If you had a strong suspicion of a coworker's diversion of narcotics, how you handle it?
I'm talking, a nurse in the ER who habitually walks into the room with narcotic drawn up on your patient, right after you medicated, so then you have to waste with him. He has a history of being on a restricted license. He's a great nurse, very experienced, works a ton of OT.
It would probably financially ruin his life to get in trouble again, I don't know how many chances they give people. He functions very well on the job. Is it really the right thing to snitch on someone like this?
the scenario described that noone had any way of factually knowing what you had in that syringe, and that's why they shouldn't witness. My question is what is the factual, DOH approved way to you do if you are legitimately in that situation?
That's different. You will need to look up your hospital's policy, but in general, you shouldn't end up in that situation if you draw and waste correctly. If someone comes to you with an unknown substance already drawn up in a syringe, you do what Emergent did and report it. I would also have refused to witness the narc waste.
Emergent, I'm sorry you're taking this so hard. I don't know why you think it's your fault that this nurse used you, because it isn't. It's his fault. I don't know why you think it's your fault that he could lose his job because of his actions. It's his fault.
The only thing that IS your fault is that you have talked yourself into being a scapegoat for this RN. It is NOT YOUR FAULT.
I wish more nurses have the strength you do, and the intelligence to figure out what's going on.
That's different. You will need to look up your hospital's policy, but in general, you shouldn't end up in that situation if you draw and waste correctly. If someone comes to you with an unknown substance already drawn up in a syringe, you do what Emergent did and report it. I would also have refused to witness the narc waste.
Emergent, I'm sorry you're taking this so hard. I don't know why you think it's your fault that this nurse used you, because it isn't. It's his fault. I don't know why you think it's your fault that he could lose his job because of his actions. It's his fault.
The only thing that IS your fault is that you have talked yourself into being a scapegoat for this RN. It is NOT YOUR FAULT.
I wish more nurses have the strength you do, and the intelligence to figure out what's going on.
I hope you feel better soon.
i think his/her point was if they used the entire vial, say 2 mg MSO4, and for some reason can't give. they made no error in drawing up without a witness, but, now, what do they do?
Diversion of Narcotics? Plain English for us low life other nurses...He is addicted to Narcs! Enough of the buzz words. Perhaps its the OT he is working. Great nurse, good with people, but EMERG? Great source of stress! If caught in the act, tell him you are concerned citizen, and fellow nurse. Does he taken them? have you seen it.
I have never left a comment on these forums but felt strongly about this topic. If you asked me 5 years ago I would have advised to not witness the waste and not report your coworker letting management deal with it. Possibly speaking to bim/her personally. That is what I did when faced wit the same situation. The nurse I suspected eventually quit and last I heard is working in another hospital in another ,ED.
I am now management at the same hospital I have worked in for the last 15 years. I was recently investigating a serious medication error where a pen IV anti hypertensive was given twice in 30 min. It was shift change and the parameters were met. The patient became hypotension be and landed in the ICU It turns out after lots of investigating that the night shift nurse gave it and did not chart. She had given the other hlf of the vial she had taken out early in the shift so they Pyxis looked like it had been pulled last 4 hrs before. The day shift nurse gave it because the parameters were met. Anyway when i did a really in depth review of all meds it turns out the night nurse was diverting. She was a good nurse by the looks of things, I did not suspect anything. She worked lots of OT. It turns out that there were at least two of her coworkers that suspected something. They came to me after she left (voluntary resignation once confronted with evidence) to ask if it had something to do with drugs. I obviously didn't say anything to protect her privacy but let them know how important for the safety of our patients to report suspicions.
Anyway i think you have to report for the safety of patients and staff. This night shift nurse had become careless that resulted in a poor patient outcome. The day shift nurse that gave the BP med that sent the patient to ICU felt terrible and didn't want to come back to work. Luckily with encouragement she is still with us. And the patient ended up ok. But who knows if and when we would have found out about the diversion of this didn't happen. But I'm are it would not have been good. There was 20 my dilapidated missing in one week.
So what's the deal with all the extra OT being a sign of a nurse who is diverting? Is it simply that they want to increase the amount of time they have access to the drugs?
That is exactly it! When you need your drug of choice to not become sick, you must be around it to get it. That's why, often, health care professionals go so long hiding their addictions. Easy access means less "addict" behaviour, i.e. Stealing from family, pawning personal items, etc. When what you need is right there...very scary how easy it really is.
"So what's the deal with all the extra OT being a sign of a nurse who is diverting? Is it simply that they want to increase the amount of time they have access to the drugs?"
