Nursing Career a Predictor of Depression?

What does current research tell us about depression, nursing work performance, and occupational health conditions? That the indicators are present of workplace burnout, PTSD, common mental disorders,  and weight gain from occupational nursing stress. Studies conducted by Weller, et. all., (2008), Peterson et all, (2008), Jolivet et al., (2010),  HS Lin, (2010), Greiger, (2007), Dillman, (1987), Welsh, (2009) , and more have contributed specific research to the body of knowledge surrounding nursing careers, job stress,  and depression. Colleagues of  Yohai, (1987) , Gartner, (2010), and Langleib (2008), also have conducted research that indicated higher instances of wellness problems from the negative impact of nursing work. The research underscores the key premise of evaluating nursing occupations as a predictor of depression.

Does nursing as a career function as a predictor of depression? This above body of research and its combinant conclusions supports increased review of depression as an occupation covariable of nursing as a work choice. The response of nursing employers, hospital wellness initiators, and occupational nursing consultants should be impacted accordingly.

Nursing requires long hours, pain and suffering, complex pharmaceutical regimens and physician-ordered therapeutic treatments. And that’s just what the patients have to go through! Nurses as occupational workers must study and internalize a great deal of empirical knowledge to perform their jobs. Then they must absorb dozens of personality types, workplace idiosyncracies, and patient preferences. This must be done working long hours with little structured rest and relief.

But as studies show, nurses on the whole pay a price for the stress of their workday responsibilities. Burnout is common.  And employers should pay attention to where their training investment is going. Because almost 80% of the respondents report at least one health problem that impacts work productivity.  More muscular support and improved employer and healthcare schemes for treatment of a signally underreported problem such as this should be immediately complemented by companies via employee outreach.

Participants in the depression studies also reported other signifiers of unhappiness, burnout, and workplace difficulty. Anxiety, sleep problems, medication interventions, errors involving safety and medication indicate a workplace disaster waiting to happen. Wellness, it seems, is a professional responsibility for nurses. But it should be an ethical responsibility from employers toward their nursing workforce.  A large portion of the depressive-skewing group showed problems with obesity, lack of mental well-being, and a marked loss of productivity. These factors directly relate to lessened ability to manage workplace tasks and nursing duties. This is not the “Dark Ages” of pink collar employment anymore. Nursing retention spells better quality of care for patients in every scenario.  But as the research shows, wellness institutions, hospital medical-surgical wards, and global nursing workplaces all show a heightened coefficient of depression, as a nurse’s career lengthens.  And for nurses and nursing employers to (still) sponsor a working environment that promotes medication errors and unnecessary instigation of poor nursing performance is of grievous concern. For the corpus of the population looking to nurses for healthcare, having a depressed nurse doing nursing tasks and performing services for you is an alarming possibility, and yet now a statistical probability.

Nursing institutions themselves can most concretely change the elements causing some of the depressive orientation in nursing occupational experiences. Lessening workplace impairment should be a cooperative goal between all parties. Workers suffering from Depression, reporting health and coping issues, and committing errors are a risk. Nurses at risk for impaired work performance do not make positive role models.The validity of depressive indicators across all samples illustrates a higher demand for employer assistance programs.

High rates of depression can occur in every profession from stockbrokers to firemen. But nurses are the kind of specialized workers that should know enough to recognise stress and intervene before formal depression takes hold. And healthcare managers are far from immune to depression either. According to Welsh’s study of 150 nurses, the estimated prevalence rate for major depression is above 20%. Job satisfaction and burnout are also reported, but experts theorize that much more internalized stress is simmering under the surface.  The etiology of depression and the implications of depressive symptom incidence in nursing employees transcends mere lifestyle and cultural backgrounds.

   Total Depression Score (TDS) is the factor that rates the individual as a participant in the depression-growth dynamic sketched in research literature. Nursing associations throughout the United States actively participate in these studies to prevent growth of occupational difficulty and regression. The gender factor remains somewhat skewed, as an overwhelming share of aging nurses are female. In the North Carolina study, 91%, of the respondents were female. As male populations in nursing occupations changes, more data will be available with more updated research. 

