Drug Diversion in Nursing

One of the most serious challenges in the occupation of nursing is resisting the lure of addiction. But with the sheer availability of narcotics and opiods in nursing occupations, it is the casual use of pilfered ( and very strong,) pharmaceuticals that can springboard casual abuse into an unhealthy drug habit. Mood elevation and stress relief by the pill method can begin a nurse’s journay to drug dependency.
In the dark bolgia of drug addiction, factors such as affording drugs and the need to go to work can often prevent an overdose in the making. But in the case of career nurses, attendance, daily habits and the nursing lifestyle can feed a habit. Nurse may see evidence that another nurse is stealing meda, and using patient medications, without understanding what these behaviors mean.
Other nurses may shrug off strange behavior and mood swings that occur while otheers aee them doing unsupervised med pass duty. Nurses may not realize that state discipline records for regulatory infractions will follow them around their entire career.
Ideally nurses are caught and disciplined by management for incidents of drug diversions. But where oversight is slack and cost-cutting eradicates supervision, some nurses will slide down a slippery slope. If a nurse commits one act of drug diversion anf getsv away with it, they are likely to do it again.
Usually the casual abuser or recreational user of drugs stops short of a worsening a habit through exhausting their resources. But all a nurse has to do to feed their habit is to go to work. This fact doesn’t even begin to be able to address the difficulties that drug diversion makes for the patient.
People might expect nurses to know better. But when the only thing between a nurse and a drug overdose is a thinly spread staff and an unlocked medicine cart, problems will occur. Sometimes the nurses doing the drug diversion are on too-friendly terms with the individuals doing the closed circuit camera scrutiny
And many nurses fall victim to addiction by the dint of by having immediate access to powerful and clinically addictive nedications. Because the world of nursing is suffused with tasks consisting of interactions handling drugs. The temptation is impossible to ignore.
Once a drug habit forms, superhuman strength can’t make it stop
And nurses are only human.
About 80% of theft in retail or service professions is estimated to be internal. As value-based medical service models replace community benefit models, facilities that dispense drugs to patients become part of those crime statistics.
While police officers do not patrol nursing corridors and hospital wards, the goods are much more stringently restricted than folded sweaters or designer handbags. Electronic handprints and punch codes for med cart access cannot eliminate instances of drug diversion. Rather, unsupervised access to schedule one and two drugs such as narcotics enables any nurse to abuse their pharmaceutical access. Each nurse can elect not to exercise discretion in palming this or that pill or stealing an unwanted drug dosage.
Technical specifications and licensed nurse training are designed to prevent the mishandling of drugs and pills. But medications in the dosage sizes given to patients are usually a tiny pill or two. These are so small that drug diversion is not physically difficult. Such pills can be concealed in the mouth, hand, fingers, pocket, or even a hairband or cellphone cover.
Many nurses feel insulated from the threat of detection or capture due to the small community or office space that nurses inhabit. Nurses who filch medication from patient dosages may feel that the presence of other nurses in a small staff or closed community discounts the risk of getting caught.
There is an old saying that “familiarity breeds contempt.” Familiarity with the nursing homr or hospital workplace may orient a nurse to oversight shortcomings. Daily nurse work can bring forth feelings of antagonism against patients and causr anger and aggression against the facility owners or operators.
The angle of security cameras and the known infrequency of the facility to review the security footage may encourage drug diversion. Also, in a facility where narcotic record keeping MAR fidelity is poor, certain nurses may exploit these circumstances to pilfer patient medications.
In the nursing world, theft of drugs from patient dosages is called “drug diversion”. This practice indicates by its name how nurses behave as if they are following routine med passes. Drug diversion usually occurs in a busy hospital or care facility where oversight responsibilties are routinely overlooked.
Three case studies below illustrate how nurses can exploit vulnerabilities in hospital and long term care facility. But it is not only medical institutions that must be wary for drug diversion. Home health nurses operate in an environment even more probable to experience drug diversiin. The isolation and probable unlikelihood of detection creates a temptation some nurses may not be able to resist.

