What is the easiest way for a nurse to be suspected of diverting narcotics? What things raise red flags and can cause a big headache for someone who isn’t diverting narcotics but might be doing some of the things that someone who was might do? So, I came up with a brief list of things I see the most amongst my clients accused of diverting. And then we’ll go through those and maybe talk about how to fix some of those problems. Before we even get into that, nurses do divert narcotics. That’s not a myth. It happens. It probably happens more frequently than you would expect. And it can happen for several reasons.
Most of the time, it’s due to self-medication. The nurse has substance abuse issues, they have access to the narcotics, and then it’s just a simple way for them to use them. For whatever reason, either emotional or physical or whatever it is, it starts with, well, I’ll do this once. And then, well, I’ll do it a couple of times, then it spirals. It will always get to a point where the nurse can no longer hide what they’re doing or get sloppy, whatever the reason is. But very rarely would a nurse be able to do this long-term without being caught.
What Are The Red Flags of the Person Who is Doing Drug Diversion?
Let’s go through some red flags of what an employer would look for in determining or alleging that a nurse is diverting narcotics. Well, the first one is simple. It is not wasting with a witness. Very simple. In almost every scenario, the nurse needs to waste with a witness. Some excuses are I’m too busy, I couldn’t find somebody on the floor, this is what we usually do on this floor, maybe someone swiped in and then left or something like that. There’s always an excuse as to why it couldn’t have been done. Still, if the employer audits all the medications the nurse pulled, it doesn’t show that every single medication that needed to be wasted with the witness was a big red flag. The nurse will talk about that at some point. And they’ll have to explain why they didn’t waste with a witness.
Those are not valid excuses because everyone does it, or this is how we usually do it on the unit. Not correctly documenting is a violation of every state’s nurse practice act. And so, simply the nurse must waste with the witness whenever possible. The next thing is pulling more narcotics than your peers. And how the employer does this is they’ll do an audit of all, let’s take opiates, for example. All the opiates that a nurse prescribes or administers to all the patients. Maybe there’s a scanning order, and they can take out of the pyxis and give the patient a certain amount every four hours. The nurses tend to be on the very high range compared to their peers of administering or pulling narcotics are simply going to be red flagged.
Effective Ways of Drug Detection
And so, the employer will use what’s called standard deviations. Suppose a nurse has a certain number of standard deviations above the average nurse in her unit. In that case, that nurse will likely have a complete audit on their entire administering history. And they will have to talk to their employer about why they’re pulling so many opiates. The next thing would be not documenting the administration of the medication. It’s a simple one. Suppose you pull it and don’t give all of it all. Two, you need to document that you presented it. A straightforward one, but if a nurse has a bunch of pulls from the pyxis, but it doesn’t show that they administered it or wasted it, that’s a big problem for the nurse.
So, make sure that you document and administer it. Next, removing meds on patients that aren’t the nurse’s responsibility. I guess the most normal excuse for something like this is, while I was helping a colleague, she asked me to pull whatever, and then I gave it to her to give to her patient, can’t do it. And unless there’s a policy at the facility that says it is okay, which I would highly doubt, the nurse cannot pull meds from patients that aren’t there. It’s just a huge red flag. The next thing would be removing meds from a different unit. If you are working on one team, it shows that you’ve been taking meds out of the machine on another unit. That’s a big red flag. In a scenario where they were entirely out of, I needed medication on one unit, and they jumped over elsewhere.
What is Considered Big Red Flags?
But once again, just a big red flag. And these are all things that nurses who are diverting do or, in combination with some. Then the last thing would be too many overrides. Many nurses say, well, the machine doesn’t work correctly, or to get to my patients, I must do a lot of overrides or something like that. Too many overrides are just a huge red flag as well. I know it’s standard practice on some units. I know some facilities have float nurses that assist with whatever is necessary. So they must do a lot of overriding, but still, it’s a big red flag. So, it would be best if you didn’t do it.
The main red flags are:
- Wasting without a witness,
- Pulling more than your peers,
- Not documenting,
- Removing meds from another unit,
- Removing meds from a patient that isn’t yours,
- Too many overrides.
How To Avoid a Board Complaint?
