Nurses' grieving processes after a drug diversion experience

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I am writing in response to the article “Using Servant Leadership to facilitate healing after a drug diversion experience” (Vol 88, August 2008). The article's author, Lynne Marie Ramer, RN, MSN, CNOR, states that little attention has been focused on coworkers affected when a nurse is caught diverting drugs from patients for personal use. She writes that these staff members experience a grieving process, and she discusses how Servant Leadership interventions can be used to address the different stages of grief.

I agree with most of Ramer's points, but I disagree that the phases of grief described by Robert Kavanaugh in Facing Death are more applicable to nurses' healing processes than the stages of grief described by Elizabeth Kubler-Ross in On Death and Dying. Kavanaugh's phases are shock and denial, disorganization, volatile reactions, guilt, loss and loneliness, and reestablishment. Kubler-Ross's stages are denial, anger, bargaining, depression, and acceptance.

In particular, I disagree that disorganization—Kavanaugh's second phase—applies, because most nurses are very organized, mentally and physically, in their work, even in a crisis. From my own experiences, I believe that Kubler-Ross's second stage is more applicable. Most nurses will be angry after the shock of learning that someone they trusted and relied on has let their profession down. Anger is an appropriate emotion when thinking about patients who do not get the care they need and deserve.

I have, on several occasions, worked in departments that have been through interventions because of medication diversions. I believe that we, as nurses entrusted to care for the sick and dying, are angry when we find out a coworker is stealing drugs. Diverting medications from patients is a betrayal of the essential trust required in the profession. Is the patient left suffering because of a lack of medication? How would we know? Some patients cannot speak for themselves, and the RN must be there to advocate for them. Suspicious behavior always should be reported to prevent drug diversion. This will protect our patients and ensure that they receive the care we took an oath to provide.

Ramer concludes that

Failure to address the grieving process in proactive ways can lead to the loss of staff morale and may affect staff retention and the delivery of quality patient care.^(p258)

This is an important statement to remember. After losing a coworker to drug addiction, we must not only support each other but also preserve the integrity of the nursing profession.

I believe that all of Kubler-Ross' stages serve a purpose in grieving the loss of a nurse to drug addiction. Drug abuse in the workplace drains coworkers emotionally and physically. With the support of Servant Leadership interventions, nurses can be helped through the grieving process to acceptance that these things do happen, and they can make plans to prevent drug diversion from occurring in the future.