Introduction: Definition & Description
Work with drugs and psychotropic substances in medical organizations is constantly in the field of view of law enforcement agencies for the control of drug trafficking and health authorities. Failure to comply with regulatory requirements in this area is fraught with administrative and even criminal sanctions (Phillips et al., 2018). However, currently, there is no concept of an express test in labor legislation to determine whether a person is in a state of alcoholic, narcotic, or other toxic intoxication (Nafti et al., 2019). Therefore, there is no clear answer to the question of whether nurses should be checked for the use of drugs.
Admission of employees to work related to the trafficking of drugs and psychotropic substances is possible if there are certificates issued by medical organizations at the place of registration. These certificates should contain information about the absence of employees who, in accordance with their official duties, should have access to narcotic drugs, psychotropic substances, drug addiction, substance abuse, and chronic alcoholism (Wilfling et al., 2019). However, these certificates are obtained annually and do not involve regular testing, whereas the period of withdrawal of narcotic substances from the body is much longer. This problem is a leadership issue since it is the manager nurse who is responsible for the quality of medical care provided to patients by the subordinates (Molzof et al., 2019). The duties of a nurse leader include monitoring the performance of official duties by nurses, including the turnover of medicines. Therefore, the establishment of mandatory drug testing for nurses is a leadership issue.
Background & History
The 90s
Medicines containing narcotic or psychotropic substances, in accordance with the laws on the circulation of medicines and on drugs and psychotropic substances introduced in the 90s, are allowed to be used for the purpose of providing medical care. Simultaneously, their turnover in healthcare institutions was put under strict state control (Höbler et al., 2018). For violation of the rules of trafficking in narcotic drugs or psychotropic substances, which resulted in their loss, liability is provided for under the criminal code. The public danger of this crime lies in the fact that narcotic or psychotropic drugs, once in the sphere of illegal trafficking, are further illegally distributed for the purpose of non-medical consumption (Resnick et al., 2019). Therefore, their withdrawal from the control of responsible persons undoubtedly poses a real threat to public health.
2001
At the same time, according to the precedent in 2001, the destruction of medicines containing drugs or psychotropic substances by medical workers in violation of the established rules does not constitute a crime under the article of the criminal code (Pecci, 2014). At the moment, a nurse who has injected a drug containing a patient and destroyed its remains in violation of the established rules, for example, by pouring it into the sink, is not subject to criminal liability (Tokac & Razon, 2021). A laboratory assistant who inadvertently scattered potassium permanganate on the floor, flushed it into the sewer, and used part of this powder to prepare a solution for watering flowers should bear disciplinary, not criminal, responsibility (Majken et al., 2020). In these cases, dangerous substances do not get to unauthorized persons and, accordingly, do not pose a threat to public health.
2006 – 2018
Due to the effective activity of law enforcement agencies, courts, and other controlling state bodies, the number of crimes provided for by the criminal code can be kept at a fairly low level. For example, in 2018, only eleven cases of criminally punishable violations of the rules of trafficking in narcotic drugs or psychotropic substances were revealed (Ersek et al., 2019). For example, in 2006, 2,700 crimes of this type were registered (Lim et al., 2018). At the same time, it should be borne in mind that due to high latency, not all crimes are detected and fall into the statistical records of law enforcement agencies. However, the reduction in the number of cases of drug trafficking by nurses occurred after the introduction of mandatory annual testing in 2016 for taking narcotic drugs as part of a professional examination to obtain a certificate from a narcologist (Dworsky, 2013).
Literature Review
Summarizing
Ersek, M., Nash, P., Hilgeman, M. M., & Neradilek, M. (2019). Pain patterns and treatment among nursing home residents with moderate-severe cognitive impairment. The American Geriatrics Society, 54(4), 1–9.
This article highlights the moderate-severe cognitive aspects of the psychological temptations that medical professionals face with long daily contact with substances and people who use them.
Tokac, U., & Razon, S. (2021). Nursing professionals’ mental well‐being and workplace impairment during the COVID‐19 crisis: A Network analysis. Journal of Nursing Management, 29(6), 1653–1659.
