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Recently in Montreal, two nurses were fired for stealing opioids (narcotics) and using them themselves rather than administering them to patients.

In addition to hearing it on the news, I happened on this story online and read comments people made. The jist of these comments was zero tolerance, no second chance and jail time for the perpetrator.

In the hospital where I work, on my unit, one nurse has been fired, investigation ongoing, and another is pending investigation and on sick leave .

While it is indeed illegal to steal from your employer, the legal aspect cannot be so easily teased away from the medical aspect of this: when you're addicted, your judgment is impaired. When your depression is untreated, you reach for a "buzz". The consequence of this is that you use while your patient's pain remains uncontrolled because you've substituted water for the actual drug and injected water into the patient. Unrelieved terminal cancer pain is true agony, and this kind of cruelty to another human being is unthinkable.

I can tell you that if some addict had my mother as his/her patient, and did that to her, I would feel homicidal towards that nurse.

Only now, that nurse on sick leave is a good friend of mine. In drug rehab and undergoing psychiatric treatment for depression. I cannot picture her in jail. It is very difficult to be objective.

Where does "medical" stop and "legal" begin? What should the punishment be? Should there be mandatory random drug testing on all of us nurses all the time? Is a serious, first offense, breach of ethics, reason for irrevocable dismissal from the profession?

My opinion: the public needs to be protected from the dubious practices of substance-dependent nurses. But, striking a nurse off the Roll for a period of one, three, or five years is insufficient. Because of the shortage of health care workers, I think obligatory, unpaid, hospital service should be the sentence. With, of course, no access to the drugs. Until all rehab and treatment are successfully completed. And then, random control testing to monitor possible relapse.

Yes, heads would hang in shame, but shame is, in these cases, appropriate. Until, God willing, pride returns.


------
Of all known institutions, I attend only two: church, in my heart, and school, in yours. Both are subject to demolition. - Lucie Adams, 2007
It is only for poetry to know how many stanzas fit into one caress. - Lucie Adams, 2008


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Comments

The following comments are for "Judgment daze"
by windchime

Lucie, funny you should bring this up....
I just had a conversation yesterday with one of my daughters, where she mentioned to me that it is a problem in elder care. She told me that apparently there is a real problem with the nurses and staff of these institutions an homes stealing the medication that is meant for the elderly. I was shocked to hear of this...I had never considered that such a thing went on, and it is horrible. Someone suffering in pain while an addict enjoys their pain medication as a high or self-medicating addiction need. It pisses me off the thought of it, and it makes me wonder just how prevalent this sort of thing might be among the very under paid poorly trained (non-nurse) staff who care for the elderly these days. It makes me wonder why some folks would even want to take this kind of bed pan cleaning job at minimum wage when they can be paid the same at MacDonalds and not have to clean after anyone's personal hygiene mess...unless of course there are perks to working this kind of thankless underpaid job, eh? Stealing the old folks meds? Gross!!! By the way, the reason she knew of this was because she once knew a lot of addicts and she is still in a recovery 12 step program herself for cocaine and heroin use she developed during her years as a on the road performer. She never worked these kind of medical/convalescent jobs but she said she knew of several people who did do these jobs and it was inside knowledge among addicts. And that she still hears stories about it being told in the narcotics anonymous meetings. Scary thought. Very scary thought. To think it goes on in hospitals by trained real nurses is so much worse. There is some major suffering in the hospital. I have known my share of pain in the hospital...and I know when I am being given real pain medication because it stops hurting. But what about those who are so weak that they cannot complain, all they can do is suffer. I'm sorry but I have so little compassion for folks that abuse the weak among us. It's right up there with child abuse. It is really sick. Yet, I do recognize the need for more compassion and that solutions to this problem so that it does not continue. I mean, one day I don't want to be in a hospice expecting my good meds to kill the pain and have some nurse/staff person getting high off of my suffering. Thanks for posting this Lucie, something to definitely think about.

( Posted by: TheRealKarmaTseringLhamo [Member] On: December 7, 2007 )

You draw the line
Lucie,
Every time I started writing a reply/comment it soon turned into my own rant. So, I will simply say you bring up a very good point, that when a friend is the one who has crossed the line (moral, ethical) it is very difficult to be objective. The simple fact is only you can decide where you draw your line, or lines; how far are you willing to extend your compassion? How far are you willing to let your own ethical and moral boundaries stretch under that strain of friendship? Because you must live with your choices, nobody else. I wish you well in dealing with your difficult situation.

( Posted by: BWOz [Member] On: December 7, 2007 )

Judgment daze
I just want to say that, I suppose mandatory drug testing would be the answer to the whole thing. It would catch the problem early and save everyone. The nurse from getting "embedded" in her addiction, so to speak, and the poor patient who is the real victim here from unspeakable suffering.
Now I am an American, and that goes against something ingrained in me deeply, which is being searched without a reason, without probable cause. So it really would need to be a voluntary thing on the nurses part, but I would certainly be willing to volunteer if I were a nurse and this was a big problem. Robert.

( Posted by: robnjop [Member] On: December 8, 2007 )

Lena
There are indeed a lot of addicted health care workers, and many more of them are doctors and nurses, than aides or attendants, because of accessibility. Doctors get samples from pharmaceutical companies, and nurses carry the keys to the narcotic cupboard. I think that no matter what the situation, and no matter who the person using, addiction and the compassion needed for caring for the sick, are mutually exclusive.
Thanks for responding with so much sensitivity and personal investment into this. It does stir up a passion for justice, doesn't it?

