Substance abuse is the number one reason named by state boards of nursing for disciplinary action (Sullivan & Decker, 2001). I started thinking about this topic recently when my mother’s best friend (a registered nurse) relapsed into a Vicodin / morphine addiction after a terrible car accident.
I watched her eyes roll into the back of her head as she slurred out the word “ten” every time the nurse asked her how much pain she was in. Before she received treatment, she was apparently addicted to every pain relieving medication she could get her hands on.
She was told to receive help when her nursing supervisor discovered she was withholding her patients’ pain meds for herself, ultimately keeping her patients in a state of excruciating pain. The unfortunate truth was that she had been addicted to pain relieving medications since nursing school. When she was caught, she had already been a nurse for ten years.
I’ve heard several other stories about nurses becoming addicted to prescription pain medications in which they fall asleep on the job, steal from their patients, hurt themselves…etc. and it should be a growing concern within hospitals to take strict precautions in monitoring drug dispensing and nursing behaviors.
It wasn’t until 1984 that the American Nurses Association (ANA) publicly recognized the problem of narcotic addiction in nursing (Dabney, 1995). Though more widely recognized as a growing problem, it is still hard to identify.
It is noted that the rate for prescription type drug misuse is 6.9% (Trinkoff, Storr, & Wall, 1999), with the average rate of narcotic and alcohol abuse in nursing at 6 to 8% total.
Identifying a nurse who is participating in prescription narcotic abuse can be difficult because denial is the first reaction to an accusation. However, the nurse’s behavior will eventually make things clearer. Usually, there is not just one indicator but several. There may be an increase in absenteeism, tardiness, and use of sick time with vague excuses. The nurse may take long or frequent breaks. Job performance becomes inconsistent as function declines. Charting suffers with errors and omissions. Inadequate reporting and discrepancies with what is charted may be apparent. The nurse does just enough to get by with increased complaints from other nurses, doctors, or patients.
When challenged, the nurse may offer implausible excuses for behavior or become defensive. Behavior changes may include mood fluctuation, sleeping on the job, or isolation. The nurse may have a chaotic home life or feel picked on at work.
They may over react emotionally with snapping out or disproportionate crying. Signs of diversion can be subtle. The nurse may volunteer to administer medications for others or hold the narcotics keys/count. Their patients receive more PRN pain medications but report non-effective pain relief. There may be frequent reports of lost or wasted medications.
Medications should be checked for tampering such as torn packets, missing vial tops, puncture holes, and uneven fluid levels. This nurse may request to work in an area of high pain medication administration. If injecting at work, there may be blood spots on clothes. (Smith, L., Taylor, B., & Hughes, T. (1998).
Effective peer responses to impaired Nursing practice.
Nursing Clinics of North America, 33(1), 105-18.).” It is quite obvious that all of these behaviors put the patient at risk, and the nurse in question should be asked to receive some sort of treatment. Patients go to the hospital to receive relief from pain. I couldn’t even imagine how her patients must have felt when they asked for true pain relief and received a Tylenol instead.
Forensic Nursing Chronicles 