The legal liabilities that any nurse opens themselves up to, when caught committing drug diversion, are significant. The legal problems such nurses may create for a hospital group or long term care facility management corporation may be career-ending lawsuits.
Not every nurse steals medication. Some nurses are so wary of falling prey to drug use and drug diversion temptations that they make sure to dispense medications under closed circuit cameras and in the presence of another person or a group of nurses. But drug addicts are prone to secrecy and stealth to support their habit.
The possibility is also very high that some nurses are using employment in long term care facilities as a means to skim narcotics from their routine pharmaceutical distribution. If a nurse has a predisposition to emotional problems, job stress, or drug addiction, they may seek out second-rate facilities where security and supervision are slight.
(see the following article for case studies in Drug Diversion).

The Changing Vision of Nursing

†Today nurses face challenges in the nursing world their predecessors never did. The slightest mistake can end up on YouTube. A crotchety patient might become a vexatious litigant. And worst of all, you could make a career ending mistake.

Newly licensed LVN nurses and RN nurses can safeguard their careers by following the best practices of their facility and the standard operating procedure of conventional nurses.For nurses to stay ethical and keep their noses clean, vigilance and propriety are necessary.

Good manners toward patients is the best practice. But for peers and other staff as well. Managers can appreciate the benefit of a new hire who is a good example. The spectrum of nursing careers can always include a nurse who is polished,perfect, and professional.

The stereotype of s nurse can be from a TV show or from examples people see over time. A paunchy, chain-smoking nurse tapping away at their phone is dividing their attention span before they clock in. The oversexed stereotype nurses who spends most of heir time socializing will often end up the subject of complaints.And nurses given supervisory roles when their performance is substandard will always suggest unfounded favorirism.

Additionally, nurses can look for good ways to stay motivated and meet personal goals. The stability that a career in nursing can offer provides financial security, as well as a few “chicken soup for the soul” experiences.These are often priceless insights into the human condition.

The payoffs of a career in nursing can be concrete and financial in nature or they can be as abstruse as angels dancing on the head of a pin.But each nursing professional needs to decide for themselves where monetary goals stop and vocational goals begin.

Many nurses find their vocation in helping people. Others ate looking for a way to migrate to another career, such as teaching or business. But the toll that care giving occupations take is becoming more difficult to ignore. Statistics on addiction, drug abuse, Petty crime and white-collar crime in the field of nursing is a well kept secret. Nurses often admit to feeding an addiction while on the job. Nurses fight smoking habits made deadly by their sheer casualness masking a dependence. Nurses can have delayed reactions to many of the experiences by they see and encounter PTSD later.

And some nurses worry about if there will be a nursing field in the future. Technical issues are turning the field of medicine into an adjunct of the insurance industry. How much nursing benefit can decades of dialysis provide? How can pacemakers and stints and implants improve the quality of life?

Decisions are being made every day to extend and lengthen life using equipment and materials foreign to the body’s natural makeup. The safety and longevity of many of these methods requires backups of conventional nurses to oversee and treat complex medical conditions.

This type of scientific leap forward will always need development and monitoring by medical professionals. And as long as people age and have health crises, a nurse ( or several hundred thousand) will be needed. Therefore the future of any nursing career is wide open.

 

The Nurse’s First Day of Work

The first day of work as a nurse introduces a new student nurse or newly licensed nurse to the complex world of professional nursing. Occupational nursing, working for a living in the field of nursing and medical care, is a different challenge than merely answering test questions and performing nursing tasks for a limited number of patients and cases in a minute capsule of time. Putting on a show for a teacher or clinical preceptor is not as tiring as doing nursing tasks all day for inconsiderate or indifferent patients.

For new nurses, all too soon, after their first day, the workday becomes a repetitive chain of days that some new nurses find daunting. Nursing school wasn’t this much work!
Practical experience is what makes the most difference, in career nursing, because people are behaviorally trained to do what they have done before. Therefore, a nurse is best qualified who has done the same thing, medically speaking, for patients, over and over again.

Volunteer nursing experience and even intern duty at clinics can count. A nurse seeking work will want to demonstrate the most diverse and complete work history they can. The most complete medical knowledge level, and the most important skills are the accomplishments that nursing facilities and hospitals look for. A nursing home or hospital ward has enough of one thing, they are looking to fill a gap in skills, time schedule, or bedside manner.
A nurse coming into their first shift or first week of work, must understand that they are now the question “answerers” than the question-askers. people depend on them not only to do the right thing, but to say the right thing, and write the right thing in the chart. Nurses should get the knack early of writing vitals details of patients on little memo books or remembering case details all the way to the end of the shifts when it comes time to chart the patient responses. Keeping track of several different projects a day, even per patient, is a norm that new nurses must acclimatize themselves to. No nursing day on the job will be the same.