Finding out more about what causes nursing career stress can illuminate the changes necessary to minimize wear and tear on the ‘ candy-striped collar ‘ industry. In a cross -sectional survey performed across 2500 random North Carolina nurse samples, only 47% bothered responding despite a dollar bill being provided! ( The Dillman strategy.) This shows a discomfort present when half of all nurses have to come to grips with how depression is affecting them.

For those considering the nursing profession, statistics and studies exploring depression as a coefficient of occupational nursing have something to say. There is no ” free-ride” in any career. In a nursing career, as studies and depression literature indicate, the cost of interaction and wear and tear of being a nurterer and a caregiver may have hidden social costs. Workplace characteristics play into this trend. The occupational risk of depression in the nursing field co-varies with employment type, age, level of nursing education attained, and communication elements between other nurses at the place of work.

Many of the above research authorities noted obesity as a depressive co-factor, and a synthesis of high BMI and other depressive indicators in stressed out  nurse candidates suffering burnout. . While the stigma of being overweight and the concept of career dissatisfaction is not unique to nursing professionals, the clusters of other signifiers attending incidence of career longevity in nursing, as well as the obesity factor, are. But other factors such as overcrowding of the patients in the healthcare environment,  and a lessened ability to communicate with other staff can also exacerbate depressive trends. Communication operates to solve many problems, and its absence in a nursing envirinment is a sure sign of workplace dysfunction. And the communication breakdown does not only limit profession nursing performance.  In cultures where many individuals are cued to conceal concerns about their own mental wellness, nurses are not as reliable for self-reporting symptoms of depression.

The current research offers new treatment options for depressed nurses and those experiencing job stress. Computers can offer Lcd-enabled counseling interventions and Internet–based cognitive  therapy technologies. Nursing assistance strategies for support should quantifiably emphasize more robust participation in these programs. Healthcare employers should introduce employees to their mobile and smartphone pathways to wellness.  Brands such as Mind street, E-couch, and Moodgym are examples.

Incidence of depression, depressive tendencies, and behaviors associated with depressive symptoms have been tracked in nursing sample groups of varying occupational nurses around the world. From field hospitals in theaters of war to metropolitan hospital wards, the research compiles statistics and observations that hint at a need for organized proactive response. One study of German nurses reflected the combination of lowered mental health rating, health problems, and lowered workplace productivity. Registrations of continuous and consistent depressive problems in nursing professionals should be resonant enough, by now, to incite employer-side support.

Studies and literature from varying institutions and scholars have been actively researching the extent to which depression correlates with nursing.  Medical-surgical nurses and intensive care nurses show a stronger inclination to self-reporting depression or depressive symptoms. These symptoms are correlations of somatic complaints (trouble sleeping), major life events, addictive habits, and signifiers of occupational stress.

The burden on nurses is to support the healthcare mission of physicians in hospitals, clinics, nursing homes, and field hospitals. Any type of nurse, it seems, may be subject to depression as his or her age rises and their career longevity extends. Yet nurses receive education and training about the downside of depression and its impact on well-being. The research begs the question ‘Why can’t nurses actively discount depression in their own lives, let alone offer impactful interventions to their patients?” Employers and wellness institutions should answer this query with a set of nursing occupational supports that reinforce the investment nurses have made not only for their own careers, but for optimum patient-side medical care experiences as well.

 

Test Strategies for Nursing Students

After a nursing student has managed to complete all their coursework and pass all their training seminars, the big qualifying tests loom ahead. So many years are spent attending lectures, taking practical training, and working to support the goal of the future, that the nursing exam can become almost larger than life. Then suddenly it’s next month. That faraway goal is now a reality.

After preparing for the big exam forvso long, the first test for proper formal nursing exams can be a shock to the system. Perhaps a nursing student that did so well on their nursing section tests got comfortable with their study habits and just soldiered on. They thought the final exam and State Board nursing exam would be the same. Yet all too often, even these test takers are jerked back to reality with a non-passing result.  There is little room for error on the state qualifying nursing exams.

