Substance abuse is one of the most important issues in nursing because access is so easy. Even with Pyxis machines that distribute medications with a thumb print, there still are ways that a determined nurse can divert medication.
According to the Indiana State Nurses Assistance Program [ISNAP]:
Impaired nurses demonstrate mood swings and irritability. He/she may seem depressed for no apparent reason. There can be frequent complaints from nursing peers, patients, or family members that the nurse has responded inappropriately to their requests and/or concerns. At times, nurses have abused patients or engaged in abandonment of duty.
Impaired nurses often demonstrate problems in their job performance. They write inappropriate orders for patients, are less timely, and often do not follow policies and procedures. Impaired nurses often administer far more PRN narcotics than their peers or administer PRN narcotics to patients who have never been known to request them. They may fail to get waste of narcotics witnessed or fail to document the narcotics they administered to a patient. An impaired nurse may demonstrate poor concentration, significant problems with short term memory, an inability to learn new procedures within a reasonable time frame, and/or poor priority setting. Some nurses have blackouts, a period of amnesia in which he or she can’t recall what he or she said or did.
Impaired nurses sometimes work large amounts of over time to ensure they can obtain their drug of choice especially on midnights. They may also use their peers’ codes to sign in with a Pyxus system.
Impaired nurses may have excessive tardiness and/or absenteeism. They often call in sick on Monday’s after a weekend off or after a holiday or vacation. They may be absent from their assigned floor for long periods of time or make frequent trips to the bathroom. He/she may avoid employer sponsored social functions and may often eat alone.
If you see any of these behaviors or have any such concerns in a co-worker, please take note. I know as nurses it is difficult to say something about your peers. You certainly don’t want to get them in trouble. But, who are you protecting? Are you helping that nurse by allowing them to continue this destructive behavior? Are you depriving a patient of the best care by not sharing a suspicion about a particular nurse? Do you want to work with somebody who is not reliable?
Now, sometimes even nurses who are not impaired get in trouble for administering more narcotics than their peers. The best advice I can give you is to document, document and DOCUMENT! Not to record just the subjective that the patient is in pain and they were given two Vicodin, but document the patient’s vitals signs and their behavior. Show the clinical indication of why you are giving the narcotics. This will help protect you in the event of a license investigation.
On co-signing waste of narcotics, there’s simply no getting around this. It must be done and needs to be done as a priority! I know it takes you away from patient care but it is the best way to protect yourself and your license.
Although there is no affirmative duty to report a co-worker as someone you have a suspicion of being impaired, again ask yourself the question: “Is your silence helpful to that person, your other co-workers and the patients?”