Duragesic patch + recovering nurse with chronic pain = ???

  1. The title really kinda says it all. I have been clean and sober for 2 years and have a long history of chemical dependency. Fortunately, most all of this history was pre-nursing. I did have a relapse while working in nursing and did get help. Prior to that I had several years clean and sober.

    Now to the situation at hand. Recently I have been promoted to a clerical/supervisory job which is extremely busy {house supervisor}. Also, 6 weeks ago I herniated a disk in my lumbar spine. When I am not working the pain is bearable with just ibuprofen. But when working I have excruciating pain.

    I am working hand-in-hand with my internal med doc who knows my history very well. Recently he prescribed the 25mcg/hr Fentanyl patches. They really help and I cannot perceive a feeling that I am "high" in any way. I also cannot tell that they affect my performance at work one way or the other. And most importantly, I do not control the dosing.

    Now the hard questions....

    As I see it I have 4 options:

    1) continue to work and keep my mouth shut
    2) talk to my Director and CNO about this and risk being viewed as "impaired" or "relapsed"
    3) take a short medical leave of absence and pray and seek advice on this
    4) try for a permanent medical disability

    Two things I will NOT do:

    1) surgery {yet again}....2 cervical fusions and previous laminectomy
    2) suffer needlessly

    Your help greatly appreciated,
    loerith
    Last edit by loerith on Jun 7, '04
    •  
  2. 17 Comments

  3. by   NurseKimberley
    I wouldn't call it a 'relapse' because it's a prescribed drug. If it were me, I think I'd have a talk with your director, just to be sure everything's out in the open and on the up-and-up. That's a hard one. Congrats on the being sober part, and sorry for the pain.
  4. by   leslie :-D
    i would opt for #2. i would hate to see you relapse which is always a possibility. good luck.
  5. by   Quailfeather
    Have you checked your hospital policy regarding working while taking a narcotic? In our hospital, nurses involved in direct patient care may not work if they are taking a narcotic pain medication. The administration makes it very clear that if you are in such pain that you need narcotics, then you shouldn't be working. I don't know what our policy is for clerical/supervisory positions, though. Also, have you tried Vioxx? When I put my back out last year, my pain resolved w/in 24hrs of starting Vioxx. I have a sensitive stomach so I can't take ibuprofen and most narcotics, but the Vioxx did not cause any GI upset. I wish you the best in resolving your dilemma. Also congrats on your recovery from addiction. I strongly agree that recovered addicts deserve the same level of pain relief as everyone else.
  6. by   loerith
    Quote from Quailfeather
    Have you checked your hospital policy regarding working while taking a narcotic? In our hospital, nurses involved in direct patient care may not work if they are taking a narcotic pain medication. The administration makes it very clear that if you are in such pain that you need narcotics, then you shouldn't be working. I don't know what our policy is for clerical/supervisory positions, though. Also, have you tried Vioxx? When I put my back out last year, my pain resolved w/in 24hrs of starting Vioxx. I have a sensitive stomach so I can't take ibuprofen and most narcotics, but the Vioxx did not cause any GI upset. I wish you the best in resolving your dilemma. Also congrats on your recovery from addiction. I strongly agree that recovered addicts deserve the same level of pain relief as everyone else.
    1) I do not do direct patient care {clerical/bed control/paperwork}
    2) I am very close for opting for #3

    As you said I need to find out what my hospital policy is. But surely they make a distinction between a patch and just popping pain pills....but then again....who knows. I think I need to be relatively sure on this and I need more advice and time to mull it over.

    I have quite a few sick hours acccumulated and I think I need to look out for myself here.