Many of the nursing students being proctored for exams are top-notch nurses wirh fine minds. Yet the competition for placement on occupational qualifier tests is more fierce for nursing than  in almost every industry, from aviation to veterinary practice. The bar set by current occupational nursing test programs are very high. The cutting edges dividing qualified nurses (who pass the RN test), and successful nursing students (who don’t), are very sharp. The cracks through which the nursing exam lets its student fall are getting more and more rare and much more fine every day.

Nurses getting ready to take their NCLEX or other qualifying nursing exams need to optimise every minute spent before the test. The tests have grown in sophistication and complexity over the past few decades. Nurses looking to see the highest and best score possible  should use some strategies to ensure the best payoff for all their hard work.

Nursing exam applicants and nursing students should tailor their test taking strategies to what works for them. Nursing exams measure three things: memorized medical knowledge, ability to incorporate that knowledge into medical nursing scenarios, and ability to perform virtual nursing duties in a number of imagined scenarios. The test crams the demand for problem solving and quick thinking into every question.

1. Set a game plan based on past test results.

Nurses must be honest about where their strengths and weaknesses lie. Look at what your study habits were when you attained your best grades.  If you have trouble focusing on test preparation,  consider hiring a coach. If you have trouble absorbing new material, think about getting a tutor while there still time left. Getting coached on how to study ranges or develop symptoms into therapies can boost your confidence on test day.

This is why flash cards and mere rote memorization of lecture notes don’t work. The retention from cramming  is too low to matter.  Many nursing students become insulated by good test score experiences and relax their discipline towards the last and most important nursing exams there are. Often the test results can be disappointing for the top graders or ‘teacher’s pets’ in  each individual school’s class or lecture section. The formal test for certification is much more tough even than your nursing final for your entire degree program.

Nursing students generally depend on their notes and test review sections to prepare for their tests. But test finals and professional level final nursing exams do not match this format. These tests are conceived as a competitive challenge.  Commercial test prep materials suggest a more credulous practice format and compatible test example for preparation strategy.

Teachers and lecturers are required to assign and cover scheduled amounts of topics and book material over calendrical points of time. But the commitment to master the material must come from the nursing student themselves. Just re-reading the book a hundred times isn’t test preparation anymore. By the time the final sessions of test preparation occur, nursing students must have absorbed the knowledge and moved on to applying it to likely problems or scenarios. Test questions will likely ask which of two of the most likely nursing  interventions are best.  At that time, it is the comparative knowledge of both quantitative and qualitative factors that are required. In addition to general practice knowledge. Nurses struggling to remember primary themes will be left far behind on the scoring curve. Make a folder for every area of knowledge in which you need a soup-to-nuts indoctrination. Fill this folder with research and case studies that emphasize key concepts.

2. Plot your time use strategically.

About a month up to the final scheduled test date, plot allyour time on a master calendar. Break down your study time into hours. If you have a job, consider freeing up enough time at work to achieve test prep goals. Working while distracted can throw you off your game at work. That’s when mistakes happen.

And a major incident at work can distract you from using your personal time for best test preparation. Because now your work rhythms are thrown off. Some time planning issues will have come to the fore. Time maximization is crucial at this time.

Review of study materials is essential. Nursing students should consider if the quality of their textbook is everything they need. Observe the results discussed by nurses attending other schools. Is there a book that explains things better? Often a coursebook can be the particular choice of the instructor, and not the most beneficial for nursing. Or nursing exam preparation.

When preparing for tests, the World Wide Web can be your friend. Join chat boards online and learn what other nursing students are saying about the quality of their own preparedness. Do students evaluate themselves as ready for some topics more than others?  Then identify which part of your nursing academic material needs a reboot.

3. Evaluate the best use of your time.

If you needed four weeks of additional chapter study and two weeks of terms memorization, as well as performing several weeks of part-time work, commuting, and/or childcare. three and a half weeks until test time isn’t going to work. Time management is key. Splurge for baby sitting and/or put yourself somewhere you can achieve a silo of concentration. Plan on less driving and unnecessary physical activity.

