Would you report possible diversion?

[Emergent]

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?

Feeling conflicted...

[Emergent, RN]

All is well. Haven't heard anything new about this case. Haven't worked with the fellow since this.

[LuvTheOR]

I would discuss the issue with my charge nurse or unit manager. It is your duty to the patient to report your suspicions. Also if you do waste with him knowing that there is a possible diversion your license may also be in jeopardy. If he is using he needs help. Does your facility have an employee assistance program or does your state nursing organization have a program to assist nurses that need help with substance abuse (WI does and works with the BON so that the nurse is not penalized)? Hazelden in MN has one of the few programs for healthcare providers with substance abuse problems. They treat nurses, physicians, and other providers.

[BCgradnurse, MSN, RN, NP]

As hard or uncomfortable as it is to report, you have to. There's only one thing that matters here-patient safety. Your obligation is to your patients, and not your co-worker.

[lifelearningrn, BSN, RN]

Should a recovering addict be working with narcs at all? Maybe that is too big a question, but I'm thinking that recovering alcoholics probably shouldn't be tending bar... nor should narc addicts be working in the ER..

am I wrong? I'm not saying addicts shouldn't be nurses... because I do think everyone deserves a second chance... but it seems to me a recovering narc addict shouldn't be working with narcs, maybe ever.

[nurseinthezoo]

When I worked ER there was a nurse who fit the same profile as you described: seemed very professional, worked OT, one you would never suspect to divert narcs. One day she was escorted off the job after a cache of morphine was found in her locker. We all know how easy it is to divert narcs, but the question is why a trusted professional would do it? Diversion needs to be reported to maintain the integrity of our profession and get help for the nurse involved.

[Penelope_Pitstop, BSN, RN]

All is well. Haven't heard anything new about this case. Haven't worked with the fellow since this.

Have you looked up his license? I know I wouldn't be able to NOT do that. In cases of suspected diversion in my state, a lot of times an emergency suspension is declared and that shows up immediately to prevent the diverting nurse from obtaining employment elsewhere.

[kidsmakingmecrazy]

In this case the suspicion is theft, possible drug use or sale, your own failure to report which risks your license, and depending on payment source medicare fraud or the like. Worse yet, imagine he works parttime in home care or a nursing home or some setting where it's not a computer accessed drug cart. In that scenario he may not be diverting, he could be replacing. Tylenol for Percocet, watering down the liquid Ativan or roxanol, etc. but now the patient is not getting the medication and their pain/condition is not managed. Who's going to know? He's risking your license and facilities do get uptight when it's a reportable event, the longer you wait, the more you put yourself in jeopardy. It's hard to make this call but you didn't work this hard to risk your career and your integrity. Good luck.

[wolf9653]

maybe I'm naive. why would the user take the syringe into the patient's room, instead of shooting himself in the bathroom? unless he's worried the patient will ask for pain meds and someone will say the user gave it a half hour ago and the patient says he didn't. so he shoots the pt with diluted. but if he did that, the nurse would check when the last dose was given. I just think users are a little slyer than this. And if he got caught doing this more than once, which I would think the odds are against the timing, why would he keep doing it that way?

[Sober1]

Amen, sounds like a meeting and a call to sponsor is in order. The first principle is honesty.

[Sober1]

Better to lose one's job than one's life

[Sober1]

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.

I get the second guessing yourself. When I do it in a situation like this, I always turn out to have been right the first time. I'm always surprised when I find out I'm not the only one suspicious of a situation. It's only after I speak up that I find this out.

As a group we addicts are bright overachievers- to make up for feeling we're not good enough. I am highly competent. I can also be highly manipulative and dishonest with absolutely no integrity at all.

Addiction is not a disease of immorality, IQ or competency. It is a disease of thinking. My disease is in the primitive part of my brain, not the grey matter. It urges me to use just as it urges me to eat, drink, and seek shelter. In active addiction, I do not have a choice. I wanted desperately to stop, to not be the the person I had become and prayed for help. I got it in the form of being reported for which I am truly greatful.

Something I've learned is it all comes down to motives. I can do the right thing for the wrong reason- to get back at someone perhaps and it turns out all bad. I can do the wrong thing (make a mistake) for the right reason and it turns out good. From you're OP, it appears you were doing the right thing for the right reason. Rest easy, check out EAP, and be good to yourself. (((Hugs)))

[joverhol]

As someone who has a relative that was diverting as a nurse, I would report it. One of the "signs" that someone may be abusing medications as a nurse is that "very experienced, works a ton of OT". My loved one was diverting pain meds from their workplace, and patients, and being reported not only saved their patients from potential harm, but themself as well.

Since then the hospital assisted them in getting help for their problem, although that meant they have a suspended license. Patient safety comes first, but ruining his life financially isn't as bad as losing that life.