The new nurse should take in the data and treatment information they are given. Follow a single patient until you learn their medication schedule and care approaches. Nurses should use this time to observe all the things they can’t know from a patient’s medical chart, such as patient personality, manner, typical responses to questions.

The new nurse should show a minimum of argumentativeness, resistance to the process, or possession of too much superior work knowledge. The new nurse should understand that all the nurses she or he is working with have all gone through the process of getting to know the workplace and getting to know the patients and the staff procedures.

A new nurse should be watchful or ways they can improve on present nurse performers. The facility has hired new staff for a reason. Either they have worked the present staff to death, or you many nursing personnel have left. Local hiring pools give rise to dips and valleys in talent, and nurses may be working other jobs and not be available for all the shifts they are scheduled to work. The new nurse should make it look as attractive as possible for the facility to schedule them as much as possible.

The myth of a “nursing shortage” has come about for a reason. The fact is, nursing work weeks are set up to give nurses a break between long and arduous shifts. The anxiety and stamina that takes its toll on a nurse during the work week needs to fade away. A nurse needs time, sleep, and relaxation to unwind. The biggest advantage that a new nurse can bring to the table is their youth. The fact is, new nurses with strength and stamina to withstand long shifts of repetitive tasks and minute details are in demand. These nurses don’t come around every day. The best nurses get snapped up.

But the mistake most new and experienced nurses make is to try and fill all of their time with the most number of shifts. And nursing directors know that a nursing job candidate may not be as frank about their availability as they would want. The result is a kaleidoscope of co-workers instead of a reliable schedule of teammates.

A nurse should not assume another nurse will always be there to do a certain tasks or them or deal with a certain patient so they won’t have to. So, nurses cannot rely on a close set of friends on any nursing staff to function as a crutch. Social niceties like chatting, telling stories, or having lunch together should come second to attending call light systems and patient monitoring. A new nurse should be able to perform their duties no matter who is supervisor or charge nurse per shift. Long-term care can often be lonely and hard.

The hiring manager for a long term care facility or nursing home is trying to improve services to the public at all times. It is for them to review your skill set and decide how many nursing hours you can handle. Overworked nurses get sick, lose retention, and have mood swings. Often, nurses have second jobs whose work shifts do not complement well with the ‘primary” work assignment. For the respect of your nursing co-workers, try reporting your availability as honestly as possible. And don’t make a habit of coming late and missing the endorsement handoff.
The new nurse should treat the first day at work as the first day of the rest of their career. This is the last day their time is all their own. The patients now come first. The first time a new nurse punches in the time clock, all their focus and attention should be on patient directives and medical care objectives. From this beginning time onward, the nurse’s hands and mind are there to function for the good of the patient. This is the vocation of a career occupational nurse. Anything less of a commitment lacks the merit of a fully dedicated professional nurse.

Looking For a Nursing Job

Looking for a nursing job involves really evaluating your own personal job strengths. Applying at the same places as your friends or peers doesn’t always work. Working from newspaper ads only ads you into the mix with a huge bank of competitors. Occupational employment in nursing is an ongoing challenge for even the most senior and highly paid RN and LVN workers. Building  a lifetime network of people to consult and exchange information with about job opportunities and local trends starts now. A decade from now these will be peers working in places with new openings or new departments.

One strategy is to apply for weekend or part-time work at a long term acute care facility or long term care facility, to put some nursing hours and experience on your resume, without burning out from a heavy schedule and the stress of a full time work week. Limited interaction with key players can allow a new nurse to learn the job responsibilities without getting caught up in the vortex of a facility or nursing institution out of step with the nursing world at large. By limiting the scheduling availability, a nurse can allow for ongoing interviews during their off-hours in the full-time nursing employment space.

The first job of a nurse should be to absorb as many skills and workplace nursing abilities as possible. Making the transition from nursing student to nursing employee is not always as easy as the textbooks would suggest. The nurse candidate may interview with a Director of Nursing, or Human Resources Director, who has little or no idea what terms and in actual nursing job for an average shift is really like. The job description may not tell the whole story in a nursing position. Only the training preceptor can get a feel for what the new nurse is actually capable of doing.