Many nurses try to take their current schedules into the test taking season. But the competition isn’t doing that. By ignoring time management challenges you let the competition get ahead.

Many nursing students respond to the freedom from lecture schedules as if they are on vacation. Suspend the party time until after the test. The need for constructive time management is too important. You can’t clone yourself and the pace of trying to do too much will wear you out just in time for the testing sessions.

4. Get enough sleep.

Nurses know from their studies thay shortages of sleep negatively affect diet,  sleep, temperament, concentration, and mood. Loss of sleep can affect short term memory and change in sleep patterns can erase the very mental sharpness nursing students need most for their tests.

Trying to stay up and force your brain to mentally absorb and retain quickly scanned information is impossible. Studies have shown that the human brain cannot accommodate these needs. Setting up the human body to fail during test time due to exhaustion. stress, or worry over preparedness is very common. Plot adequate meals, rest, exercise and sleep. Avoid crutches like caffeine, smoking, energy bars and junk food. These can alter your body chemistry and fool you into thinking yourself prepared by playing with your blood sugar. Make sure that sleep quality is a constant during your test prep phase.

5. Find A Study Buddy

A study partner can assist any nursing student to extend their study time and grow results. Students can put up notes at their school before lectures end or network during the session to get phone numbers of likely partners. Persons who have always depended on themselves for study results should not discount the benefits of active verbal  discussion of terms, examples and case studies. The active discussion can enable  positive  reinforcement of many important concepts and better enhance a student’s understanding of nursing course material. This leaves the test of their time free to focus on uniquely targeted “cribbing” information sets.

The grind of testing preparation can wear anybody down. This is not the time to get sidetracked! Both parties win by reinforcing proper use and discussion of topical nursing test subjects. The verbal intercourse with another nursing student is an efficient way for test prep to focus disciplined energy towards testing success.

 

Hospital at Home

A new model of nursing involves providing hospital level care for patients transitioning to living at home. This model can improve the efficiency of hospitals and other facilities by lengthening the time between hospital stays and facilitating better medical outcomes. The recovery of any patient in the context of their own home will always feel better. The care plan can thus be carried out with minimum discomfort of the patient. And lack of malaise will always trump pharmaceuticals, or so many psychologists believe. Patients can therefore meet the demands of their illnesses and meet their healthcare challenges without having to encounter a fearful hospital experience and culture shock.
The patient eligible for Hospital at Home must have sufficient oxygen flow and non-ischemic chest pain or absence of chest pain. After meeting clinical criteria for eligibility, the Hospital at Home patient will part of a new and progressive service model for acute-care candidates. The resources such as oxygenation and infusion are mobilized, the service performed at the patient’s home, and the nurse provided for “outpatient” aftercare. Thus the patient receives the best in skilled postprocedural nursing, without the awkward and often uncomfortable (and frequently painful) transportation hiccups, to and fro.
The patients feel they have more control over their lives while in their homes, while a hospital is a sterile and unwelcoming environment that maximizes the unknown element of any serious medical procedure. The room in a hospital may have to be shared with another person the patient find threatening. Occupying a hospital bed in a room with a stranger can be overwhelming for a patient already uncertain about their outcome. The noise and intrusions of people such as nurses. physicians, housekeeping, technicians, phlebotomists, administrators, case managers, and records clerks, can be annoying. The coming and going of such people in their space can keep patients awake, disturb their slumber patterns, and fan anxiety.

Hospital at home involves skilled-nursing level care and aftercare attributes without high hospital costs. Hospital at home allows a patient to receive nursing facility level care, specialty treatments, and adjunct technical nursing services in the comfort of familiar surroundings. Often just the proximity to friends and family can assist patients in recovery and recuperation. Hospital-at-Home is rated highly by caregivers, nurses, patients, and family members. This factor alone should become a consideration when reviewing scenarios for medical procedures.

Medical centers across the country favor Hospital at Home (Hah!)as a way to ease the burden on limited-bed hospitals and medical costs the patients at the same time. Hospital-at-Home is a care model that can be adapted for metropolitan or suburban community recommendations. Usually these costs factor into the overall cost of any hospital stay. By shaving the expense of hospital level services with adjunct mobile providers, health management organizations can more feasibly recommend in-patient stays and facility admissions without the likelihood the procedures will be rejected on a basis of cost.

