When I worked with this nurse, they had sustained injuries from a car accident and had been prescribed prescription pain medication. Eventually, the nurse started mentioning that the medication wasn't helping with the physical pain anymore.
"Tolerance builds and they need more," Wright explains. "The brain has been rewired so that the drug becomes necessary for survival on a very unconscious level."
This rewiring interrupts their ability to make proper choices and, biologically, addicts become unable to "just say no."
2. Know the signs and behaviors of impairment.
There are often red flags that there is a problem with diversion and addiction well before the narcotics counts are "off."
A nurse may become forgetful, unpredictable, or lack concentration. He or she may have frequent illnesses, physical complaints, and elaborate excuses for things. They may pick-up extra on-call shifts, have a labile mood with unexplained anger and overreaction to criticism, or have an increase in unexplained tardiness or absenteeism.
"When it gets to the point, when nurses are diverting, where it's noticeable on audits and in the Pyxis, it's way out of control," Wright says of addiction.
3. Turning a blind-eye helps no one.
Colleagues who notice signs and behaviors of drug diversion and addiction are often hesitant to raise their concerns.
"The people who love them know that they're a great nurse, and they don't want to get them in trouble… because they're worried that they're going to be the one that causes somebody to lose their job," Wright says.
But inaction can lead to permanent harm and even death. Creating policies that incorporate rehabilitation and reentry into practice versus automatic termination could help peers feel more comfortable speaking up when they notice something is suspicious, she says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.