Working part-time to start allows a nurse more time to evaluate if a new working environment is right for them. It takes time for a new nurse or new nursing school graduate to understand which parts of the working environment are fixed and which can be changed with experience and skill improvement. And the gradual build-up of skills and orientation will length the learning curve and leave a new nurse less likely to be overwhelmed. Thus a nurse can investigate what a facility or nursing department is like before committing to full-time availability.

A part- time schedule can allow you to burn in to a new place and absorb their rules and standard operating procedure, without trying to perform a full week of work at the same time. This kind of stress can affect how you learn all a facility’s rules and how you interact with all the staff. instead of burning bridges by becoming a moving target, start slow and begin to learn the ways of a new place slowly. interaction wit staff can remain minimal, so as not to get involved with any personality conflicts.

Part-time work generally begins with assignment of a preceptor. Today, nursing people call this “shadowing” a worker to learn their job. Nurses need to learn their preceptor’s ideas and functions before allowing a full time work schedule to break down the lessons and training. And sometimes a preceptor may not “fill in the blanks” as well as they should. But a part-time nurse can observe others at a nursing department and long term care facility and select whom they want to imitate in practice.

If a new part-time nurse blends in with the group and adheres to the institution’s policies and procedures, the director of nurses or nursing supervisors will schedule the candidate in for more hours and shifts. This is a good time to set limits for the availability. A nursing employer will not always respect the availability limits a nurse gives, and this is the best time to set the rules in stone. The ongoing battle for a nursing supervisor to staff the facility fully must co-exist with respect for a working staff of nurses and their need to rest and conduct their life in the off-hours.

The nursing job search includes a lot of phone calls, a lot of emails, and a lot of application forms. Job fairs and newspaper sections for jobs available aren’t always going to be the pathway to the best jobs. Many nursing homes and long term care facilities don’t have time to post individual job ads, and don’t have the staffing to vet the responses. If there is an area you want to work in, or a specific place you want to work, walk in and directly submit your application. By bringing your resume, three letters for character reference and your nursing school transcript , you will complete the application without the staffer having to do any work. The nursing supervisor or the director of nurses may decide to do an interview right then and there, and keep your application on file.

Newly minted nurses can’t always rely on the people at the other end of the line understanding nursing terms, medical courses, and departmental specialties. Many recruiting firms now do a lot of the screening for key posts. It’s best to get your dates and information about past work places straight, in the format of a general work application, because you’ll be filling them out almost constantly. Make sure your version of these events remains consistent, and be sure to have at least three character references from business and personal life at all times. If you feel that your contacts are being mined for marketing purposes, mark them “available upon request”.

If you feel your work experience is thin, write a cover letter describing your strengths on the job.  Talk about your individual abilities that make you unique to the nursing desk, hospital department, or long term care facility floor. Keep a list of the agencies, companies, nursing homes, and facilities you have applied to. You may want to look for older positions advertised or wait for another cycle or hiring to begin. Some larger companies wait and restart a cycle of interviews and training at the beginning of the first quarter and second , certainly not at year-end. if you are flexible to moving to begin a work assignment, say so on your voice mail message or the last sentence of your cover letter.

 

 

 

When Nurse Training Makes a Difference

Nurse qualification by degree is a choice each nursing student must make. Many nursing curricula organize the classes by degree goal. A bachelor’s nursing degree will set up a nurse candidate for positions of greater prestige and greater longevity. But nurses intent on long term career longevity can groom higher aspirations by achieving higher benchmarks from the outset. Institutions looking to recruit nurses with bachelor’s degrees can expect more fluid patient response’ and more intelligent care plan response.

There has been a significant blurring of the lines between candidates who have achieved an assistant of science in nursing and a bachelor’s degree in nursing. The ability to operate at a higher technical level is what some institutions need. The breakout requirement in the performance capacity is what a health care facility depends on when wards fill up with heavy need patients. These caliber professional performance levels are what hiring managers look for when screening applicants.

Nurses should not put patients into panic mode. A professional attiude is key. They should do everything the can to secure the patient from any feelings of pressure, worry, or discomfort. By charting interactions and vitals, nurses begin to document the case. A care plan for the patient’s outlook is indicated as noted in the charts. For follow up, nurses then can refer back to these notes. Progressively senior nurses should be able to handle multiple patients per shift managing these dynamics.A thorough knowledge of resident care plans encourages the nurse on duty or med nurse to interact with the patient in a beneficial way.