Not every patient adapts to services in a hospital environment. Privacy, communication, access to the physician and a case manager can complicate the overall scenario. Reducing the cost by up to one-third is one advantage of Hospital at Home. But in addition to cost concerns, a patient can regain the rights of residency and all the benefits it confers. Patients can use their home phone, computer, receive mail, host pets, and receive visitors any time of the day or night. Patients can enjoy all the benefits of their home surroundings while getting optimum care. These can be important advantages when a patient envisions a planned and necessary medical procedure.

    Many people are not comfortable in hospitals and grow nervous at the thought of staying in one

. The may have negligible confidence in the “system”. Distance, cost, and awkward transportation issues may make the whole idea of a hospital procedure, no matter how needed, become a horror. And many seniors are homebound and have limited access to hospitals and other needed. Given these problems, a decline may be envisioned by the physician recommending the procedure. But Hospital-At Home is likely to be sponsored by the HMO the patient belongs to, on a cost basis alone.

The complete package of services and the organization necessary may be beyond their grasp. But Hospital at Home allows for these vulnerabilities and assists many seniors and homebound others to gain their medical services without negative outcomes. And many patients rightly fear the contagion and infection that many medical professionals know is present. Hospital admission and continued skilled nursing can present many more problems than a patient is willing to deal with. But pre-treatment in a clinical setting and follow-up services after the performed medical service enables patients to receive vital and necessary treatment, and then recover in the comfort of their own home.
The modern world allows technical mobile access to treatment and lab services like phlebotomy, radiography, dialysis, and skilled nursing bedside care. Acute medical problems grow scary for the individual patient uncomfortable alone in a hospital bed, surrounded by strange noises, equipment, and people. Just the sound of their home and natural surroundings and resuming regular living patterns can ease patients back to recovery. The outcome of any hospital procedure or service will be improved for every patient. Additional follow up testing, such as EKG, PICC line placement or removal, X-rays, ultrasound or others, can be dealt with at home.

Evaluation of HaH candidacy starts with the Emergency Room staff. They will be trained to identify the patients that require inpatient services but may benefit better by being treated at home. The clinical eligibility criteria will be part of an attribute list developed by the Hospital at Home model. A team will be assigned to prepare the patient for Hospital at Home services and scheduled in conjunction with their medical procedure or treatment. The quality of the ultimate outcome can be radically improved on a per-patient basis. Less stress, fewer complications, reduction in the mortality rate, and more value for each element of care should contribute to the Hospital at Home model being used more and more. Satisfaction from use of the Hospital at Home model is had by the patient, by the caregivers, and by the HMO, and ideal result.

Nursing and the Wound Care Dilemma

Wound Care in recent years has become big business. As a medical specialty group wound care has grown into a competitive market of the larger medical services provider industry. Wound care has also made a name for itself by providing mobile services. For many at-home patients and institutional clients without in-house debridement doctors, this is a winning solution.

But many patients receiving wound care by such onsite providers have to wrestle with a whole new set of problems. Because of the frequency and the proximity of the new surgeon’s provider visits, this brand-new physician now rules over the patient’s care plan. This random new doctor now is the most influential surgeon in the patient’s orbit.
In the medical world, certain conventions of eminence and integrity are assumed. A physician is generally esteemed by the level of education attained, the prestige of their academic credentials and their source, and the work history performed after graduation. The prestige of the places a physician works after graduation and the relative importance of their work experience determines the opportunities in the medical industry. This also predicates their authority in future patient care giving advice.
The occupational issues the physicians will come up against in the medical community will be a reflection of their formal training. But a position in wound care is due to years spent practicing in the field of wound care medicine. This standing
comes after years, sometimes decades working in professional medical care. Patients receiving wound care services almost never choose the doctor or know anything about them, unlike other types of doctors.
Mobile wound care surgeons analyze the condition of the skin. They measure and record the size depth and breadth of wounds and infected areas. The debridement surgeon can advise new courses of treatment. The wound care surgeon can also discontinue applications if treatments he or she finds detrimental or causeless. They may dismiss effective regimens without a second thought.
Soon the orders for the wound care may bear no similarity at all to the most successful and most impactful wound care regimens the patient has known. No other services can be authorized anymore. The patient is cornered. Then in addition to the discomfort and trauma of heavy infections, the wound care patient is twice over a victim. He or she will be left scratching their head, wondering ‘How did I get here?’