One way to avoid a board complaint or an employer investigation is to ensure you’re doing all these things. And then, more importantly, if something is preventing you from doing that. If there’s something like a roadblock that the employer has put up, something is not working, or the machine is malfunctioning. Immediately let the charge, supervisor, or the owner know what’s happening so that the nurse cannot be the one that’s given the blame for the situation. In those scenarios, find someone, let them know what happened, send an email, and do something to document that this thing happened. And it wasn’t because I was trying to do something sneaky.
Other Blogs of Interest
- Professional License: Does a DUI Affect your Nursing License?
- What Happens When a Nurse is Reported to the Board?
- What Does it Mean When a Nurse is Suspended?
Can You Be a Nurse With a Misdemeanor Theft and Work In Any Health Care Facilities
Can You Be a Nurse With a Misdemeanor Theft? A couple of things first, this is not a state-specific discussion. I’m talking about a general analysis of what you need to think about if you have some past criminal incidents involving theft or shoplifting. Each board has different laws or ways to handle things. So, I will comprehensively analyze what you need to consider.
First, for any board, when you have criminal convictions in your past. I’m just going to talk about nurses applying. I’m not going to talk about what happens if you already have a license. So this will discuss my past theft convictions, and I’m applying to become a nurse for the first time. What are the things I need to consider?
Could You Say It Happened More Than Five Years Ago?
The first thing is, how long ago did they happen? If these things happened 20 years ago, maybe when you were a kid or early twenties, nothing has happened since then. There is almost no chance you wouldn’t be able to get your nursing license. People make mistakes. People change over time. When they are young, they tend to do stupid things. And so, if you had a few shoplifting incidents as a kid, it’s honestly not that big of a deal. Most boards find, I think, five years is like a reasonable amount of time if you’ve stayed out of trouble. If it’s been 20 years in this scenario, it will not become a hindrance to you getting your nursing license, most likely.
Only One Misdemeanor Theft?
Two, how many there were? Now, if you’ve had seven misdemeanor theft convictions, that’s different from one. If you’ve had seven, that probably means you have a chronic compulsion to steal. Let me put it this way: it’s hard for people to wrap their minds around this, but they have substance abuse issues. They’re addicted to drugs, or they’re addicted to alcohol. Some people have an addiction to theft and shoplifting, and it’s not like it’s a diamond heist. It’s like they stole a box of chocolates and a shirt from Costco. It doesn’t make much sense to the average person, but it is a simple compulsion. It is an addiction that some people must handle.
I even have clients like shoplifters anonymous, or they must work through these issues. They go to counseling; it is a problem in their life. There is a big difference between stealing some headphones when you’re 19 versus having habitual criminal issues involving shoplifting. Suppose it was just one or maybe two times from a long time ago. The more recent the theft conviction is, the more concerned the board will be. So, if you were convicted six months before you applied, the board will investigate that and most likely say, alright, well, what happened? They’ll probably interview you. They’ll want to know the outcome as far as the court case goes; did you do a diversion program? That type of thing.
Most of these cases result in the nurse going into a diversion program where they must do education and maybe leave some community service, pay a fine, and that’s that. But, in the scenario where you continue to have criminal problems involving theft or shoplifting, the board will get into, alright, well, does this person need a psychological evaluation? And then what the person was stealing is essential as well. Let’s say you were maybe not a nurse but worked in a healthcare setting, and then you got caught stealing supplies, or if you’re stealing medications, that’s a huge problem. But in that scenario, the board will take a closer look and say, is this someone we need to monitor? Or is this someone we need to make sure has been given the treatment needed to move forward with her life and not have this be.
I guess, a constant problem? Any board that will issue a license to a nurse wants to ensure that they can provide safe patient care. And they don’t have behavioral concerns that could result in an unsafe patient environment. So, the worst-case scenario in a board’s mind is that someone has a whole bunch of theft convictions in their past. They give them the license, and then they steal medications or supplies from a patient, which leads to negative outcomes because the patient no longer has those things. You think the board always goes down like in the worst-case scenario. That may be convoluted and unlikely to happen, but that’s how the nursing board thinks. So, those are the things they will most likely go over.
Common Effect of Misdemeanor Conviction on Licensing
Overall, it will not be a big deal if you have a few misdemeanor theft convictions. Most likely. Very unlikely you wouldn’t get your license. If you have a handful of theft incidents involving something more valuable, more importantly, or tied to patient care, that could be a problem. The board will probably make you jump through some hoops and potentially put you on probation. So, that’s the little analysis of whether you could become a nurse if you’ve had a misdemeanor theft conviction. I think this is good information for everybody looking to become a nurse.
