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...

[Rose_Queen, BSN, MSN, RN]

What a complete crock of horse manure.

That may be an insult to horse manure.

OP, I'm glad you're not sitting idly by on the sidelines with this.

[Been there,done that, ASN, RN]

Do not report him. If you do, you are likely not a good person.

I have a history of diverting IV narcotics. I was eventually caught because of a pharmacy audit. There was an investigation taking place while I was in a rehab facility and I didn't even know it. Almost all nurses who divert drugs are eventually caught and when they are caught, it is through a paper trail. For example, where I worked if a nurse pulling narcotics at a rate of three standard deviations above what is average for their unit, they get flagged and a critical eye is put on them. Eventually their addiction catches up to them.

If I were you, I would leave it alone. You could really be sabotaging him by demonstrating that you know about his diversion. When a nurse is diverting drugs, management will often try to rehabilitate that nurse as long as the nurses' peers have no knowledge about it. The moment that you demonstrate that you are aware of what the nurse is doing, management will assume everyone else knows and they will be much less likely to give that nurse a probably well-deserved second chance because they will be afraid of drama and rumor and so forth. It becomes a bigger issue at that point.

If you take the initiative by reporting, you are really doing some unnecessary harm.

Nurses have a DUTY to report. Not protect. OP is is legally bound to do so and needs to report ASAP. OP is smart.. be like OP.

[heron, ASN, RN]

Emergent - you did the right thing. That you were worried about harming a possibly innocent colleague speaks well of your ethics.

Think of it this way: relapse is as much a part of addiction as getting high in the first place. Browse around the recovery forum - many posters there say getting reported saved their lives. By declining to enable your co-worker's possible relapse, you are doing him a favor, too.

[macawake, MSN]

RNdynamic, I don't take your post seriously but I will respond anyway

Do not report him. If you do, you are likely not a good person.

So, in your opinion a good person lets a nurse coworker who works impaired and/or diverts narcotics continue to do so and simply turns a blind eye?

For example, where I worked if a nurse pulling narcotics at a rate of three standard deviations above what is average for their unit, they get flagged and a critical eye is put on them.

This sounds made up but even if it isn't it's hardly a foolproof method of uncovering diversion. I have placed thousands of drug addicts under arrest for various offences (yes I know, I'm a terribad person) and since I started working in the healthcare arena I have reported two nurses. The first one was actually when I was still a student. I was dismayed to see that the people who worked with her seemed oblivious to her problems/issues. Her miosis was so pronounced that I could barely see her pupils and given her lightblue eyes this was rather noticeable. She slurred her speech and moved through the unit at such a sluggish pace that a sloth looks like the Duracell Bunny in comparison. By the way, the amount of narcotic medications that she pulled from the Omnicell was exactly what her patients were prescribed and at the correct intervals. She probably used about seven standard deviations more of 10 ml sterile NaCl vials than the average nurse on that unit. Her patients suffered. I do not regret reporting her.

If you take the initiative by reporting, you are really doing some unnecessary harm.

No. Ignoring a coworkers attempt to ruin their career, health and life and gambling with your patients' safety is the harmful and wrong choice.

[Magsulfate, BSN, RN]

Stick with the facts when you report it. Don't go on about your suspicions, that could get you into trouble. Let management investigate, you don't have to prove anything. What you're doing is making it clear you won't witness unless you actually see the waste. Also, that your coworker pulls out drugs for your patients without you asking him/her.

[Magsulfate, BSN, RN]

Here is how you do it... draw up saline- tape an empty vial to the syringe- pocket the full vial. Waste. Score.

I tried many times to quit, but I could not say no to the extra shift, or when I actually did quit my job for 2 weeks, and the manager called an begged me to come back. I thought "I have quit for 2 weeks- so I must be able to go back to work without a problem". Wrong

Here is what I wish had happened-

1) I wish when I started diverting I had quit my job and moved on to another career- I knew it was wrong- but my addict self came up with reasons why it was right.

What happened was my diverting went from a little here and there, to enough to kill me... I didn't think I was impaired as I was still in the most emergent cases performing at a high level. One of the last things I did was get a line in a patient who two anesthesiologists could not get... Still, my cognitive tests at my substance abuse evaluation showed impairment in my ability to think. Now 4 years out I cannot believe I was so impaired, my mind is so clear now.

So definitely share your concerns with the manager- it is your duty to report this suspicion. If you do not this can go on for some time, until your coworker dies or hurts someone else.

Thank you for sharing :) and I have to agree, don't let this go on until someone gets hurt or dies.

[nursecatRN]

I would at least put a bug in my manager's ear and would not sign any unwitnessed drawn up meds or wastes with that nurse...

[dishes, BSN, RN]

Nothing personal against you, but with that statement, you're basically demonstrating that you are really ignorant. Care to expound?

Some (but definitely not all) hospitals will indeed take a rehabilitative approach to nurses who divert for the first time. Not everyone loses their job. Usually management wants to see the nurse has gotten treatment for their addiction, is in an assistance program, and basically demonstrates that they are trying to do the right thing after having been confronted.

However, it puts management in a harder position to do that when everyone on the unit knows about the diversion and starts talking about it. Not sure what's hard for you to understand.

It wasn't the first time, the nurse had a history of being on a restricted license and the employer gave him a second chance and allowed him to continue working. The situation emergent describes seems like a relapse, if the temptation is too much, it is in everyones best interests that he not work with narcotics.

[ponymom]

Do not report him. If you do, you are likely not a good person.

Annnnd blah, blah, blah.....then:

I have a history of diverting IV narcotics.

Then more blah, blah, blah...then (again):

If you take the initiative by reporting, you are really doing some unnecessary harm.

LOL too bad...so sad (nnottt).

[roser13, ASN, RN]

Nothing personal against you, but with that statement, you're basically demonstrating that you are really ignorant. Care to expound?

Some (but definitely not all) hospitals will indeed take a rehabilitative approach to nurses who divert for the first time. Not everyone loses their job. Usually management wants to see the nurse has gotten treatment for their addiction, is in an assistance program, and basically demonstrates that they are trying to do the right thing after having been confronted.

However, it puts management in a harder position to do that when everyone on the unit knows about the diversion and starts talking about it. Not sure what's hard for you to understand.

And in your (admittedly unusual) mind, where is the commitment to keeping patients safe? To put patient care first above all?

Putting management in a "harder position" should be the least concern of anyone involved.

[RNdynamic]

Nurses have a DUTY to report. Not protect. OP is is legally bound to do so and needs to report ASAP. OP is smart.. be like OP.

Do you have a statute you can point to that states nurses have a duty to report drug diversion? May we see it?

In general, state law does not hold nurses responsible for ratting out diversion. Your own employer's policies may vary. Rather, institutions are often required to submit a report to the state for suspected diversion following an internal investigation, not nurses. It helps to know what you are talking about, instead of spewing out a bunch of boo-hooray like "Nurses have a DUTY blah blah blah dgnsdfklgnjsdlkgads."

[Emergent, RN]

Do you have a statute you can point to that states nurses have a duty to report drug diversion? May we see it?

In general, state law does not hold nurses responsible for ratting out diversion. Your own employer's policies may vary. Rather, institutions are often required to submit a report to the state for suspected diversion following an internal investigation, not nurses. It helps to know what you are talking about, instead of spewing out a bunch of boo-hooray like "Nurses have a DUTY blah blah blah dgnsdfklgnjsdlkgads."

I know for a fact my hospital mandates reporting theft. Diverting is stealing