Medical provider services are part of an industry that makes money not doing its job. The more disorders, wounds, lesions, and infection that occur, the more money the hospitals, clinics, and services providers make. Of the gargantuan corporate behemoths that run modern medicine, all of them run on a modern theme: Sickness is an income opportunity.

Wound Care is a segment of an industry that nevertheless subscribes to business drivers that try to curry relationships with their business-to-business clients. In this particular, the patron is the long term care facility or Home Health corporation the patient belongs to. This means that a side contract is attached to the agreement between the physician and the patient. In the B2B world, this means that the interests of the facility and their case management prerogatives come before the wishes of the patient. While the patient may be under the impression that they are in partnership trying to improve their wound care ailments, the real boss of the situation is the facility or Home Health provider management.

This is a dilatory arrangement, as the patient will take consideration of other providers’ advice, including that of the PCP, assuming ongoing wound care success. They may discuss and develop the care plan with a projection of straightforward cooperation from the wound care service. But this assumption may be unwarranted. After making communications with other physicians regarding treatment, medication, and new therapies, the patient may find that the care plan is the victim of a hostile takeover.
Now the patient has heard so many different opinions about her case she feels seasick. After years of listening to persuasive opinions about treatments, the pendulum never rests. There is an endless cycle of wound care referral, the provider’s care initiation, the physician’s kindly bedside manner and befriendment. Then comes the sales pitch, the heavy sell, the isolation from other treatment doctors, and then the coup de gras. The wound care physician announces “It’s my way or the highway”, and the patient wonders how they got into this mess.
Now, all the documentation sets up the wound care provider as the decision-maker of the care plan. Nurses would do well to assist patients in coping and dealing with their doctors double-crossing them. Nurses and counselors should update case managers and family members if the observe patients feeling upset and confused by unsuccessful efforts to make their wishes understood. The concept of respecting resident rights is one that nurses should apply very seriously to all their charges.

The wound care physician now holds the upper hand and if the patient does not obey orders, the doctor can fault the patient for not being compliant. This can discredit the patient with the medical insurer. Documentation like this can risk the patient losing their medical coverage.
All of the assurances and advice that the patients received when other physicians were following the along the case somehow now gets lost. And it is surely a sheer coincidence that the recommendations of the most recent wound care visits dovetail with the least cost scenario for wound care treatment.
Nurses should recognize when patients feel distressed about any treatment they are receiving. But the impetus of hospitals and long term care facilities is to allow the business drivers of any medical care instituion have the last word.
Nurses today must decide whether to honor patient wishes or put the fiscal gains of their employer first.
This is the wound care dilemma for nurses. To step forward, and help, or do nothing, and hinder the situation. Nurses must acknowledge when the transparency and quality of patient care is compromised by the absence of patient consideration. Nurses must also operate with loyalty toward their employer. For nurses experiencing the above referenced type of scenario, serious reflection should ensue. These issues should make nurses everywhere advocate for patients who are getting manipulated by the ‘system.’
And professional nurses will serve their ethics best by obeying traditional standards of nursing handed down by generations. Namely, to put patient health, welfare, and recovery above all other considerations. Monetary and otherwise.