Lucie

( Posted by: windchime [Member] On: December 8, 2007 )

Francisco
You sure do get this! Some of us are equipped to care for the sick and dying as well as live our lives outside of that extremely emotionally-charge milieu. Some of us may not be, or our lives are now a little less tolerable for whatever reasons, and "chemical coping" ensues. One of these nurses was a mere coworker. Whatever happens to her is not that important to me. The other nurse is my friend. What happens to her matters a lot to me. I am afraid for her. She already attempted suicide once...She is not a bad person. But she did a very bad thing. For which she needs to "pay". I hope she survives it.

Thank you for zeroing in on one of the core issues here.

Lucie

( Posted by: windchime [Member] On: December 8, 2007 )

Brian
Thank you for empathizing so completely and with so much generosity of heart on this! The moral dilemma of this is easier some days, but so difficult overall. I don't like to see my friend suffer medically and legally from this, but then, I won't compromise, either, on what's right and just and compassionate. Or on what's ethical. I know I must live with my choices. I do plan to remain friends with her even if it is decided that she cannot return to "our" work.

( Posted by: windchime [Member] On: December 8, 2007 )

Penelope
Thank you for recognizing the problem of addiction exactly for what it is. You are right: people will not change into something they are not, and addicts will always be addicts, except, there will be addicts who will always use, and addicts who will have stopped using. Therein lies the hope...

It is, indeed, important to make our work climate as pleasant as possible in order for us to give our utmost to those who need us. But you know, Pen, not every nurse has a satisfactory HOME climate to go to when all this bedside devotion ends at shift change...

Then,...I know, because I tried...being a Union Representative and, better you than me in that title, for all concerned!

( Posted by: windchime [Member] On: December 8, 2007 )

Robert
Thank you for courageously answering one of the questions I posed in this piece. It would solve the problem in the easiest way. As soon as there is suspicion, boom! random mandatory drug testing. Or even, drug-testing us all, any time, any day or night, impromtptu...Except it goes agains the Charter of Rights and Liberties. Big roadblock here...So then, the question becomes: whose rights and liberties are more important? The nurse's? Or the patient's? And from that, the debate could explode, literally...

The other thing is that an addicted nurse ain't volunteering for drug testing. Trust me on that.

( Posted by: windchime [Member] On: December 8, 2007 )

Eric
I need to get going for my night shift, but I'll get back here to reply to you as soon as I can. I was hoping you'd see and read this. Thanks for taking the time to respond at length. Later!

( Posted by: windchime [Member] On: December 8, 2007 )

Back to you Eric
You address several different points, and I agree with you about the taser death of the Polish traveller. I think that in a ten hour period they could have found a translator! Hell, in ten hours, they could have gotten ME, for chrissakes, with seven hours to spare for explaining whatever needed to be explained! And we live in a "civilized" country? Anyway, don't get me going on that!

In terms of my colleague who is also my friend, I saw signs but was in denial I guess. Several of us had a "funny" feeling, but couldn't bring ourselves to trust our gut instincts and did nothing.

There is a big difference between good pain control and poor pain control for a patient, and an even bigger difference for family members. Family members can't stand unrelieved pain in their loved one. They figure there's so little time left, the little time there is MUST be comfortable time. So that, when pain medication comes and there is relief, that's good, but when it comes again and there is no relief, the first thing that comes to mind is NOT that the nurse used it for herself. It is, rather, that the terminally ill patient needs more pain medication. So more gets prescribed. And more, and more, and more, unless/until the nurse is caught and exposed.

I don't think anybody, clever or not, mandated or not, knows how to deal with this. You have to noth get treatment for being sick (addicted) and get punished for doing something illegal. That's a lot to bite off and chew for the person experiencing it. For the person(s) victimized by it, it's not enough. I don't know who would be the best at figuring this out...

My colleague has been my friend since the Spring of 2000. I have known for a long time that she is an alcoholic but she doesn't know that I know. I once confronted her about her binge drinking and she went into denial. I knew she was headed for trouble, expecially when her husband lost his job, but I never ever suspected drug addiction and drug theft from the cupboard here.

I'm still in an awful position.

I still believe that it's very serious, it's a huge big deal, and it needs to be dealt with as a huge big deal. But how? If I were to tell her she needs to feel yet more shame than she already does, by giving away volunteer hours to this place, I don't think that would exactly fly, eh?

But that's what I do think.

( Posted by: windchime [Member] On: December 8, 2007 )

I agree with Eric...
One of the stories I heard of was that of a real nurse who did this very same thing, but instead of going back into the nursing profession after her rehab and recovery, she instead was intelligent enough to realize that she needed to start a new career and stay clear of the environment that led to her addictive behavior. She became an engineer. She realized that the temptation was just too great for someone like herself who, like the alcoholic is forever and alcoholic, the drug addict is forever a drug addict...and it would be ridiculous for anyone to expect an alcoholic to return to bartending as a career. Same for nursing.

( Posted by: TheRealKarmaTseringLhamo [Member] On: December 9, 2007 )

Eric and Lena
Volunteer hours with no drug access. Every "addictive" drug is locked and counted every 8 hours and keys are safeguarded. Anybody caught giving her the keys would see their own license to practise in peril.

How do you start a new career at 50? With a work life as a nurse lasting 27 years. With 15 years left to work before retirement. Depression and substance abuse recovery are not pals with return to school. Taking any job means working for 25-30% of this current salary. So....Welfare? Unless...the Order of Nurses Court decides she must never work as a nurse again, she will. It is highly likely that they will NOT decide that, because it's a first offense. So she'll be back. And we will be looking over our shoulders, paranoid.

The bartender alcoholic example is a good one, though.

Unpaid volunteer work in the hospital might be a useful device: it might convince that health care work done for nothing is not going to pay the mortgage any faster than burger flipping for minimum wage might...

( Posted by: windchime [Member] On: December 9, 2007 )





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