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?
First and foremost, before"turning any Nurse in", triple check yourself. This is that persons' lively-hood and possibly making an assumption that could be wrong can take that persons' job and career away.
So, please make certain before accusing, turning in and/or judging, get your own facts straight.
Exactly how certain do you feel you would have to be before reporting your observations to your superior? Would you have to wait until you witness the nurse prepare and inject the narcotic medication right before your very eyes?
The scenario that OP has described is a situation where I would feel I was obligated to report. There are too many warning signs to ignore and since OP has co-signed wastes with this nurse it's also necessary for self-protection.
Falsely accusing a Nurse could have you facing the Board, even though you have good intentions.
If you by "falsely accusing" mean reporting your observations up the chain of command, I don't see how a nurse would get in trouble with the Board if the report was made due to legitimate concern based on observations and in good faith.
@aeris99
5-have small pupils and am shivering d/t prescribed stimulant medication
I would expect mydriasis and perhaps difficulties with accomodation, not miosis, from stimulant medication. What am I missing?
First and foremost, before"turning any Nurse in", triple check yourself. This is that persons' lively-hood and possibly making an assumption that could be wrong can take that persons' job and career away. Also, understand that just because someone has been in a Nurse Monitoring program, he or she may not have a substance abuse or diversion problem. Here what IS happening....True Fact: Many Nurses have a complaint filed, ie; suspicion. The downhill spiral begins. Your Nurse Monitoring agency in the State get's your name and circumstance. Guess what? It's almost easier to say ok....get an eval, do drug screens, etc., than to pay crazy amounts to a lawyer, have your life on hold, sometimes for years to attempt to prove your not. Now, here is another reality. Some Nurses do have an addiction illness, and some Nurses will steal medication for addiction and for profit. I have studied the monitoring program as well as the Nursing Board in my state. It seems to be easier to go ahead and have someone monitored, even if it is only hear-say; protect the community. This is where changes need to be made; help those who need the help. And remember, addiction treatment is a HIGH money making business. Most Nurse Monitoring programs are in place to make money too...now that is a hard pill to swallow! So, please make certain before accusing, turning in and/or judging, get your own facts straight. We need each other! If you are aware of someone who DOES have an addiction illness, it is our responsibility to protect our patients too. Give it to management and let them investigate. Falsely accusing a Nurse could have you facing the Board, even though you have good intentions.
Observing open sessions of the BON and reviewing minutes is not the same as actually sitting in on closed sessions. Not all boards operate in the same way. We also should all have our own professional insurance against claims to the BON. I have NOT seen doctors, nurses or pharmacists slung out of their professions by their respective boards for this. I have seen those being monitored throw in the towel. Not the same thing.
As a colleague I am not an investigator. It is not my job to run a private investigation into my colleagues behavior on the floor. I am neither qualified nor am I placed to do such a thing. It also may appear like harassment on my part. It is not my job to question or counsel my colleague about potential drug seeking/using behaviour.
First and foremost, before"turning any Nurse in", triple check yourself. This is that persons' lively-hood and possibly making an assumption that could be wrong can take that persons' job and career away. Also, understand that just because someone has been in a Nurse Monitoring program, he or she may not have a substance abuse or diversion problem. Here what IS happening....True Fact: Many Nurses have a complaint filed, ie; suspicion. The downhill spiral begins. Your Nurse Monitoring agency in the State get's your name and circumstance. Guess what? It's almost easier to say ok....get an eval, do drug screens, etc., than to pay crazy amounts to a lawyer, have your life on hold, sometimes for years to attempt to prove your not. Now, here is another reality. Some Nurses do have an addiction illness, and some Nurses will steal medication for addiction and for profit. I have studied the monitoring program as well as the Nursing Board in my state. It seems to be easier to go ahead and have someone monitored, even if it is only hear-say; protect the community. This is where changes need to be made; help those who need the help. And remember, addiction treatment is a HIGH money making business. Most Nurse Monitoring programs are in place to make money too...now that is a hard pill to swallow! So, please make certain before accusing, turning in and/or judging, get your own facts straight. We need each other! If you are aware of someone who DOES have an addiction illness, it is our responsibility to protect our patients too. Give it to management and let them investigate. Falsely accusing a Nurse could have you facing the Board, even though you have good intentions.
Regarding "Falsely accusing a Nurse could have you facing the Board, even though you have good intentions." - My state (and others) have a law that protects individuals and organizations who make reports to the BON and other professional organizations "in good faith." As long as your concern is made in good faith and your statement is honest, you cannot face civil action or action by a professional board.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
I don't care about RN Dynamic.
Part of me is angry that this nurse was playing me for the fool. He put me on the spot with these wastes. Part of me doubts myself, that I AM a fool to doubt his integrity.
He's a veteran to the unit, a highly seasoned ER nurse. This is an inconvenient blow to our staffing, if this turns out to be true. His social standing is higher than mine. I feel like I'll be viewed as troublemaker.
Also, I was considering going back to this as my primary job. It's a social minefield of course, as it is, with many strong personalities. This makes me feel vulnerable. and insecure.
You had a moral dilemma. It wasn't an easy choice. You are having some negative feelings now, but it doesn't mean you did the wrong thing. You would have had negative feelings either way, that is the nature of a moral dilemma. The answer isn't clear, you make the best choice for the situation.
I support your idea of going to counseling if you want to. I don't understand why anyone would oppose that. In counseling you can deal with your concerns about the social dynamic.