    /sigh


    Thanks,
    loerith
    Last edit by loerith on Jun 6, '04
  7. by   traumaRUs
    Well first congrats on being clean anId sober! As I'm sure you are aware - you must care for yourself first before you can care for others. I think a short leave would be appropriate. Good luck and hope you feel better soon.
  8. by   vanrn
    Please be careful, as you well know. Personally, I would find it easier to keep my mind and body busy at work than at home with the narcs, especially with your history. A red flag to me about this situation is why you consider an injury of two weeks "chronic pain". Be honest with yourself and your employers and you can't go wrong.
  9. by   moia
    She suffers chronic pain from repeated neck surgeries I would think.
    Fentanyl patch/popping pills..no difference you are on narcs and therefore considered impaired.
    I am a little surprised the doc chose fentanyl as it is one of the last drugs in the line but it may be because you can't alter the dose.
    I think you need to take sick leave immediantly and keep your mouth shut.
    If you tell your facility you are on narcotics at work they will freak....nurses who test positive on a surprise urine test on the job can be fired or referred to rehab...the fact that you got your drugs legally isn't going to save your licence.
    Your job may help in moderating any punishment but no one believes you are not affecting patient care...just because you are not directly caring for them doesn't mean your actions don't effect them directly.

    The college will consider you working while impaired...with your history it spells disaster.
    Book off sick..get a doctors note...then approach the facility about returning to work while on pain medication...let them make the decisions not you.
  10. by   Hellllllo Nurse
    Unless you have a VERY understanding NM, I would opt for option #1.
  11. by   DG5
    You can never go wrong with prayer.
  12. by   tommyperkins
    Quote from DG5
    You can never go wrong with prayer.
    As long as it is your choice how and where to pray.

    "There goes many a ship to sea, with many hundred souls in one ship, whose weal and woe is common, and is a true picture of a commonwealth, or a human combination or society. It hath fallen out sometimes, that both papists and protestants, Jews and Turks, may be embarked in one ship; upon which supposal I affirm, that all the liberty of conscience, that ever I pleaded for, turns upon these two hinges--that none of the papists, protestants, Jews, or Turks be forced to come to the ship's prayers or worship, if they practice any. I further add, that I never denied, that not- withstanding this liberty, the commander of this ship ought to command the ship's course, yea, and also command that justice, peace and sobriety, be kept and practiced, both among the seamen and all the passengers."

    Roger Williams
    Letter to the Town of Providence
    1654
  13. by   loerith
    Thanks everyone sooooooooo much for your time and help. I am leaning more and more towards Moia's slant on things here. To be blunt, I dont trust the reaction I am going to get if I even mention the word "narcotics" ; even with my super-supportive director. :uhoh21:

    I think the safest thing I can do is take off work immediately. {I am off work right now - just 3 paid time off days}. I will go see my family doctor ASAP and get some type of documentation from him saying that due to the herniated disc I need 3-4 weeks of medical leave of absence. I like the idea of THEM making the decision Moia but I am still hesistant to even mention the narcotic to them as I write this.
    Then again if I am off work, with physician's letter in-hand it might be beter to be open and forthright about it.

    As far as the "red flag" and "short time" chronic pain thing, let me elaborate just a bit. First I see red flags and feel them everywhere, but not because of the reasons you stated. Have had multiple spinal surgeries and have had chronic pain for a few years now.

    Please feel free to post any other thoughts/sugestions.

    And again.....

    Thank you.


    Love and Peace,
    loerith
    Last edit by loerith on Jun 7, '04
  14. by   bellcollector
    I am a nurse with chronic pain. I have fibro and several herniated discs, degenerative disc disease and I am on duragesic 75mcq. I was on a 3day off leave from the doc to adjust to the medication. As soon as he put me on it I went straight to my DON (I am a floor nurse). She was very understanding and checked things out with the BON of my state. According to what she told me they could not discriminate against me just because I have a condition requiring narcotic pain meds and that like any other med the body adjusts so therefore I would not be impaired once my body adjusted. They did however request that I take an entire week rather than just 3 days off and that I have my MD fax my dx and current meds. I do not have a history of drug abuse and they had already known about my illnesses. I also had been on lower scale narcs for quite some time. Anyway I hope my experience can in some way help you out.

close