Drug Diversion Case Studies

The previous article on drug diversion explored the ways in which professionals in the nursing occupation respond to temptation by stealing medication from patients. This occurs when environmental security in a hospital, nursing home, or home health situation is not sufficient to detect and/or prevent this crime. Drug diversion is doubly dangerous because in some cases the patient suffers. The therapeutic value designed into the patients’ care plan is degraded severely by drug diversion.
Nurses who pocket or take medications cheat their patients of needed pharmaceuticals. But the nurses may also succumb to the near-universal lure of addictive pill-taking behaviors that impair their ability to think clearly and conduct their nursing activities responsibly. Opiate addiction is a global problem, and nursing can be a gateway career for addicts.
Drug diversion occurs when a nurse makes a decision to go against his or her better judgment. When this happens, day to day patient care is compromised. Since single-staff nursing plans don’t allow for auditing, the problem of pilfered medications will get much worse before it gets any better. Detection is the first method of arresting drug diversion. Symptoms of missed medications may blend with the patient’s pain spikes or be termed mood swings by distracted nursing staff.
Patients who vocalize extra pain or think that the nurse missed a pill may be disregarded.
Nurses who practice drug diversion may be in a position to target patients that nurses dislike and have no sympathy for. It may be some time before patient complaints are heeded and med counts correlated. And many nurses may move on before any official action can be taken.
Official complaints are the second step to take action against suspected drug diversion. Yet an official investigation by state or local nursing agencies is cumbersome and time consuming. And nursing homes go to great lengths to cover up their internal problems. When faced with legal liabilities a hospital may nullify patient lab reports or other evidence the patient’s care was impaired.
In instances when drug diversion takes place in home health scenarios, the abuse may never be discovered. The privacy and isolation of a home health environment are ideal elements for a nurse planning drug diversion. In any case, the patient will suffer. And the family members may never know why the patient is struggling for relief.
The third method to control drug diversion is peer policing. Nurses must take a stand from inside their community to cite and counsel nurses guilty of this crime. Leaders on every nursing staff should set an example of how to intervene and/or report drug diversion suspicions. Nurses who witness palmed medications should document what they see, and report the incident to the human resources director or the State Nursing Board. Anonymous complaints are allowed.
The most likely medication targeted by nurses for drug diversion is narcotics, painkillers, and opioids. These medications can alter mood and hinder feeling “down” effectively. Nurses practicing drug diversion are in fact trying to medicate themselves.
These pharmaceuticals are not only targeted for personal use. Drugs like Fentanyl, Dilaudid, Vicodin, Morphine, and others are highly marketable among addicts. Nurses may use pilfered drugs as currency among junkies with access to illegal street drugs. When a nurse is desperate enough for cash, students looking to maintain a high grade point average are good cash customers for diverted drugs. Students who reject shady contacts and promote a drug-free persona can utilize their nurse contact on the sly for ‘lifestyle enhancements’.
Case Study #1
Valery Gomez is an LVN working 4 days a week at a metropolitan hospital with high patient turnover. Valery started working six months and ago nursing is her first job. Her husband prefers her to have weekends off and her two children are taken care of on the days she works by her husband’s mother and family. Valery Gomez usually works the morning day shift.
Although initially Valery is bright, funny, and congenial, lately her personality when dealing with patients has changed. After twelve months on the job her nursing skills have not improved. Among the nurses hired in tandem with her, most have risen to supervisor or specialized posts. Valery’s peers have graduated to more complex work responsibilities,
It has been observed by the nurses on staff that Valery is often ” sitting doing nothing” and shoulders little of the actual individual tasks requied of desk nurses, and her charting and case load is usually poor or unfinished.
Lately several incidents with patients and Valery have brought unwelcome scrutiny to her employer from the County Health Department. The Ombudsman has received complaints about problems with Valery’s patient, problems that remain unresolved despite past counseling. Valery shows no remorse for causing great difficulty for other nurses and extreme physical stress to some of her patients.
Valery rarely lends a hand to any other nurses. She exhibits fits of temper when meds are requested and denys patients their needed painkillers without explanation. Valery makes a practice of hanging around the desk when the med-cart is adjacent and unattended. Valery recently has requested changes to her work assignments to shifts where the majority of staff wre gone.
While Valery made comments initially that she prefers a schedule with weekends free, now Valery has requested work on Saturday and Sunday. This is when most of the staff are gone. One of the patients, Nancy Lee, remarks that in private conversation Valery always told her that Valery’s husband wants her free on the weekends to entertain and care for the children.
Nancy Lee is a patient who recieves very heavy pain medication for multiple conditions. Nancy Lee has documented painful needle sticks from Valery. The Nursing Director has counseled Valery about not delaying Nancy’s med pass routine unnecessarily. The D.O.N. has repeatedly received complaints of Valery denying Nancy Lee her needed medication.
Valery alone of the many med-pass nurses resists the instruction to inform Nancy Lee how many Fentanyl she has left on her pain management precription. Mancy Lee has made complaints to the State Nursing Board about the matter.The local authorities have substantiated Nancy’s complaints.
Nancy Lee is articulate, alert, and ambulatory. She notices that paperwork in her chart written by Valery is inaccurate and incrimminating documentation concerning incidents with Valery has been removed. Nancy Lee hears from other nurses that Valery has refused to chart for them on occasion and also has refused to cooperate with requests from other nurses to perform tasks for them while they do her work.
Nancy Lee steps outside her roomn one day and observes that Valery Gomez visits the trash room frequently. Since the housekeeping staff normally do this, Nancy wonders why Valery alone of all the nurses disappears from the nursing desk floor while on duty. In the past, when Valery was Nancy’s nurse strange pills would be found in the floor. Nancy wonders why Valery avoids the closed circuit camera view so often.
In the past, Nancy Lee has noticed that many of the CNA staff hide in the supply room or the trash room and text to friends, play video games, or talk and use their cellphones. Nancy feels strobgly that Valery Gomez has been pilfering and experimenting with pain medications intended for the patients.
Nancy feels that Valery watches for opportunities to steal, hide, and ingest patient medication while on the job. Nancy has noticed that
Valery has lost weight and taken an interest in a handsome young nurse new to the facility. Nancy sees Valery drift through the weekend avoiding family responsibilities.
Suddenly it is found and told to Nancy that repeated impropriety concerning her pain medication has caused the med cart run out many months in a row. The pharmacy cannot account for the errors.