This article examines the reasons why nurses turn to drug abuse while working during the COVID‐19 crisis. Among them, there are psychological aggravating factors of work.
Majken, E., Söderström, M., Jirwe, M., & Tucker, P. (2020). Sleep and fatigue in newly graduated nurses: Experiences and strategies for handling shiftwork. Journal of Clinical Nursing, 29(1), 184–194.
This article is devoted to the use of drugs by nurses in the process of combating chronic fatigue that they experience at work.
Molzof, H. E., Prapanjaroensin, A., Patel, V. H., Mokashi, M. V., Gamble, K. L., & Patrician, P. A. (2019). Misaligned core body temperature rhythms impact the cognitive performance of hospital shift work nurses. Neurobiology of Learning and Memory, 160(33), 151–159.
This article examines third-party factors influencing nurses’ decision-making, including the choice of taking drugs or refusing them.
Solution
Lim, S., Han, K., Cho, H., & Baek, H. (2018). Shiftwork nurses’ work environments and health-promoting behaviors in relation to sleep disturbance: A cross-sectional secondary data analysis. Journal of Clinical Nursing, 28(9), 1538–1545.
This article carries out statistics that drugs cause the effect of vivacity, so nurses should be given the opportunity to get enough sleep as a prevention of drug use.
Nafti, M., Sirois, C., & Laurin, D. (2019). Is benzodiazepine use associated with the risk of dementia and cognitive impairment–not dementia in older persons? The Canadian study of health and aging. Annals of Pharmacotherapy, 54(3), 501–509.
This article suggests the distribution of vitamins to nurses as a solution to improve cognitive abilities since drug use can also be caused by their actions, such as improving memory.
Resnick, B., Kolanowski, A., Haitsma, K. V., Galik, E., Boltz, M., Ellis, J., Behrens, L., Eshraghi, K., & Zhu, S. (2019). Current psychotropic medication use and contributing factors among nursing home residents with cognitive impairment. Clinical Nursing Research, 30(1), 59–69.
This article suggests working with a psychologist for nurses as a prevention of their drug use since narcotic substances can act as a means of escapism.
Wilfling, D., Dichter, M., Trutschel, D., & Köpke, S. (2019). Prevalence of sleep disturbances in German nursing home residents with dementia: A multicenter cross-sectional study. Journal of Alzheimer’s Disease, 69(1), 227–236.
This article examines the use of drugs as a means of combating sleep problems and suggests giving free insomnia remedies to nurses as a solution.
Addressing the Issue: Hollenbeck Palms Nursing Home
Phillips, L. J., Birtley, N. M., Petroski, G. P., Siem, C., & Rantz, M. (2018). An observational study of antipsychotic medication uses among long-stay nursing home residents without qualifying diagnoses. Journal of Psychiatric and Mental Health Nursing, 28(12), 1–12.
This article is an observational study of Hollenbeck Palms Nursing Home, which is the organization where each team member is employed. The control of drug testing of employees is mandatory there. Testing is conducted monthly for all employees. Among the positive aspects of the approach, one can note the high quality of patient care: it is safe to say that they are given all the necessary medications. In addition, one can be sure of the adequacy of the decision-making of medical personnel since their consciousness is clear and they are not in a state of drug intoxication. However, among the shortcomings, it is possible to identify significant expenses for monthly testing of all employees.
Höbler, F., Argueta-Warden, X., Rodríguez-Monforte, M., Escrig-Pinol, A., Wittich, W., & McGilton, K. S. (2018). Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: A qualitative study. BMC Geriatrics, 18(235), 1142–1146.
This article examines the state nursing home, which, according to its legal status, cannot oblige employees to undergo drug testing. The result of this approach is a monthly discrepancy in the number of drugs and frequent fines of employees due to their allegedly negligent attitude to drugs. In addition, the paper notes a case of a nurse using narcotic drugs on the territory of a medical institution for which she was responsible. Thus, among the advantages of this approach, compliance with legal requirements can be identified, and among the negative ones – is a high risk of employees using drugs intended for patients.