Can You be a Nurse with a Misdemeanor Drug Charge?
Can you be a nurse with a misdemeanor drug charge? This question is not going to be state-specific. I’m just going to give you general tips and things to consider if you apply for your nursing license. I know that many people that read these blogs may also think of going into nursing school and are thinking, alright, well, maybe I can get into nursing school. Still, I couldn’t get a license and wasted time and money. So, I will talk more about applicants or even people considering attending nursing school. It is not going to be directed towards currently licensed nurses.
Alright, so you have a past misdemeanor drug charge which could be a possession of a bunch of different drugs, potentially distribution. There are some misdemeanor distribution charges as well. If you’ve been convicted, you’ve gone to trial and lost. Or most likely reached a plea with the prosecutor. Then you had to do community service, fines, drug counseling, treatment, whatever. The board cares about convictions for the most part and not just charges.
It doesn’t mean you’ve ultimately been found guilty if you’re just charged with a crime. Most boards find that the nurse, in their minds, would be convicted. So, if you’ve had one misdemeanor possession of marijuana from 20 years ago, that will not keep you from getting your nursing license, let’s say.
What Does the Nursing Board Usually Look For in Drug Charges?
When a board looks at the criminal pass of a nurse, they’re going to run two things. They will ask in the application, which changes from state to state. Still, usually, they’ll ask: do you have any felony convictions? And then two, potentially, do you have any misdemeanor charges involving substance abuse? It does vary from state to state. You need to look at the specific language in the application of the condition that you’re looking to apply to and then see what you have to disclose. And then, the board is also going to write a criminal background check. Then anything that pops up in that criminal background check will likely reach out to you. And ask you to summarize what happened and maybe even potentially provide them with the police records or court documents, so keep that in mind.
What Do They Care More?
Now, in a board’s mind, what they care about is that they’re going to license safe nurses that don’t have drug problems. And the board’s stated mission is to protect the public. They’re not there to protect the nurse, so they will see how many different misdemeanor drug charges or convictions they have? If you’ve had 15 in the last three years, that is a big problem, and you will probably not get your license.
If you had, as I said before, maybe one from 20 years ago, almost no chance you wouldn’t get your license. It’s a sliding scale. It would help to consider how much time had elapsed from when you had your last conviction until when you applied and how many you have. You can also think that if you did have a drug problem at the time, what have you done to fix the problem?
If a nurse is addicted to methamphetamine doesn’t mean you won’t get your license. Still, the board wants to know, alright, if you had addiction issues, what did you do to solve that problem? Did you go to AA or NA, or did you go to counseling? Did you seek treatment, maybe you went into inpatient rehab, or maybe you went into an intensive outpatient treatment program in IOP. Perhaps you’ve made some lifestyle changes, have a different friend group, or got away from an abusive spouse or something like that. There must be a change if there’s just a big cluster of drug problems at a time. There must be some rehabilitation change for the board to feel comfortable with issuing a license.
When Charges Are Frequent and More Than Just a Misdemeanor
Let’s say it’s a recent number of drug charges, and they think this nurse hasn’t done what they need to do. It’s possible they could issue the license and put the nurse on simultaneous probation for drug issues. Most states would include random drug testing, supervision at work, continuing education, a nurse recovery group, counseling, rehab, whatever. I mean, there’s a variety of things they could do. But even if you’ve had a bunch of recent items, but you’re willing to do what it takes to get your license, the board can, as I said before, issue the license but put you on probation. It could be anywhere from 12 to 36 months, sometimes more. And if you were to get through that period, your license would no longer be burdened.
One Caveat About Being Placed on Probation
Now, one bad thing about being placed on probation is if an alternative to a discipline program is not available for you, in an alternative discipline program in most states. There’s a confidential monitoring program where you can do everything I just listed, but it wouldn’t be public. And it wouldn’t be considered formal discipline. If the board only offers you proper discipline, that will stay in your record, at least in most states.
So, you need to think about, alright, even if I do get a license, if I have this blemish on it forever, is that going to dampen the chances of me possibly getting the job I want to get? I would say no, but it is more difficult to find a job if you have a disciplinary history.
