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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000421032.02199.be
Reflections

A Good Nurse?

Brown, Theresa PhD, BSN, RN

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Author Information

Theresa Brown is a hospital staff nurse and New York Times opinion columnist. Contact author: theresabrownrn@gmail.com. Reflections is coordinated by Madeleine Mysko, MA, RN, mmysko@comcast.net. Illustration by Eric Collins / ecol-art.com.

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Abstract

When addiction is too close for comfort.

This all happened a few years ago, but the when of it doesn't much matter. I got to the hospital floor in the morning, grabbed my papers, and started listening to taped report with the other nurses. While I was listening, the night-shift nurse who had taped the report, and whose patients I was getting, gave me a brief verbal update, and then left.

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One of my patients needed a fairly toxic drug for which dosing decisions come at the last minute depending on urine output, heart rate, and blood pressure. However, even with the taped report and the verbal update I still wasn't sure if the patient should get the next dose, so I went to get clarification from the night-shift nurse.

But the nurse wasn't anywhere on the floor. I started looking around, asking other nurses. My frustration grew when I realized that something about the entire floor felt wrong. The entire night shift had disappeared. My chest tightened and I started to worry about what had happened at the hospital last night.

Then another nurse pulled me aside and under her breath filled me in. “This is big,” she began; I nodded, and she told me: the nurse who'd given me report, who'd been taking care of patients through the night and many nights prior, had been stealing and using narcotics.

Oddly enough, my first feeling was relief. My fear had been that an RN had accidentally killed a patient. Then the seriousness of what had been going on hit me, and I stood there, silent and disbelieving. A nurse, one of us, was stealing narcs?

My patient had to come first, though. I paged the medical fellow and we talked over the drug's clinical parameters. We did the right thing for the patient, although for the life of me I can't remember what that was. The entire shift was a haze of concern, outrage, and incredulity.

It's hard to put a sense of professional betrayal into words. The idea that a nurse might show up impaired, and thus be incompetent, or unsafe taking care of patients, is deeply at odds with the ethical demands of the job.

The night-shift staff, who had worked regularly with the nurse, had an even harder time, since they felt personally deceived. Several times during recent shifts that nurse had had a soaring heart rate and profuse sweating. Concerned, the other nurses had urged an immediate trip to the ED, but the nurse had refused, blaming the symptoms on too much caffeine and not enough sleep. Replaying those moments in their minds, some of the night-shift nurses felt like fools for not having caught on.

A high heart rate and profuse perspiration could be symptoms of opioid withdrawal, so in hindsight it's possible they were evidence of the nurse's integrity: maybe the nurse was making an effort not to be high at work despite the difficult symptoms. But tachycardia and diaphoresis can also be caused by stimulants. Perhaps the nurse stayed alert on the job, but only by being jacked up on other drugs as well.

Research I've seen suggests that, despite our access to narcotics and other mood-altering drugs, the percentage of nurses with addiction problems is probably the same as that of the general population—around 9%—which means that roughly one of every 11 Americans, and potentially one in 11 nurses is, to use an ugly word, a junkie.

For the nurses on my floor it was a shocking discovery that the one in 11 included one of us. That the nurse was not just using, but had found a way to steal from our locked, password-protected narcotics dispenser, made the situation even more sordid and upsetting.

Here's the thing, though. There was no evidence then, or ever, that the nurse hurt a patient or practiced negligently. Sometimes routine work didn't get done when it should have been, but in the end no one was physically harmed.

I often think back to that day's morning report. This nurse had a reputation for being sloppy, but the taped report was impeccable. Coming in to give extra detail revealed a thoroughness we usually didn't see.

By that point the nurse had already been caught and, I'm sure, knew the job, and maybe the RN license, were at risk, and possibly lost forever. Some people would cynically view the better-than-ever-before report as a last-minute attempt to make a small piece of an imploded life look better.

They may be right, but being a nurse myself I saw it differently. Like many people who struggle with addiction, at the moment when everything was falling apart, the nurse still wanted to make a claim to competence and compassion. Whatever the personal troubles that led to drug abuse, the junkie had wanted to be a good nurse.

© 2012 Lippincott Williams & Wilkins, Inc.

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