A phenomenological study of nurses who have diverted controlled substances with Temporal Representations of their experiences

Abstract

AbstractBackground: There is limited information about the lived experiences of nurses who have diverted controlled substances. Drug diversion by nurses puts patients at risk of harm and is costly for the health care system. The literature is focused on processes to secure controlled substances, detecting and prosecuting diverters, substance disorder treatment for health care providers, and the efficacy of nurse monitoring programs. Objective: The purpose of this study was to describe the experiences of nurses who have diverted controlled substances to develop knowledge of the factors and life events associated with diversion and the temporal relationships between them. Method: This study used the complementary methods of descriptive-phenomenological interviews (Beck, 2016; Giorgio, 1992; van Manen, 2014), modified life history calendars (Axinn & Pearce, 2006; Nelson, 2010), and Visual Graphic Analysis (Brown, et al., 2007) to guide the planning and development of this study. In depth interviews and completion of life history calendars were completed with seven nurses who had diverted drugs. Themes reflecting the participants’ experiences emerged from the data and Temporal Representations were developed and analyzed for temporal relationships. Findings: Results revealed the following themes. The themes were: the impact of childhood exposure to family dysfunction; the seeds of substance abuse and dysfunction were planted; lost and alone in a caring profession; opiates flipped a switch; slippery slope to diversion; in the grip of diversion use; the signs were there and the alarms were sounding; the roles of diversion enablers; depression, anxiety, and other psychiatric and behavioral issues impact diversion; with subthemes of: manipulating the system in a full-time job; and nurse heal thyself – I’m trying. The visual graphic analysis of the temporal representations revealed two findings. The most significant finding was that opiate use disorder occurred for all the nurse participants after they began diverting, apart from one participant who developed opiate use disorder during treatment for pain and began diverting when opiate treatment was terminated by the provider. The second finding that was identified was that the initiation of drug diversion is most likely to occur in the first year of nursing practice. Conclusion: The results of this study provide nurses, nurse managers, nurse educators, nurse regulators, treatment providers, employers, law enforcement insights regarding nurse identified factors that impact initiation of drug diversion. Information from this study will assist with the development of future studies to improve treatment and monitoring, changes to nursing practice to reduce factors contributing to initiation of drug diversion, and strategies to reduce the opportunity for diversion in healthcare settings and the risk to patients.