But all too often the hospital wards or long term care floors are filled with anxious and confused patients who have been left to sit or lie down for hours or even days without clarification or proper addressing of certain problems. Patients who feel ignored by their nurses will file complaints and tell visitors their nurses are slacking off. Senior nurse staff should make sure these patients do not feel “lost in the mix”. Inexperienced nurses might be able to miss certain details but peer nurses and managers will notice and hear about patients who have been left by the wayside.

A nurse knew to the facility might miss important cues. Sometimes this can be too late. Hidden bruises, unusual lesions, draining ulcers, and stiff or numb extremities must be noted. Is the color worsening? Is the affected area becoming larger? A nurse should watch the way a patient walks around or gets up from the bed, transfer to the wheelchair or toileting apparatus.

The physician must be notified and the Change of Condition filed in the patient’s medical chart. Nurses need to keep a weather eye on patients who may hide their symptoms. Patients who fear their treatment due to pain or physical discomfort will take their bead from nurses. If the nurse comes off as too busy or distracted they may drop or suppress medications, palm them, even mix them up. This is fraud. Nurse cannot depend on patients to put them straight. Hyper-adrenalyzed patients can collect the medications and trade or sell them on the street.

Sufficiently trained nurses will watch their patients consume all ordered narcotics and medications and closely observe their effects. A professional nurse does not leave unconsumed medications at the bedside or anywhere near a patient without witnessing their intake. For example, a patient consuming multiple painkillers should display drowsiness and lethargy. Trained nurses should take away patient’s own medication. Patients undergoing narcotic and other pathologies of medical care will lose track of what personal medications they may take, confusing displayed symptoms.

On the job training and experience will progressively groom a nurse to deal with such patients.. Sometimes another nurse may be more effective for caretaking goals. Patients may hide problems and nurses can only tell by examination and assessment what is going wrong. progressively trained nurses should be able to observe changes in hygiene, outlook, and mental condition. Perfectly normal patients sitting in a room all day can turn manic after induction of medications and excitement.

Nurses who are properly trained can skip over important details in haste. So when re-checking patient conditions and vital statistics over time nurses can catch a problem with a patient or even a machine. Nurses can pick upon failure in machines or other technical problems only with usage experience on patients and issuing of improper results. If a nurse is trained to assess both the patient condition and the readings, they may simply report inadequate readings.

The patient then has inappropriate and inaccurate readings reported to the physician and to their chart. This can really impact negatively the care plan for that patient. Nurses assigned to different patients in the same room cannot pick up the slack. They sometimes may switch working machines for technically unproductive machines without the nurse’ knowledge. The timing of dealing with these machines may be more than the nurses can handle.

Therefore a properly trained nurse is required for patient care because they can determine the difference between a technically accurate vitals reading from an erroneous one. But only highly trained nurses capable of independent thought processes and independent decision making can achieve these top notes of nurse duty performance. Otherwise patients suffer in silence. And supervisors wonder why their feedback card ratings are declining.

Later, when the nurses determine a problem with the machine, they will need to retake those readings and then commit them to the patent’s chart. This can make a window of doubt into the patient’s care because these missing readings are not present in the records. This prevents a physician from following the path of a treatment plan or set of medications results. The pathology of this error may be lost but it has a negative impact on a patient.

But how will they know? This is just one of many problems that occur during a busy shift and may not even be detected until the next shift when nurses begin their vitals readings on rounds. This can be hours into the next shift, creating problems for every patient’s care plan. The regression backwards over time affects different patients in varying ways. For every patient struggling with mood disorders, over-medication, untreated pain, burgeoning infections, and multiple organ failure, the gap in sloppy nursing allows a documentation blindness.

Nurses at the desk will discuss various cases and verbally update each other with observations. This patient is sick. That one is still coughing. This one isn’t sleeping so well. That one is not walking straight. This way nurse bounce the patient symptoms off each other, reporting and seeing what other nurses think at the same time. Without such communications, there is a temptation to ignore the problem or conceal it. A more professional nurse grooms her co-workers to recognise a problem and deal with it.

The other detriment of such practices is to the entire nursing ward or health care facility. Healthcare systems and HMO businesses are the most stringently planned budgets in the world today. The patient stay in the hospital becomes longer because problems in the care plan need to be changed and the patient stay extended. These costs can add up and change the health care approach of an entire facility. These are the far reaching consequences of poorly trained nurses.

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