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).

When Nurse Training Fails

Nurses lacking training dealing with general population, the public by phone, patients specifically and staff can lose their performance rating or even their jobs by letting their “slips show”. There are some examples where proper training, research and learning might have saved the day. In many cases the motivation for a patient to care for themselves and look forward to recovery can be affected. Assertive nurse supervisors may care to review the following real-life scenarios.

1. Proper Device Maintenance

Recently a patient approached the ward office and asked for a blood sugar reading. But the patient was made to wait 45 minutes while the lost battery to operate the device was found. But it was never found. A line formed in the nursing area while the incompetent nurse floundered around asking other nurses what to do. The nurse responsible could not make the blood sugar machine work because they did not know what a “C” battery looked like. This is evidence of lack of training.

They didn’t know how to replace the battery. They didn’t know how to find a new “C” battery, replace it in the device, and return it to the ward counter. The patient stood there in shock. No other nurse could do it either. The blood sugar count machine, the reason for their admission actually, was never derived upon discharge because the nurses were not sufficiently trained to replace a required battery in a critical piece of hospital equipment used on the recorded vitals for every single patient on the ward.

True Story. They couldn’t find the key to the room with the battery in it. The nurse went twice to the room but could not identify the correct battery. The nurse got bored attending to the task and went off to do something else..

Now, imagine you are the patient. Is this chronic ineptitude at a crucial moment? Poor nurse training or laziness? Or merely habitual inattention to detail that costs a patient time and energy? These things matter. Proper nurse training is a needed element for contemporary hospital care that patients need.

2. Backing Up New Admissions

Emergency rooms all over the nation are overfilled. This is due to administrative shortfalls in overall hospital design and throughput which cannot be addressed fully in this arena. Yet the only route almost all patients have is through the Emergency Room, and through general care and primary care admissions to the a hospital or wards. Nurses must process these admissions. Nurse without proper training and support to do the best job possible do a disservice both to themselves and others.

Unprofessional nurses stave off new admissions because they are lazy and do not want the additional responsibility. When an administrator calls the ward to see if they can accept a new admission, the charge nurse must assess the condition of the wing. Poorly conditioned equipment and nurses creating patient/nurse disputes put their ward at risk for lowered ratio caregiving and lost hours. Supervisors tend to assign less effective, poorly trained nurses fewer hours and shifts,

The admission process involves a careful review of all needed medications and the programmed timing of each. Patients who are admitted are dependent on the nurses to fulfill their medical needs via pharmaceuticals in a capsule. Therefore as time passes, properly trained nurses are on a time clock from the moment a new admission is announced. Better trained nurses address their patient admission tasks promptly. Poorly trained nurses go smoke cigarettes and delay patient tasks as long as they can.

Nurses must submit the medicine orders for each patient in time for them to be administered to the patient on time. The patient may not have any other medications on them and be in pain or distress without this assistance. But the attending or resident physicians may not be the same primary care physicians familiar to the case. And many of the medications the patient needs require physician approval due to their qualities and restrictions(narcotics). Sitting on these orders and coordinating poorly with the pharmacy is a sign of poor nurse training.

In the incidence of the above example, a nurse the ward had tasked with restoring batteries to the devices on the ward was never completed. This had not been done overnight on the night shift. (We’ll call her Sue). When the new nursing shift came in for duty, all of their patient vital statistics recording were delayed until the battery issue could be addressed. This extended hours of all the nurses on shift, a further cost of inadequate nurse training.

This was not part of the nursing handoff report because it did nt accord to any patient records. But many blood sugar readings were not tracked because the machines were not working. The nurses (though their ineptitude) made sure that enough machines were offline to delay any incoming admissions. This would give them a break between new admissions and handling current patient cases.

3. Patient Baiting

The removing any standard of case with or without ward notice constitutes patient baiting. Since the onus of treatment ends when a patent discharges themselves, malicious nurses or simple even careless ones can harass a patient into leaving by providing care that is substandard enough to make a patient believe they are better off out of a hospital or doctor’s care.

