Pharmacology Unit 1: Drug Diversion and Exam Preparation

Course context and exam emphasis
- The course prioritizes application and clinical decision making alongside information from lectures and readings.
- Exam application target: the instructor notes that last semester exams reached about 60 ext{ extendash}80 ext{ extendash}?? application; this semester starts at 80 ext{ extpercent} application and remains at that level throughout the term.
- The exam style emphasizes clinical decision making and prioritization; many questions involve applying knowledge to scenarios rather than pure recall.
- Rough translation: there will be substantial practice with application-type questions in class to mirror NCLEX-style items and real-world nursing decisions.
Textbook and lecture relationship; study approach
- Some students are avid readers of the textbook; the instructor notes the textbook is a great source when used strategically.
- Lectures will follow the book chapters; the PowerPoints provide outlines of curriculum and book material.
- When you’re unsure or feel shaky on a topic, locate the corresponding paragraph in the book and read it for clarity and faster memory retention.
- The goal is not to cherry-pick random sentences to appear as exact test answers; alignment with the book and lecture content is emphasized.
- Practical guidance: choose study methods that work for you, whether reading the paragraph, outlining from PowerPoints, or other methods.
Attitude toward study tools and exams
- NCLEX and exam design: the exam tests situational knowledge and clinical judgment, not just memorization.
- The instructor emphasizes that nursing is not about knowing everything in advance but about making the right decisions with what you know.
- Acknowledgment that standardized testing has limitations; the course uses NCLEX-style preparation to foster clinical reasoning, not to punish memory gaps.
Medications and pharmacology focus
- A rotating list of medications is involved: approximately ext{a large set (about }140 ext{ medications) } will be covered; the course lists around 140–150 meds in some modules, with roughly 140 ext{+} appearing in practice.
- There is also reference to the NCLEX prioritizing the top 200 most commonly prescribed meds; those top meds are considered core for every body system with up-to-date practice.
- Important practical point: you will not be tested on memorizing every medication; the focus is on core meds, recognition of safety implications, and prioritization in clinical scenarios.
- Reason for emphasis: even if a specific drug is not in your memory, you should be able to reason through safety priorities and essential nursing actions.
- The instructor notes that a disease process or medication you haven’t heard of in class can appear in questions, so focus on safety, assessment, and critical thinking rather than memorizing every drug.
Pharmacology resources and study tools
- NP Pro flashcard maker (Quizlet-style): supports adaptive repetition (green = mastered; yellow = review; red = difficult). This helps with spaced repetition and retrieval practice.
- Dynamic Health: a nursing-specific resource updated daily for current best practices.
- Quizlet: useful but cautioned against overreliance; it’s a tool for memorization but not a substitute for deeper understanding.
- NotebookLM (Google AI platform): converts lectures and slides into a podcast-like format for quick review. Features an AI that can be used to discuss or summarize material; a free account is available.
- Additional AI ethics: MIT research cited shows that using AI to perform cognitive tasks can decrease cognitive retention by about 30 ext{ extpercent}; AI can aid organization and study planning, but should not replace active studying or memory work.
- General stance: AI is a time-saver for organization but should not be used to bypass actual study or memorization; cognitive retention may suffer if used improperly.
AI-enabled study aids and their caveats
- NotebookLM can generate podcasts from lectures to aid outside-class review; the podcasts are concise (roughly 10–25 minutes per unit) and provide a big-picture overview.
- The instructor is open to showing how NotebookLM works but emphasizes that tools are supplementary.
- Caution: AI tools do not replace hands-on practice with clinical scenarios and problem-solving.
Unit 1 focus: Drug diversion (substance use and drug diversion in healthcare)
- Central question: What is drug diversion and what does it mean in nursing practice?
- Definition: Drug diversion is taking a medication away from its intended use, which can be intentional or unintentional, and can involve abuse, misuse, or redistribution.
- Common targets: Narcotics and drugs with abuse potential (e.g., narcotics, amphetamines) because of their high abuse potential and accessibility.
- Public health context: CDC has labeled prescription drug misuse as an epidemic; diversion is a major concern in healthcare settings.
- Why prescription drugs are diverted: they are more accessible than illicit drugs; they can be hidden more easily; safe disposal and accountability are critical.
- Nurse’s role in diversion: recognition, prevention, education, safe use/disposal, and reporting when concerns arise.
- Key statistic: Approximately 10 ext{ extendash}15 ext{ extpercent} of nurses nationwide are currently abusing or recovering from medication (including alcohol).
- Access and risk factors: high access + high education level about meds increase opportunities for diversion; work-related injuries and stress contribute to risk.
- Stress and coping: Nursing work is highly stressful; some individuals turn to substances as a coping mechanism; stress contributes to the risk of diversion.
- Addiction is multifaceted: Drug addiction involves both physical and psychological dependency; treatment is often long-term and insurance coverage for rehab is limited (commonly around three weeks).
- Systemic issues: The healthcare system’s structure and insurance can limit effective long-term treatment, leading to relapse risk.
- Monitoring and safety: The highest priority is patient safety; regardless of drug identity, ensuring safe care is essential when diversion is suspected.
Signs, assessment, and interpretation of diversion indicators
- Physical signs to watch for may include changes in appearance, behavior, mood, or cognitive function; however, no single sign confirms diversion.
