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Old 11-10-2007, 08:22 PM
MyOwnWoman
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Default Dirty Laundry

About 10 or 12 years ago, I was assigned to orient a nurse new to the ER. She was not a new nurse, just new to the ER. I went over the standard policy and procedures with her that would be a bit different in the ER and asked if she had any questions, she didn't so off we went to start our day.

From day 1, I felt there was "something" wrong. This woman, who had been a nurse longer than me was having difficulties doing the simplest of procedures and couldn't calculate a drug dosage to save her soul. We went over these things in depth because I felt that perhaps the ER was just a tad bit overwhelming than what she was used to and she needed a little comfort zone. Try as I might, she just wasn't catching on.

As each day went by, things got worse. I asked her what the problem was, if there was something that I could do to help her make the adjustment to ER and her response was, "you intimidate me." Thinking I was being a bit more over zealous than I should be, I backed off a bit and tried watching her from a distance. Nope, that didn't work. Each day became worse. Then, early one morning, as we were preparing a "game plan" for our day, the overpowering smell of alcohol invaded my senses. It was her. For about 5 days she was able to cover up the odor, but on this particular day, she couldn't. I confronted her about it and of course, she denied it. She said it was her perfume. I gave her the benefit of the doubt but when I smelled it again the next day and confronted her again, she told me it was her mouth wash. By the third day, I knew with certainty that she was drinking not only before work but during work as well.

In the middle of a procedure, as her hands were shaking and she couldn't calculate a simple drug dosage, I gently grabbed her wrist and told her, "I'm going to give you two choices, you need to tell the Nurse Manager about your alcohol problem, or I will; and as for the rest of the day, you need to think up of an excuse to go home early because I will not allow you to touch any of my patients." She was stunned, I was stunned that I could be that bold, but she ended up going home that day. She didn't come back to work for about a month or a month and a half. She resumed her orientation with me and things went along rather smoothly. I didn't smell alcohol. I did notice some hand shaking, but she seemed to be much clearer in her thought pattern. A year later, she sent me a card thanking her for confronting her alcoholism and saving her life. Wow. She handed me the card personally, and we both wept. I am happy to say that she is doing well and still alcohol free as far as I know.

Pretty easy huh? The next time things were not as easy. One of the nurses has called in from home asking if anyone would like to have a few hours off and she'd come in and work for them. Of course half the department jumped at the chance and she arrived on the floor about an hour after calling in to the unit. I was the nurse in charge at the time and from the moment she arrived on the floor I thought "something was wrong," but I couldn't put my finger on it. Then it hit me. This girl is "stoned." I didn't want to accuse her of something if it wasn't true so I just kind of watched and the simplest of tasks were difficult for her. When she ultimately missed the patient's hand while attempting an IV and hit her own hand, I stopped her and asked her what the problem was. She told me she wasn't feeling well but she'd be fine. I suggested that she go home since she wasn't feeling well and she refused. I had no choice (in my mind) but to call the nursing supervisor and have her checked for fitness for duty. She got angry and ran out of the office, quitting in the process -- never to return. I was pretty much the "bad man out" for quite some time after the incident because she had a lot of "friends" who thought I did her wrong. I could have left it a mystery as to who "told" on her because there were rumors running rampant, but in my stupidity, I admitted that I was the one who did the deed.

OK, that time, not so easy. A few months later, one of the nurses arrives to work on my day off (thank goodness) and is arrested for stealing and selling narcotics. I was stunned. I would have bet my last penny that this man would never have done such a thing. He was a "health fanatic," drank only protein drinks, he pumped iron and looked physically fit. The worst part? I liked him. I thought he was a good nurse and that he was honest. Oh Lord was I wrong! I didn't recognize his addiction because he came to work "high" all the time. It was his normal state of being. I felt so stupid. How could I have missed such a thing that was before my eyes on a daily basis? I even defended him to other co-workers thinking that this "arrest" had to be a mistake; but, there is was in black and white. Stealing drugs, writing verbal orders on patients without being ordered to do so. It was awful. His whole life crumbling down all around him and he didn't even have the decency to admit his downfall and get help. I remember vividly being called to his house by his girlfriend one night because she couldn't wake him up. When I got there, he was asleep in his underwear, track marks all up and down his arms. I almost vomited. I turned to his girlfriend and told her what was happening to him and to get her kids out of this house and away from him. He woke up long enough to shout out obscenities and I just pushed him back onto the bed and told him to take comfort from his needle because it was what was going to rock him to his death. I was repulsed and angered and I still don't know if it was more to do with him or more to do with the fact that I didn't recognize what was happening to him.

Now there is a 4th one. One that I have suspected but been unable to prove. One that I'm not sure I would have said anything about because of the treatment that *I* would endured if I said anything to her about what I thought. I'm usually a person who asks face to face if I have questions, but it seems this subject is just one that can alter and divide entire units. Once again, on my day off (God must really be watching out for me,) she was hauled in under the hot lights and asked questions about some discrepancies occurring in the pyxis (drug dispensing machine). She got mad, said she's going to sue "everyone" and quit prior to any drug testing.