Patient Baiting takes place largely while doctors and physicians are out of circulation. Since the current staffing model of any healthcare facility is spread so thin doctors are rarely hanging around, the patient can be long gone before the physician has noticed there is any problem. Since an onsite nursing administration faculty is prone to covering up the problem, only the patient loses.

Except in this era of online reporting, increased institutional oversight, and streamlined problem solving, a nurse’s performance may come up for review. Nurses cannot pick and chose which patients they want to be nice to, or respond to handsome or pretty people in preference to others. Nurse training should orient the caregiver to apply best nursing practices and standards to every patient, not just the “favorites”.

If two nurses, (Let’s call them Cynthia and Neemar), decide not to administer standard care to a patient and make them all a doctor or come to the nurse’s managerial wing to address problems, they have been guilty of patient baiting. It speaks to the poor training of a shift charge nurse that they let this happen. This drains nurse power because the attention of other nurses and the supervisory staff is distracted from care issues.

But this places more of a burden on other nurses, who must make up the shortfall if the charge nurse assigns them to the patient or if the patient is moved to a new wing. The time and energy this drains from other personnel can never be repaired.

4. IV Maintenance

Intravenous therapy was invented to deliver treatment to the vein. The IV machine is now used for everything from infection to hydration. The care treatment plan for any patient now requires in almost every state an IV plug/PICC line so at any time emergency administration of fluids or other medicine can be transmitted this way.

An IV machine placed in a patient room is under the operation of the nurse at all times. Visitors, patients, and family members must be made to know this. Dehydration drips are administered for patients even not under the care plan because changes in their condition may require it. Nurses who are poorly trained cannot handle the responsibility of checking the IV line periodically so that shifts in patient arm or hand positioning may change its effectiveness. Properly trained nurses will instruct patients how to rest their arms and hands so as to not disturb medical product distribution.

The administration of an IV line is the charge nurse’s alone. If the nurse observes a technical problem with the device, they should report it or exchange for a properly working one. There variable settings for IV usage that a nurse should be trained to use. In nursing practice, where patients are lodged more than one to a room, the noise should be kept to a minimum to afford proper rest for others.

Alarms on an IV machine go off when the power is disconnected or battery winds down, or the treatment product runs its course. The alarm setting on an IV machine is usually denoted by a small bell, which should be set to “off”. IV fluids can run concurrently. Set an alarm for when it will finish!

But when a machine is not running properly the noises and alarms can buzz in an annoying manner and create a need for the nurse to constantly return to the same room. Setting one or all of the medications to “Gravity drip” can assist in providing rest for all the patients in the room and reduce the need for technical review of the equipment through the night.

5. Inability to Admit/Report a Mistake

If a nurse notices they have made an error or committed a breach of institutional or care treatment policy, their best practice to to report it or advise a supervisor who can take action. Patients can report this to nursing administration. Simple mistakes can be rectified by peers if necessary. More important errors concerning medications, treatment, or patient interaction can be addressed by a supervisor. Without this accountability nurses should think of working in other professions.

 

What 4 Medical Skills Make You a Better Nursing Hire?