- Potential indicators include: unusual mood changes, defensive behavior, forgetfulness, decreased accountability, or unexplained access to medications.
- Practical sign examples discussed: a nurse who previously managed pain well but suddenly reports unrelenting pain relief demands; wearing long sleeves in hot weather (needle marks or injection activity); signs of needle use or injection elsewhere on body.
- Assessment approach: perform a full patient assessment; avoid diagnosing solely from one symptom; gather a full story and objective data.
- Conversation approach: start with a caring, non-accusatory dialogue with the nurse if you notice concerns; discuss concerns and offer support before escalating.
How to respond if you suspect diversion
- Step 1: Prioritize patient safety; do not wait for confirmation to take action.
- Step 2: Talk to the nurse with a non-confrontational, supportive approach to assess the situation and gather information.
- Step 3: If concerns persist or you have concrete reason to believe diversion is occurring, escalate via chain of command and document observations.
- Step 4: Collect and preserve evidence; avoid making unverified accusations that could harm a colleague’s career without justification.
- Step 5: Understand that false accusations can ruin lives; but failing to report can expose patients to risk and carry legal implications for the reporter.
- Step 6: After reporting, the nurse may undergo formal investigation; outcomes vary by jurisdiction and severity; possible outcomes include treatment pathways or licensure actions.
Consequences and rehabilitation for diversion cases
- For the nurse: consequences can include investigation, license suspension or revocation, and in severe cases permanent loss of licensure.
- Some cases allow for rehabilitation programs and reinstatement with restrictions (e.g., not administering narcotics without oversight).
- In some settings (e.g., certain regulatory frameworks), licensure can be permanently revoked with no reinstatement option.
- The recovery process is long-term and varies by case; addiction treatment often requires ongoing support and monitoring.
Real-life cases and public examples (Utah context)
- Nurse Ella Nielsen (ER nurse): delivered drugs at two hospitals; used dirty needles; spread hepatitis C to 12 patients; stole and burned narcotics; sentenced to ~60 months in federal prison; license revoked.
- Home health nurse case: attempted murder by overdosing an elderly patient with insulin after a personal motive; case pending.
- Pharmacy tech case: stole a provider’s prescription pad and wrote narcotic prescriptions for self and family for nearly a year; licenses revoked.
- PACU nurse during COVID: diverted fentanyl syringes by pocketing them; admitted, rehab, and license reinstated with restrictions on narcotic administration; later pursued a role as a case manager.
- These cases illustrate the range of diversion scenarios from hospital settings to home health and pharmacy practice; all show the potential for patient harm and lasting professional consequences.
Ethical, legal, and professional implications
- Duty to report and protect patients vs. risk of harming a colleague’s career with an accusation.
- Legal implications include potential criminal charges for diversion and professional licensure consequences.
- The public can access licensure records (e.g., through state licensing boards such as Utah DOPL); license status and disciplinary actions are public information.
- Protecting patients and ensuring safe practice are the primary ethical duties for nurses and all healthcare professionals.
- Stigmas exist but must be balanced with accountability and support for rehabilitation when appropriate.
Regulatory and licensing context (Utah example)
- DOPL (Utah Division of Occupational and Professional Licensing) provides public information about license status and disciplinary actions.
- Employers routinely check license status and any restrictions as part of hiring processes.
- Public records include license restrictions, disciplinary actions, and criminal charges related to professional practice.
Practical takeaways for students and practitioners
- Be aware of the prevalence and risk factors for drug diversion in healthcare settings.
- Develop skills to recognize subtle and diverse signs of diversion, not just obvious red flags.
- Use a measured, evidence-based approach to addressing concerns: observe, document, talk to the colleague, and escalate when needed.
- Prioritize patient safety in any suspected diversion scenario.
- Understand that addiction is a complex, long-term issue; referral to appropriate treatment and support services is essential.
Course logistics and additional notes
- There is a math module at the start of the term; the unit covered here (pharmacology) will be part of Exam Two in about two weeks.
- Unit 1 content (drug diversion) will be tested on Exam Two; Unit 2 and Unit 3 materials will be covered for subsequent examinations.
- The instructor emphasized that the exam will require applying knowledge to clinical scenarios and making prioritization decisions, not just memorizing facts.
Quick reference numbers and terms
- Nursing diversion prevalence: P( ext{diversion}) ext{ for nurses}
  oughly = 0.10 ext{ to } 0.15 (10 extendash15%).
- Prescription meds as diversion targets: prescription drugs are commonly diverted due to accessibility and concealability.
- Top medications and core curriculum: NCLEX prioritizes the top 200 most commonly prescribed meds; aim to be comfortable with these in each body system context.
- Rehab duration and insurance reality: rehab typically extends longer than the typical three weeks covered by insurance; long-term recovery is common and necessary for lasting change.
Final reminders for effectiveness
- Memorization has a role (as referenced with “FARM” in the lecture), but deeper understanding, critical thinking, and application are emphasized as the keys to success.
- Leverage a mix of study tools (outlines, flashcards, dynamic health resources, and AI-assisted study aids) but avoid overreliance on any single tool.
- Stay aware of ethical considerations and the importance of safeguarding patients, colleagues, and professional integrity through appropriate reporting and supportive intervention when needed.
Quick break and next topics
- Break planned after this segment for ten minutes; next topics will continue with further pharmacology content and case discussions.