Sorry, have never responded here before...I did hit the QUOTE button, but it didn't put it in white boxes as other quotes have been. So I added my own quotes!😜
I'm considering going into nursing (not a nurse yet) but I have a patient's perspective on this. Had surgery in January and was prescribed morphine during post-op. My first morphine shot by the day nurse was the first time I had ever been given morphine and it had a strong and noticeable narcotic effect (because: morphine). I was supposed to get a second dose of morphine for breakthrough pain hours later by the night shift nurse, but when she injected me...there was nothing. Same vial of clear liquid but no effects. No flushing or feeling of tingling warmth, no dizzy opiate high, no pain relief. Nothing. As I lay in bed hurting over the next hours I began to suspect my pain medication had been diverted (If not by the nurse, than by someone else.) I asked the CNA and later my nurse why I felt no effects from the second shot. The CNA was perplexed. The nurse shrugged noncommittally and said maybe the first shot had felt stronger "because I still had anesthesia drugs in my system following surgery."
I don't know for sure if my pain medicine was diverted, though my suspicion was strong enough that I did express my concerns both to my surgeon and to the hospital's HR hotline (never heard back from either--that hospital was terrible, disorganized and sketchy as hell from the beginning of my stay to the end. It was exactly the sort of place you'd expect to find that sort of thing). Still, I'd like to point out that, even in cases where patient safety isn't necessarily jeopardized, diverting pain meds can still really hurt patients. Lying alone and in pain in a hospital room, still disoriented enough from surgery that I did not know how to advocate for myself, and feeling like I couldn't trust my care team was a terrible experience. A sick or post-op person is inherently vulnerable and I shudder to think about patients who are even more vulnerable than I was--elderly people, babies, people who are nonverbal or don't speak English--people who might be in worse pain, for even longer, because their care team is either stealing their medication or turning a blind eye when someone else is doing it.
So yes, please report suspected diversion. Even if no one dies from bad care, they can still really be hurt be it.
I am, by far, no expert in this. However, having been on both sides of the coin, having caught a physician in the act and reporting him, while, ironically, I was doing it myself, I feel I do have some knowledge. I am wanting to just post a list of behaviours to watch for if you have suspicions.
1. OT. For sure, as explained above, the user will not turn down an opportunity to be near their drug.
2. Extended or frequent bathroom breaks, tending to frequent a less used bathroom.
3. Reluctance or refusal to let another nurse medicate their patients.(I used to take the keys to my cart on break with me, "by mistake," of course.) Likewise, being very helpful, offering to answer bells and medicate patients for other nurses.
4. Patients who seem to have a higher pain level than usual.
5. Pin point pupils, slurred speech, nodding off at odd times, shivering.
6. Hanging around med cart area, seemingly doing nothing. Probably waiting for the area to be less busy.
7. Large amounts of wastage, sometimes strange reasons for wasting, wasting entire doses.
8. Mood changes! Down, pale, sluggish one moment, usually at very start of shift, alternating with hyper, chatty, friendly, helpful!
9. Hanging around rooms where there are PCA pumps in use.
10. Always wearing long sleeves, even during warm weather months.
11. Becoming very defensive, angry, overly sensitive to talk about addiction. Though it is frowned upon ethically, morally, we know we all have "regulars," or "frequent fliers," who we know as "med-seekers," who are on that bell EXACTLY every three hours. The addicted nurse will be friendly with these patients, even offering to be their nurse as much as possible!
These are just a few things I know I used to do when I was trapped in the cycle of use. If I could help one nurse recognize one colleague in need of help, I would feel good. Also, I know that I often was in dire need of drugs right away when my shift started. I would often grab a vial immediately after count, to use on myself, then account for it later. If the suspected user's cart is checked within an hour of starting shift, often, something will be missing.
Sorry for such long posts! Obviously, this subject has struck a chord with me feeling very sorry for both the nurse suffering this terrible disease, and the OP, fighting her conscience! Good luck to everyone who finds themselves on either side of the fence!í ½í¸Š
canigraduate
2,107 Posts
That's different. You will need to look up your hospital's policy, but in general, you shouldn't end up in that situation if you draw and waste correctly. If someone comes to you with an unknown substance already drawn up in a syringe, you do what Emergent did and report it. I would also have refused to witness the narc waste.
Emergent, I'm sorry you're taking this so hard. I don't know why you think it's your fault that this nurse used you, because it isn't. It's his fault. I don't know why you think it's your fault that he could lose his job because of his actions. It's his fault.
The only thing that IS your fault is that you have talked yourself into being a scapegoat for this RN. It is NOT YOUR FAULT.
I wish more nurses have the strength you do, and the intelligence to figure out what's going on.
I hope you feel better soon.