Monthly reports from the controlled substances vault showed that a registered nurse on one of the patient care units had a 3+ SD use of controlled substances compared with fellow nurses in the same time frame. Further investigation revealed that this nurse was the only one who gave several patients acetaminophen with oxycodone after charting their pain scales. Review of the charts showed that the highest doses were always removed, and no doses were wasted. The unit’s nurse manager vouched for the nurse in question, saying she was one of the most well-respected and reputable nurses in the department. She insisted that this nurse was beyond reproach—never taking vacation, always volunteering to work overtime, and available whenever someone called in sick.
The decision was made to interview this nurse and ask for an explanation for why her utilization patterns were notably different than her peers. For confidentiality, she was interviewed in a conference room outside the unit. The nurse denied any wrongdoing. She again was asked to explain the high volume of use and the unusual usage pattern. She emphasized how concerned she was for her patients and that she did not want to see them suffer, unlike some of her colleagues who encouraged patients not to use narcotic pain medication.
When the nurse manager questioned the nurse’s judgment in always offering patients the highest dose, the nurse said that she always removed the highest dose, and if all tablets were not used she would save them for later. The team then inquired why she did not follow policy and waste the medication per protocol, and the nurse replied that she did not want to waste other nurses’ time and throw away viable medication. The next question was whether or not she sometimes forgot she had the drugs and accidentally took them home after her shift. She strongly denied this. As she became increasingly upset, she was asked how long had she been taking medications from the unit and why she was taking them. At this time, the nurse finally confessed to diverting the drugs. She said she had received prescription pain medications several years ago for a work-related back injury, but that her doctor had refused to prescribe additional narcotics when she would not take time off from work for physical therapy. One day a patient only wanted one of the two tablets offered, so she took the other tablet. Because no one seemed to notice, this became her usual pattern. She apologized profusely, but explained that using the pain medication was the only way she could get through a shift. As her addiction increased, she volunteered to work more often. She rationalized that her ability to keep working was in the best interest of the hospital. This nurse was placed in a rehabilitation program.
1. Identify at least 3 risk factors for impaired nursing that were seen in this scenario.
2. Identify at least 3 behavioral and/or physical signs of impairment in the workplace that were seen in this scenario.
3. Identify at least 3 behavioral and/or work-related signs of diversion seen in this scenario.
4. Discuss the elements of Virginia’s mandatory reporting laws in the case of impaired nursing. Outline the essential steps to making a report or referral.
5. Describe the elements of an Intervention Program for Nurses (IPN).
6. Research potential employer programs and initiatives to promote safety and provide assistance. Discuss impairment treatment options available for nurses in your area (VA, DC, or MD).
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