HI there, if you are interested in hearing the nightmare another nurse endured, and telling your own story on my personal blog please try http://RNonymous.com. You have received a lot of support here and I am glad you have.Ultimate Nurses is a great site and I will never leave it. Here is a portion of my story:
Do No Harm
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Do No Harm: A Cautionary Tale
3:00 pm: I am sitting on my sofa at home. I am stunned. Confused. Terrified. I can’t wrap my mind around what has just happened to me. How did I wind up in this predicament? How can I have allowed things to get so out of control? The answers to these questions will come eventually. They will not be easy. But they will change the course of my life forever.
Earlier that day: 7:10 AM: I rush into my department. I am 10 minutes late for my shift. I am tired and I hate being late, although that seems to be happening more and more lately. I should have just called off today. My husband even suggested that I was in no shape to go to work this morning. Resentment and denial prevented me from taking his advice. As I stumble twice on the way to the locker room, my charge nurse asks me what is wrong. “I am fine…just in a hurry…sorry I’m late.” Another stumble, this time I drop my bag. I mumble something that must have come out slurred, and am taken aback when he states, “Honey, I can’t let you work like this.” I begin to formulate an argument…just really tired…I’ll be okay. But I stop myself. I nod at his suggestion that we sit down and talk in his office. I have an inkling that my life is about to change in a big way. The small voice of reason, the one I have stifled for so long now, says quietly and confidently… “The jig is up.” Still, all things can be rationalized…and no one does this better than I. I will explain. All will be well.
8:10 AM: I sit with the Nursing Supervisor and the Employee Health Nurse, answering questions. Have I been drinking? “No, I am just tired. I couldn’t sleep last night.” Asked why I seem so foggy I reply… “It must be the medications I take for sleep.” I took my usual sleeping pills which are only a small part of my medication list. Determined to be honest, I begin to recount the events of the night before. I took my Ambien, and when those didn’t work, I took another. And still failing to find sleep I took some Phenergan.” I suddenly decide that the Phenergan explains my grogginess. I am certain that I cannot get into trouble for taking Phenergan. Did I take anything else? “Well, nothing outside some of my other medications.” What might those be? “Well I have a prescription for Xanax. I take a lot of Xanax. I am up to about 10mgs a day (more than 5 times what my primary physician prescribes…the rest are from an internet doctor. I pay a lot of money for his signature. Still, I think I am on safe ground here, because I do not buy the medications on the streets. Other meds? “Yes. I take Vicodin ES for my feet. I have a prescription. I took a couple of those, but that was hours ago.” I have two prescriptions actually, from two different internet doctors, one of whom resides in Mexico, and I am up to about 10 of those per day. I don’t really remember, but it is entirely possible that I took between 4 and 6 tablets during the night. I worry about the unspoken disapproval I sense when they look knowingly at one another. I feel the need to explain: I have had months to devise rationales for my astounding medication regimen, and am happy to recount them for these ladies now:
Rationale Number One: I have a tolerance for these meds because I have been taking them for so long.
Rationale Number Two: I don’t take them at work. This has not been true for some time and these words represent my first outright lie of the morning. The other lies are those of omission and I have gotten accustomed to “not” telling them.
Rationale Number Three: My gastric bypass surgery has affected my absorption, so I have to take more than other people to get the same effect. I have been assured by my surgeon that this is not the case…but have decided that this explanation just makes too much sense not to be true.
And Rationale Number Four…drum roll please…I have never actually diverted medications from patients or the unit and have therefore NEVER BROKEN THE LAW! In the ensuing months, I will learn that “diversion” is a broad term that represents ANY use of ANY substance (Phenergan included) that could impair one’s ability to practice safely. The “Phenergan defense” would not save me from the consequences of my addiction. And this represents my second outright lie of the day. A few months before, I stuck a bottle of Ketamine in my purse and took it home. It was going to be discarded anyway. We don’t “count” Ketamine. It’s not a narcotic…(you get the picture, right?).Besides, I was only going to use it to sedate my Persian cats for grooming. The Ketamine was for my cats…the Ketamine was for my cats…
9:00 AM: Will I provide a urine sample? Absolutely. Nothing illegal in my urine. I would never jeopardize my license by using illicit drugs. Again, something true on the surface that, I will soon discover, matters little the North Carolina or California Boards of Nursing.
10:00 AM: I am waiting for a ride home…am not allowed to drive. Co-workers are in and out of the break room where I wait. No one speaks to me. They don’t know what to say. I tell myself that this will all work out…that it will be cleared up. Still foggy in my brain, I scold myself for having overmedicated. I really will have to cut back on some of these meds. I am absolutely certain, however, that it was the Phenergan that has landed me here. I vow to never take Phenergan ever again. This particular denial of my addiction…that the Phenergan ( and not the fifteen or so other pills I took during the night) was the cause of my difficulties…will be the strongest and most tenacious. Letting go of it will be the most crucial step before recovery can begin.
……………………………………..
It has been nearly six years since the day described above.
I had been in a Diversion Program for more thanthree years when I wrote this essay, and it was only eight months before that that I was allowed to return to restricted practice (16 hours per week of patient care, no nights, no charge duties, no floating). I submit to random drug screens, provide proof of 12-Step meeting attendance (5 per week), have a worksite monitor, and send monthly reports to the Board. I am required to have advance permission to travel anywhere overnight. I may not take any cold remedies (No Benadryl, No Dayquil…No Nyquil. Chicken noodle soup is allowed). It is strongly suggested that I do not use alcohol based mouthwash (as well as about 200 other personal hygiene, food, and household products). The Board uses a controversial urine test (ETG) that indirectly detects the presence of alcohol. It has been proven that even the use of alcohol based hand sanitizer can result in a positive. Diversion nurses are terrified of this test. If I adhere perfectly to this program, I will be finished in about eighteen more months.
It is a demanding and, although the Board denies this, punitive program. It is sometimes arbitrary and unfair. The Board has the authority to change a participant’s sobriety date, remove them from the program, and revoke their license permanently in the event that a relapse is strongly suspected. Many nurses do not make it all the way through and never return to practice. Most of those who do not make it are resentful and refuse to be compliant. No one would contest the fact that the Diversion Program is hard. It is rigid. There are very few pats on the back, little room for individual consideration. When I wrote this, I believed I deserved every sting of the whip. Things happened in the program AFTER I wrote this which changed my mind, a 180 degree turn around.
Extensive qualitative literature is available that richly documents the lived experienced of addicted nurses. The path leading to intervention…the journey through recovery…the re-entry into practice. It is beyond the scope this brief narrative paper to cite these studies. But their results are intuitive. Nurses can be addicts. Addiction is a disease (effective treatment, no cure). Addiction in healthcare providers is especially dangerous and represents a breach in public trust.
Clearly, programs that oversee and ensure the recovery of impaired nurses could be both a benevolent and necessary practice. I wholeheartedly support the IDEA of a Diversion process. I just wonder if something can be done about addicted nurses before they have a February 11th like mine. From a practical standpoint, for the safety of patients and the well-being of nurses at risk for addiction, I believe that the goal should be more ambitious than to punish or rehabilitate.
I do not suggest that addiction, mine or anyone else’s, can truly be prevented (again, lots of literature, no space). Much of the literature dealing with preventive measures for addiction focuses on education. In fact, however, most schools of nursing are falling woefully short in educating nurses about this topic as it relates to patients, let alone as it applies to healthcare providers.
I have run out of room only 10,000 characteral allowed per post), so I will post part two in the next post