Nancy wants the D.O. N. to order a drug test for Valery after a weekend where the nurse repeatedly goes into the trash closet. Nancy sees Valery glaze over while another nurse is calling her name. Nancy sees a pill hit the ground after Valery comes out of the trash closet. When the good looking male nurse calls in sick, Nancy notices that Valery loses all interest in her work, snapping at peopke and gruffly answering the phone.
Does Nancy have the right to do this? How should the D.O.N. respond? How should the other nurses at the facility act at this time? Who should act, what should they do, and when does this become an investigative problem for police? How do the three methods to limit drug diversion, as outlined above, operate here?
Case Study #2
In a large hospital near Los Angeles, one of the patients in the SNF Alice. has noticed something disturbing. In the morning at 5:45 a.m. every day moans and screams start rising from the patients in the other rooms. The nurses tell this patient that many of the other patients are addicts who start yelling for their opiates and pain drugs too early. The nurses say that if they start giving out the pain medication for other patients too early, the next day the same thing will happen again and the patients will use up all their pain medication too early. The patient observes that there are no general administrator on duty at this time of the day.
After three months,the same thing happens very day. The patient notices how the exact same staff work the 11 to 7 a.m. shift daily even though alternates regularly appear on the other two shifts. Alice notices the call lights and alarm sounds series at this time, unlike at any other time, are often allowed to build and be ignored. The charge nurse responsibilities are shared beteeen a close knit group of nurses.
Soon the patient believes that the hospital does not know anything about how bad this problem seems. After months of different patients coming in and out the sane phenomena occur. On the day and afternoon shift the moans and screams do not recur as they during the “dawn patrol”.

Over time the patient fears that the hospital has suppressed recording this issue. Alice thinks that these SNF patients acting in this manner and reporting pain is being concealed and not documented so that their staffng acuity will not shift. This appears to be a cost cutting measure administered when no officials, visitors, or ancillary hospital staff can witness the outcry at dawn.

What questions should the hospital adminstrators be asking about why so many patients in the SNF are demonstrating this scale of pain indicators without a investigation or compassionate care response? What responsibilities does the facility have to monitor quality of care?

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