Be mindful that the biggest influence you have on the social dynamic is your own attitude. It is a way bigger determinant than a rumor that you reported a diversion, if such a rumor even exists. It may not.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
On the general topic of reporting suspicions, I think it is a very bad practice to report suspicions just because you are afraid that you will be implicated if you don't. That is the kind of mentality that led to the Salem witch trials. I don't think the OP did this, but it is an argument I see here a lot and I think it needs to be challenged.
@Invatile, I don''t see anyone on here suggesting Emergent report 'just because' she would be implicated if she didn't. The many reasons for reporting were all reiterated.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
@Invatile, I don''t see anyone on here suggesting Emergent report 'just because' she would be implicated if she didn't. The many reasons for reporting were all reiterated.
Dishes,
There are a few hundred replies on this thread. More than one reply states that the suspicions should be reported because if not, Emergent could be implicated for not having reported, if and when the nurse is eventually caught.
The suggestions are there. If you read every reply, you'll see them.
It happened to me. In one instance, it was a nursing supervisor who would offer to give pain meds when rounding. We were so understaffed and of course we would accept the offer because we trusted her and we wanted to make sure our patients didn't have to wait even longer for pain meds.
In the other instance, we would be asked by a coworker to punch in our code for a waste but she wasn't wasting. Again, understaffed and everyone trusted each other. We genuinely loved that nurse and when she voluntarily went into treatment after getting caught, we prayed for her recovery. Of course when she returned to work, we all had to take turns passing out her pain meds for her. As a part of her arrangement she could no longer pass narcotics.
What did I learn from these cases? Mostly that addicted nurses can slip under the radar and more so when the staffing is stretched to the max. In both cases, nobody knew what was going on until it was too late. None of us were reprimanded or punished for not knowing what had been going on. Unfortunately, there was also no debriefing or post-incident education for us.
Knowing what I know at this point in my career, I would discreetly speak up to a manager if I suspected that a fellow nurse was diverting. You aren't doing anyone any favors by remaining silent or trying to make it another nurse's problem. And if you suspect diversion but are a willing participant in waste, then you are a silent accomplice to the problem.
If anything, the hospital will check the records and if nurse X is constantly "wasting", he is going to end up giving a random sample. If your suspicions are unfounded then great, now you know. Something tells me that won't happen though.
There are a few hundred replies on this thread. More than one reply states that the suspicions should be reported because if not, Emergent could be implicated for not having reported, if and when the nurse is eventually caught.
The suggestions are there. If you read every reply, you'll see them.
I have read every reply and contributed more than one myself, one of which was to report in order not be implicated. When a nurse diverts narcotics and has their colleague co-sign fake wastes, the addicted nurse is making their colleague complicit in their diversion. In these situations, if the co-signer is silent, they are investigated along with the diverter. This thread evolved beyond the one problem of being seen as complicit and turned into a broad, thought provoking discussion of the dilemma of reporting a colleague who is potentially diverting narcotics.
There are a few hundred replies on this thread. More than one reply states that the suspicions should be reported because if not, Emergent could be implicated for not having reported, if and when the nurse is eventually caught.
The suggestions are there. If you read every reply, you'll see them.
I wrote one of those replies. Yes, Emergent is a concern to me because she is my friend. I also wrote of my concerns for the diverting nurse and all the patients said nurse could be hurting.
I'm IN my state's monitoring program. I think people who haven't been through it like to think there is an element of fairness or a process that would routinely separate, say, a spat of odd behavior or false accusations from true addiction.
Unfortunately, the state boards are in cahoots with many addiction" specialists" and many people who are not addicts are treated like addicts just so the people at the board can justify their paychecks and the "specialists" can make a crap ton of money. It is insane.
There is a website by a physician that is or was in a state monitoring program called "Disrupted Physician". People should read it to find out what really goes on and how corrupt the industry really is. When people found out that they could make alcoholism/addiction a very lucrative career, they jumped on that train and it has led to a very deceptive, corrupt and ineffective method of handling individuals with REAL addictions. State boards force many medical professionals who are not addicts/alcoholics into treatment programs and monitoring programs that cost tens of thousands of dollars just to say that their success rate is 80%, which is a complete lie. If you admit people into a monitoring program for drugs/alcohol that are not addicts/alcoholics to begin with, guess what? Their rates of success will be fantastic!!
So, that's why I said that I would confront the nurse and tell him the deal. I wouldn't say anything to management or anyone else unless I encountered a medical provider habitually coming into work with alcohol on their breath, or if they appeared to be high at work repeatedly. Turning someone into the state board is a step that should be the very last, in my opinion. I would want to know that someone was definitely an addict/alcoholic before I went that route, knowing what I know about the whole industry.
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macawake, MSN
2,141 Posts
Exactly how certain do you feel you would have to be before reporting your observations to your superior? Would you have to wait until you witness the nurse prepare and inject the narcotic medication right before your very eyes?
The scenario that OP has described is a situation where I would feel I was obligated to report. There are too many warning signs to ignore and since OP has co-signed wastes with this nurse it's also necessary for self-protection.
If you by "falsely accusing" mean reporting your observations up the chain of command, I don't see how a nurse would get in trouble with the Board if the report was made due to legitimate concern based on observations and in good faith.
@aeris99
I would expect mydriasis and perhaps difficulties with accomodation, not miosis, from stimulant medication. What am I missing?