Before Attending a Nursing School, Get an Attorney to Review Your Drug Charges or Drug Conviction
So, in summary, you’re probably fine if you have one or two misdemeanor drug convictions. The closer to the date you apply, the more scrutiny you will get from the board. But overall, every situation is a little bit different. What I would suggest, I’m in Arizona, so I only help nurses with the Arizona board.
Before you even apply to a nursing school, it might make sense to reach out to someone in the state you’re considering using, someone with experience with nursing board issues. And say, hey, have you had a similar scenario in the past? And then what is the likelihood of me getting a license once I apply? No one is going to be able to give you a 100% accurate guess. Still, if someone’s been doing the nursing board for a long time, they can usually give you a precise, decently, I guess, estimation of whether they think you would get licensed or not. And then maybe if there was disciplinary action attached to that or not.
What Can Disqualify You From Being a Nurse?
What can disqualify you from becoming a nurse? I’m only going to talk about applicants, not people already licensed by the state. This video will be a general discussion of, alright, maybe I’m thinking of attending nursing school, or perhaps I’ve completed nursing school. Now, I must apply to a board. What things in my past can disqualify me from being a nurse in the future? Lastly, this is not going to be state-specific. It’s just going to be a general discussion.
The first and probably the most obvious thing is some heinous criminal incidents in your past. Almost none of the boards in any state contain a list of things like, if you’ve done these things, you can’t get a license. No matter what, they’ll have a general guideline. But, any violent crimes, if you were a maybe heavy distributor of drug diversion in some way. For instance, sexual misconduct is brutal to rehabilitate from, or at least in the eyes of the board. And so, having those in your past can be a barrier to getting a license.
Getting a Nursing License After A Crime
It may not feel like it when I talk to nurses who are always concerned about DUIs, marijuana possessions, theft, domestic violence, disorderly conduct, and an assault charge, but these are relatively low-level crimes. Because you’ve had those in your past, they generally will not disqualify you from getting a license in the future. Now, if you’ve had 20 assault charges, it’s probably not going to happen for you. Still, if it’s a handful of things from 20 years ago, it will not hinder you from getting your nursing license.
And even in this scenario where the board was very concerned about past behavior, they would almost always offer the nurse a probationary license, meaning they would grant the license. Still, they would simultaneously put them on probation for one to three years. And at the end of that probationary period. Then their license is unencumbered. That’s what happens typically.
I guess the timing of the felony would matter. Some states require a certain period after either the felony. I think the nurse or potential nurse was either convicted of the felony or completed the probationary requirements. I know here in Arizona, someone must have at least three years from the date of termination of probation for a felony to be eligible to reapply or apply for a nursing license.
Nursing Background Check, Criminal Records, and State License
The first things are heinous crimes, and two, high adverse publicity events. Boards of nursing are very concerned about the public image of nurses. And suppose there’s been a past incident with an applicant that negatively impacts the nursing profession. In that case, that board will be much less likely to issue the license. Most of those end up being criminals. Still, it would help if you considered that these are political agencies and the politics of issuing permits to people gives the eye. Either dangerous or incompetent is not something most boards are willing to do.
When the State Revokes Your Nursing License
Lastly, if you’ve had another healthcare license and you’ve been placed on the OIG exclusionary list. So the inspector general’s office has this list where if you’ve had a license revoked, suspended, voluntary surrender, or a certain number of crimes. They can exclude you from billing under Medicare or Medicaid. The boards, for the most part, don’t care about that at all. However, the employers, or at least some employers, will. If they can’t bill for you, they will not employ you. So, you need to think, alright, what happened to put me on that exclusionary list? And then you also need to consider ways of getting off it after a period and jumping through certain hoops. It would be best if you investigated doing that disqualify as well.
Very few things can completely disqualify a nurse from getting a license. Most of the boards want to see if something terrible happened. Have you learned from it? Did you take steps to remediate the behavior in some way? If it was maybe drugs or alcohol, did you go to AA? Did you go to counseling? Did you go to an intensive outpatient treatment program or rehab? Have you made just healthy changes in your lifestyle so that you can deal with stress better? These are the things the boards want to hear. Just because you’ve had one bad thing happen in your past, if you’ve learned from it and incorporated positive things into your life, that’s what the boards want to see.
