drawers should have opened and closed, wheels should have spinned just like a winning slot machine in las vegas!!!!, I couldn't help but laugh at that. I guess it is her way of saying she should have been caught by the computers and where she was statistically in usage of the pyxis

The more that I read about this topic the disease progression symptoms , the more that i see that some of the symptoms and behavior patterns might be that of any undiagnosed disease. I know of a nurse that someone could have thought she had an issue because she had similar patterns to the diversion/abuse profile. The nurse I had to report was always early for work, volunteered to do extra shifts, on the otherhand calling in being late etc is also a s/s of abuse diversion, this nurse, call her nurse 2 called in when she was scheduled for more than 3 12 hr shifts in a row, you knew if she was scheduled for more than 3 twelves she would not make it in, and if scheduled for 5 in a row you knew for sure. after a few 12's when she was there you could see that she was visably tired, she didnt smoke so she really didnt get breaks, but sometimes in report when they werent talking about her pts she might close her eyes for a few minutes, she would yawn quite a bit. Sometimes she would sweat, sometimes she would seem nervous, she seemed classic for an abuser, there were no pyxis or pain mgmnt issues with her pt's. but everyone thought she might have been drinking or taking something.

Turns out that she had a toothache one time and her face was swollen, we sent her to the ER, since she had good insurance they did a Cat scan, they found a mass on her thyroid. she was in thyroid storm and in a hypertensive crisis as well as having tachycardia and nervousness. They took out the tumor and now she can go the 4-5 12 hour shifts in a row. She was probably really sick when she did call in and her symptoms were just so gradual she didnt realize how bad it was.

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

[sissiesmama, ASN, RN]

Hey - been wondering how everything was going. Hope you are feeling a little better about what happened. I know it was a hard decision to make, but without a doubt you made the best decision for all involved, yourself and the other staff, the nurse diverting, and of course, the patients.

It probably will be kind of strange with the daughter working there too, but don't let it bother you.

You did the right thing.

Anne, RNC