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).

Dealing With the “Toxic Patient”

New nurses just out of nursing school can be somewhat shocked by the challenges presented by “problem children” in the patient census. While every patient may have the expectation of the full range of services and care a nursing home or hospital provides, some patients do overtax the staff to an unusual degree. It is the facility’s choice whether or not to continue offering care to these patients. But nurses should not ignore symptoms and condition risks, no matter what hullabaloo the patient causes.
What is meant by the “Toxic Patient?”
The “toxic patient” is patient who experiences limited medical problems but exhibits uncontrolled outbursts, exaggerated symptoms, and conducts themselves in an annoying and distracting manner much too much of the time. They can make life miserable for other patients, room mates, visitors, and staff at every level. If one or more exist in any floor or ward, chaos can ensure at any moment in any shift. Important charting, endorsement reporting, or assessment activities can be interrupted. Nurses and CNA workers can start to call in sick to avoid shifts that have become too much work to handle.
The Burden of a “Toxic Patient” on a Hospital or Facility
The burden of a ‘toxic patient” can creep up. Dementia can play a role. If the patient’s aim to is to disrupt or annoy, they may simply escalate behavior on an ongoing basis. Finding out just when the patient will go too far is an ugly surprise. Tension and irritation can build. Nursing supervisors may acknowledge the problem, but depend on a full shift of nurses to cope. Then, nurses start calling in sick at the last moment, and the nurses that do report for work have their hands full. Administrators can experience headaches when the housekeeping staff, nursing staff, and dietary staff start stressing out and run in circles trying to please the “toxic patient”.
Facility Requirements for Toxic Patients
Such patients can require a hospital to engage additional staff just for that one patient. Monitoring one patient is not a cost-effective way to staff a hospital or nursing home, and these costs invariably end up as part of the overall assessment for the care plan of that patient. if no improvement is within view, and no intervention will work, a stalemate occurs between the duty of care and the real-time potential of the facility. Their duty of care commits them to deliver ongoing environmental nursing care, but the pushback from nurses and patients create s a firestorm.
Student nursing textbooks cannot illustrate the challenge of a dealing with a “toxic patient” while balancing the needs of an entire floor or ward of other patients, as well as dealing with the pharmacy, running IV lines, performing dialysis, charting nursing progress notes, and tracking medicine counts. “Toxic patients” have little to no curb on their behavior, choose consistently to break accepted facility or social barriers, and insistently pester nurses and other persons within the hospital or nursing home. Such a patient is completely beyond a home health situation. The patient community of a facility or hospital can be altered negatively just by inclusion of the “toxic patient” in group patient activities.
The “toxic patient” also disrupts the well-being of other patients. On this basis, they become a liability of any facility, because they stretch the resources at any given time constantly enough to cheat other patients of their allotted times with nurses or staff. generally speaking, a “toxic patient” can absorb 9/10 of a nurse’s spare time per shift. And when this demand overlaps the allotted time for any other patient, this “toxic” individual becomes liability to other patients as well. On this basis, patients can be liable for discharge or transfer if they become too irksome a burden to staff and other patients.
The “toxic patient” is one who refuses to heed warnings or “hints’ from the institutional staff. Such behavior is charted and discussed in the care plan meetings. Often a nursing home or long term care facility will meet with the patient, guardian, family or conservator to discuss such behavioral problems, often a psychiatric consult is advised. Yet the family or the conservator of this patient may refuse this. The social stigma maybe overwhelming for the family, and the impress upon physicians to limit psychiatric intervention may weigh heavily. The times leading up to any resolution are seriously taxing for any nurse. There is only so much a place can “suck up’.
But often, even when a patient has a long history of transgressing beyond patient norms, neither medication nor physical restraints are present or advised. Either the family members are in denial, or the physician does not have an accurate assessment of the case. It is important to complete incident reports and contact supervisors when such behavior occurs. Furthermore, sometimes a nurse may have to decide for themselves when it is a good time to call the physician (or social worker) and advise him of the seriousness of the patient’s aberrant behavior.

Circumstances will arise in which a nurse or nurses will look back and wish very much that they had used all their observational skills and cited occurrences involving the “toxic patient”.