Best Practice Solution: Team Members’ Organizations
The problem of drug theft from healthcare institutions is not new. The team members of the organization are attracted by the fact that drugs are used here almost legally. In order to prevent nurses from using drugs, it is necessary to use two approaches. First of all, it is necessary to identify the reasons why team members of organizations use narcotic drugs. It can be a struggle with physical and emotional fatigue or problems with sleep. It is necessary to provide nurses with free psychological help, medications for insomnia, and vitamins to improve memory, as well as to build their shifts in such a way that nurses have the opportunity to have a full night’s sleep and rest.
In addition, it was revealed that nurses are tempted to use narcotic substances because of their easy availability. Unlike the substance for injections, artistically prepared in the dens of the infernal mixture for intravenous injections, they are perfectly purified from impurities and sterile. Therefore, they cause a minimum of side effects for users, such as allergic reactions or even blood poisoning. Therefore, it is necessary to control the degree of drug sobriety of medical staff by regularly conducting special tests, which is the second solution to this problem.
Conclusion
Thus, the problem of nurses using drugs intended for patients remains quite significant. The reasons why this happens are the emotional and physical fatigue of the medical staff, as well as the scattered temptation associated with the easy availability of drugs. The solution to the problem could be both providing medical care to solve mental and physical health problems of nurses, as well as regular testing on the use of drugs.
References
Dworsky, T. (2013). Impaired nurse. lulu.com.
Ersek, M., Nash, P., Hilgeman, M. M., & Neradilek, M. (2019). Pain patterns and treatment among nursing home residents with moderate-severe cognitive impairment. The American Geriatrics Society, 54(4), 1–9.
Höbler, F., Argueta-Warden, X., Rodríguez-Monforte, M., Escrig-Pinol, A., Wittich, W., & McGilton, K. S. (2018). Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: A qualitative study. BMC Geriatrics, 18(235), 1142–1146.
Lim, S., Han, K., Cho, H., & Baek, H. (2018). Shift-work nurses’ work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis. Journal of Clinical Nursing, 28(9), 1538–1545.
Majken, E., Söderström, M., Jirwe, M., & Tucker, P. (2020). ESleep and fatigue in newly graduated nurses: Experiences and strategies for handling shiftwork. Journal of Clinical Nursing, 29(1), 184–194.
Molzof, H. E., Prapanjaroensin, A., Patel, V. H., Mokashi, M. V., Gamble, K. L., & Patrician, P. A. (2019). Misaligned core body temperature rhythms impact cognitive performance of hospital shift work nurses. Neurobiology of Learning and Memory, 160(33), 151–159.
Nafti, M., Sirois, C., & Laurin, D. (2019). Is benzodiazepine use associated with the risk of dementia and cognitive impairment–not dementia in older persons? The Canadian study of health and aging. Annals of Pharmacotherapy, 54(3), 501–509.
Pecci, A. (2014, April 29). EHR upgrades are pain point for REV cycle execs. Health Leaders Media.
Phillips, L. J., Birtley, N. M., Petroski, G. P., Siem, C., & Rantz, M. (2018). An observational study of antipsychotic medication uses among long-stay nursing home residents without qualifying diagnoses. Journal of Psychiatric and Mental Health Nursing, 28(12), 1–12.
Resnick, B., Kolanowski, A., Haitsma, K. V., Galik, E., Boltz, M., Ellis, J., Behrens, L., Eshraghi, K., & Zhu, S. (2019). Current psychotropic medication uses and contributing factors among nursing home residents with cognitive impairment. Clinical Nursing Research, 30(1), 59–69.
Tokac, U., & Razon, S. (2021). Nursing professionals’ mental well‐being and workplace impairment during the COVID‐19 crisis: A Network analysis. Journal of Nursing Management, 29(6), 1653–1659.
Wilfling, D., Dichter, M., Trutschel, D., & Köpke, S. (2019). Prevalence of sleep disturbances in german nursing home residents with dementia: A multicenter cross-sectional study. Journal of Alzheimer’s Disease, 69(1), 227–236.