Occupational employees such as nurses should always keep an eye on the basic skills that make up the daily round of nursing tasks. The quality of how well a nurse or nursing student performs these skills can make their grades or wages rise. In nursing school, many is the time a student nurse can excel in all the academic book work, but the practical shortcomings of real-time nursing performance matter much more. Because patient-centric nursing must be perfect the first time around.
Here are four nursing skills that will make you a more marketable nurse. By rehearsing these skills while in nursing school and using peer guidance and skills review while on-the-job, any nurse can shore up the gaps in his or her work skills. Immediately after improving these nursing skills and demonstrating competence, any job candidate or nursing student becomes the best prospect for a new hire or promotion. For working nurses, this means additional hours on staff or a better rate of pay. Progressive improvement of these skills will allow any nurse to be considered as a medical skills trainer, or as a nursing supervisor or senior charge nurse.
1. Needle Skills
Every nurse gets a basic training in practical skills using needles. Are you good with a needle? Nurses have been improving technical skills with needles over the course of their careers, but the best nursing students will concentrate on administering medications with needles and leaving the patient with the least amount of distress, bruising, and needle point skin tears. A hospital or facility trusts every nurse, RN or LVN, with needles. Medical and nursing facilities must be assured any nurse can work with a needle efficiently on patients, without supervision. Protocols for sharps accidents and blood-born disease control are very severely controlled.
Patients everywhere need nurses who can perform needle injections with a minimum of pain, fuss, and after-puncture bruising. Needle skills and sharps handling is important for hospital wards, log term care floors, and clinic rooms. Many systems of portable pharmaceuticals depend on steady hands and precision administration of individual dosages. Sharps treatment include disposal and sterile storage, as well as delivering medication without unnecessary skin breakage, administration site pain, and resulting needle marks or bruises.
2. Wound Care Skills
Many patients with chronic and acute conditions involve wound care and skin based dressing treatments. Administering wound care means following physician orders, working with the patient, and completing the application of medication and bandages and wrapping in a time-sensitive manner. Some wounds such a pressure sores and ulcers are chronic. Some wounds are acute, and center around conditions that involve infection, surgical recovery, and/or peritoneal dialysis tube insertion sites.
Wound care generally involves preventing infection and utilizing medications and medical supplies to prevent spread of material, decaying skin cells, bacteria, and debridement matter from contact with open wounds, skin tears, or other breaks in the skin. The skin is the body’s largest organ, and often overlooked with respect to its ability to affect overall patient well-being and health. Patients need skilled nurses adept in good wound care. Managing wound care, in sum, means nurses reducing the infection risk and optimizing a patient’s overall chance of recovery.
3. Dialysis Skills
Inserting procedure tubes near the peritoneum and administering dialysis treatments is a marketable skill. Nearly two thirds of all long-term care patients are elderly and dependent on dialysis treatment on a weekly or daily basis. Ambulance fees and transportation logistics make this a nightmare for nursing desks and facilities, not to mention home health patients.
Independence from doctor’s appointments is the dream of every patient. A nurse that can reduce a patient’s schedule y two or three visits a week is a smart hire. The nurse that can administer the dialysis wire, tubes and machinery, as well as funnel a pleasant bedside manner with patients, can be a breadwinner for any medical nursing company or healthcare organization.
4. Admission Skills
Every nurse needs to periodically review their patient charts and submit shift changes in condition, as well as the ritual licensed nurse progress notes for each patient. but progressive experience at any desk means facing the responsibilities of an admission. Whether a patient is returning to the hospital ward, facility, or a new admission, the nurse involves need to be on point for every detail of patient admission processing
The admission nurse must advise the staff that a new bed is being filled; the placement managers will advise the ward or floor that a patient is being admitted and where they are going. It is the nurse’s responsibility to immediately advise the housekeeping staff about the bed, linens, and bed rails and/or bedside equipment required. The admission nurse must take the endorsement from the discharging facility and record and advise the incoming staff concerning all variances in treatment and nursing care the new patient requires.
The admission nurse must review the documents and make sure everything is in order for the next shift’s nursing medicine nurses to follow up and distribute medications. A chart for the patient must be made and the sections and document blanks put in. The nursing assistants must be briefed about that new patient’s special needs. The medications of the new patient must be conveyed to the facility or hospital pharmacy. Any contraindications or conflicts in treatment orders or medications with the patient’s stated condition list and MDS report must be resolved before time of admission.
These admission tasks must be done while ringing phones, audio speak announcements, patient vocalizations, and other distractions are occurring. Coordination with ambulance staff, as well as directing the paramedics to which room and section of the facility to place the patient in, is necessary. Lastly, the admitting nurse must assign a nurse or staff member to orient the patient and/or the family. Communication of Resident’s Rights and facility policy is then performed. Only then can the nurse report to the Director of Nursing, detail the notes in the patient’s chart, and tell the supervisor that admission has been efficiently finished.