Nursing License: Do You Have to Report a DUI to a Nursing Board?
Does a nurse need to report a DUI to a board of nursing? First, this is not state-specific. I’m not going to talk about any state’s specific laws regarding criminal reporting for a DUI. This topic is more of what a nurse needs to analyze and determine whether they must report something or not. Then the consequences of not saying something. First, you must decide if the board requires you to write a charge or a conviction. Some states require a nurse to report a criminal charge. Then others only care if the nurse is ultimately convicted. Therefore, they wouldn’t have to report anything dismissed and go to trial.
Arrested or Not, is it a DUI Charge?
So, what is a criminal charge? Let’s say you’re out Saturday night, have a few drinks, get a DUI, the officer hands you a ticket, and there’s an arraignment date. In this case, you’ve been charged with DUI in your initial appearance to enter a plea. In that scenario, if the board required you to report a charge, you’d need to submit written notice to the board that you had been charged with the DUI.
Now, there are scenarios where a nurse can be pulled over and given a DUI but not explicitly charged. In those scenarios, maybe the nurse refused to do a breathalyzer, took the nurse’s blood, and waited on the blood test results to determine whether to charge the nurse. Maybe it didn’t involve alcohol. It was a drug DUI. They once again got a blood test and were, I guess, testing it to determine whether the nurse was impaired or not or had a level of impairment in some way.
There are scenarios where you could have been pulled over and even potentially arrested but not charged explicitly at that point. At some point, when the blood test results come back, they deem they want to charge the nurse if they’re at the level. The nurse will get a notice from the court that they have been charged. And then, at that point, that’s when they can report it wherever they are on board.
Convictions and the Nursing Board
As far as a conviction goes, I know many states will require the nurse to report a conviction immediately. And then I’ll talk about that in a second, or sometimes they’ll say you’ll need to report any conviction on renewal. So, that’s another thing you need to figure out. If it is a conviction, do you have to notify it immediately? It’s usually a 10-day window. Or do you have to report it upon renewal? For most states, that’s two years. As far as a conviction goes, most boards consider a conviction any plea agreement, obviously any result from a trial that’s a guilty verdict. Most will feel the pretrial diversion program is guilty in some respects. For instance, if you’re a nurse who got a DUI and then you sign a pretrial diversion, most boards would consider that reportable.
Consequences: Could Cause You Your Nursing License
What are the consequences of not reporting a DUI? When you initially apply for your license for any board, they will do a criminal background check. Then, if they required a nurse to report any misdemeanors involving substance abuse, many of them do, you didn’t report it. Then they do a criminal background check, and it pops up. Well, they’re going to think that being deceitful and trying to hide your criminal past. Then that could be grounds to deny the application or give the nurse formal discipline.
That one thing to think about is you must read the specific wording of the application if you’re going to apply for a license anywhere. Then determine, alright, does this fit whatever happened to me? Some states will have a period. So, they’ll say, no, we’ll only go back ten years. In contrast, it’s entirely open-ended for others, and you could theoretically have to report something from 30 years ago.
If you are currently licensed and decide not to report something when you should have. Either immediately or upon renewal, that certainly could be grounds for formal disciplinary action if the board finds out about it soon. Every renewal would be considered another lying to the board. Let’s say you got a DUI, but you didn’t report it. The committee found out ten years later. You’ve had five renewals since then. They could say, well, you violated it every two years. So, you had multiple violations beyond just not reporting it. Then that doesn’t even get into the investigation that will likely follow to determine if that nurse has substance abuse issues or chronic problems with drugs or alcohol.
In Your Defense, DUIs need to be Reported.
So, for the most part, you will need to report a DUI. It’s going to depend on if you were charged or convicted. Now, are you going to lose your license over a DUI? For the most part, it’s doubtful that a nurse would lose their license just for a single DUI. Now, if a nurse has had three DUIs, they are on probation. If they get another DUI, they violate whatever consent agreement they’re on, which could lead to the revocation of a license.
But suppose it’s a first-time kind of regular DUI, not a crazy BAC. In that case, it’s implausible that you would lose your nursing license. DUIs, honestly, are probably the most common criminal issue that we handle. Domestic violence, theft, shoplifting, and DUIs are the three most common criminal cases that we deal with for nurses. Kind of lower-level stuff, but there are still things that could concern any board of nursing.
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