What the heck is going on? I've read that nurses have a higher rate of dependence but this is out of control. It's almost like I can't trust anyone I work with these days, and I hate that feeling.

I'm just glad I can go to bed at night knowing that the DEA isn't going to wake me up and ask me about my drug use......ohhhhhhhhhhhhhhhh what a feeling!

Last edited by MyOwnWoman; 11-10-2007 at 08:30 PM. Reason: Pressed the done button too soon.
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Old 11-11-2007, 08:10 AM
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You seem to have more than your fair share of problem colleagues to cope with, but to my mind you are fair but put your patients first and that is the most important thing. In my mind you do are really good job. As you say you can and should sleep soundly in your bed with a clear concience.

By the way I have deleted your extra posts.
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Old 11-11-2007, 09:15 AM
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I'm hearing more stories like this everyday. I know this type of stuff has always gone on, but it seems like the situation is only getting worse. Maybe it's related to job stress, or maybe addicts are getting into the profession because of the access to medications. Follow Julie's advice and you will be OK: Keep alert and always put your patients first.
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Old 11-11-2007, 03:01 PM
Marachne
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I'll never forget in my student days, I was pulling some narcotics out of the Pyxis, and when I went to do the "amount left" count, the nurse I was working with cautioned me to actually check that all the "blisters" had a tab in them. She then told me about catching a colleague popping the meds out and leaving the pack in the drawer. I was shocked, although when I thought about it, the easy accessibility to controlled substances has to be a temptation for those who learn that way. I have heard of one recent event where I work now, and it took a LONG time to catch up with the person. It's disturbing, and scary to think about the risk it poses to patients and coworkers alike.

I wonder what I may miss because of it not being on my radar. I've had coworkers who have immediately picked up on patients who have been drinking, or visitors who are high on one thing or another, and I just wouldn't have had a clue.

I'm sorry you're going through this, but I'm glad there are people who are alert to the issue and don't let it pass.
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Old 11-19-2007, 11:57 AM
Mr Ian
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Of course, there are some staff you think should get stoned before coming to work. And others who appear to be on drugs but aren't... and those who aren't that really should be!
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Old 12-11-2007, 12:24 AM
DisappearingJohn
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Default It amazes me...

We have had three nurses in two years fired for diverting narcotics in the ED...

It never ceases to amaze me... To work so hard to get to this point, get a license, and then just flush it down the toilet like that...

One I might have even helped, even though I was far from being alone in that category. We are a very fast-paced unit, and our "verifying" of waste can be a little on the "trusting" side. A nurse will say, "hey can you waste this with me", flashes a vial of something and says "This is 50 of demerol" as they throw it in the sharps container... We say "sure" and punch our code into the machine... Probably happens 5-10 times a night...

Turns out this guy pulled 100mg vials of demerol for every order, even if it was for 25mg... It became quickly obvious to the pharmacy, and "boom" he was gone...

A lot of us were thinking back, wondering if we had signed off on an illegitimate waste...
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Old 12-13-2007, 04:40 AM
NurseSean
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I fear the day I need to confront a coworker with this type of problem. I hope I have the strength, as you did, to follow through. Everyone likes to think they do...but when it happens, I'm guessing it's extremely difficult and takes courage.
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Old 12-13-2007, 11:36 AM
MyOwnWoman
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Sean, it is a very difficult thing to do, and I struggled with it for a long time until one thought popped into my mind. "What if this nurse were the one taking care of someone you loved?" It's funny, the decision came very easy then. It's the aftermath that wasn't easy; but I survived, and so will you. I'm thinking of you during this tough time.
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Old 12-15-2007, 04:01 PM
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Wow...I hate these kinds of stories, but they are true. I remember a nurse in ICU...she was also in school getting her FNP. I really admired her. But she was diverting narcs. She came back to the unit after treatment...was caught again. I saw her years later. She was practicing as a NP, but with a restricted license.

I've confronted many nurses over the years...I've heard so many excuses about the smells, fatigue and stress.

We are no better, no worse than the rest of the human race. I learned long ago that almost everyone with a drinking or drug problem will lie.
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Old 12-18-2007, 01:41 AM
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Quote:
Originally Posted by DisappearingJohn View Post
To work so hard to get to this point, get a license, and then just flush it down the toilet like that.... We are a very fast-paced unit, and our "verifying" of waste can be a little on the "trusting" side. A nurse will say, "hey can you waste this with me", flashes a vial of something and says "This is 50 of demerol" as they throw it in the sharps container... We say "sure" and punch our code into the machine... Probably happens 5-10 times a night...
If you are not varyfying properly, the question is why are you doing it after "work(ing) so hard to get to this point, get a license, and then just flush it down the toilet like that...". It is drummed into us that a busy unit is not an excuse.

It is a pity that this happens.
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