RN's w/chronic pain, using narcotics

TX_ICU_RN · Mar 5, 2008

If you are in chronic pain that needs to be managed with narcotics then you obviously should take them.
I've worked with people that were on methadone for chronic pain and they performed just as well as those that weren't. But if being on narcotics impairs your ability to perform your nursing duties, then you need to find another job. Your right to proper treatment does not supersede the right of the patients to have an unimpaired nurse.
That being said, as one of the docs I work with always says: "there's always a plan B."
Acupuncture, biofeedback, PT, morphine pumps, spinal cord stimulators, RF, epidural steroid injections...
If your pain doc is unwilling to do anything other than keep you on narcotics, find a new one.

I totally agree with your post. From the beginning, I have seen a PM doctor who works with a multidiscipliary team. There is way too much danger in simply seeing a PM doctor who freely hands out narcotics and does no other interventions.

In the beginning, learning to manage my pain was a full-time job in and of itself. Chronic pain brings on such a host of issues that there is never one magic "cure-all" for the situation. I feel so fortunate to live in a society and time where we have so many pain management options as well as new research being conducted across the country.

Now that I have spent 3 years learning to control, manage and live with all the aspects of my chronic pain, I am ready to return to nursing. That being said, I would NEVER put the welfare of a patient in jeopardy due to my pain or pain medications.

I think the biggest issue that nurses with chronic pain face is the lack of understanding by our peers that people can function on narcotics and not be impaired. There are so many chronic illnesses that require medication to be properly controlled...and rarely does anyone get too upset about other medications that have side effects that can be extremely impairing. It is so frustrating to have people automatically assume that you are impaired because you take meds for chronic pain.

tracy2kay · May 3, 2008

Wow, I can't believe that people have been allowed to work with pain meds. Now here this I don't think that using pain meds is a bad thing! I'm on your side! But after the awful experience I went through... I have scoliosis and worked as a nurse's aide and then as an RN in the hospital for the last 10 years. Long story short, I hurt my back, (MRI says disk desication throughout spine, multiple bulging disks- some abut the root nerves, thecal sac flattening, end plate changes, schmorl's nodes with reactive marrow edema, facet arthropothy, etc etc)-- lived in constant, terrible pain til I couldn't work anymore,(my boss who was new and didn't know me that well was trying to find reasons to fire me d/t the intermittent FMLA was "messing up his budget") had many many many injections, PT, had nerves burned in both sides of lumbar spine. After searching high and low for a job not involving direct patient care (bending, lifting, twisting) was offered a case management job in a hospital ER - job description was clear that there was no patient direct care. I told them I was on Avinza (long acting modified morphine) because of the urine drug test. Not only did they rescind the job offer because of this but the employee health charge nurse talked to me as if I was a drug addict straight from the street corner!! Even though my doc sent them records of everything and his support of my ability to do the job, they treated me like a stereotyped druggie. I was devestated, and still do not have a job........:bowingpur

tracy2kay · May 3, 2008

You know I have a very bad back injury but not a good candidate for the 3 level fusion the surgeon otherwise would have performed (because of the severe upper scoliosis curve). I worked as a hospital nurse for 10 years and then was terminated (my FMLA ran out and I hadn't returned). I searched for months (few jobs for non physically working nurses- some of these jobs required experience say in case management) and got a part time weekend case manager job offer at another hospital (job description clearly stated no direct care duties- mostly computer work). At the urine drug screen, I told them that I take Avinza (the lowest dose of this long acting modified morphine which did not affect me adversely) and immediately the employee health nurse said "oh there could be a problem then". My doc sent all my records showing the MRI's and so many injections and procedures I can't count, as well as his support and belief in my ability to perform the job. After practically being called a drug addict, the HR director called me to say they were rescinding the job offer based on the medication I was taking. Do you think this is even legal? I showed no evidence of impairment- no car accidents or anything- I was just never given a chance.

tracy2kay · May 3, 2008

Thank you for sharing your story. I am so sorry for this to happen to you and your husband. Perhaps if people did not attach such a horrible stigma to people in pain and those that need the medicine this wouldn't have happened, because then maybe he would've been able to be more open with his doctor and ask for what he needed.

God bless you

tracy2kay · May 3, 2008

Does anyone have thoughts on this: Is it unethical or unwise for a nurse working as a case manager (in a hospital) to use pain meds (long acting) when her job does not involved direct patient care? If the job involves mostly computer work?

LilgirlRN, ADN, RN · May 3, 2008

Tracy, I can believe anything could happen in hospitals! I have chronic pain and am on medication for it. Because of my pain sometimes I do not sleep for nights at a time even though I take Ambien, I have many of the same back issues you do. I came to work, someone told the nurse manager that I "had a funny look in her eyes". Luckily the pain medication I was on at the time (talwin nx) doesn't show up on most drugs screens unless specifically looked for and I got a paid vacation until the drug screen came back negative. I no longer take that medication and there have been several times that I have hurt myself at work since then and should have reported it but didn't because they would make me do a drug screen. I often wanna ask this question... would you rather have a nurse who is so disrtracted by her own pain that she can't effectively take care of you, or one that takes pain medications so that they can function? Studies have shown that people who are on chronic pain meds function better when on the meds in every capacity, even driving than if distracted by pain. Now don't ask me to dig up the studies I just remember reading about it and even seeing something years ago on 60 minutes about patients that had huge amounts of pain who could not get enough pain meds from their doctors for fear of the doctor being investigated by the DEA. Even people who are dying are often denied medication by their own family for fear of their loved one becoming addicted. We all know this, we've all seen it. I need to find a new job this one is just to rough on me physically, however one of the things that keeps me right where I am is that I would have to be in pain for days for the medication to clear my system to take a drug test for the new employer. UGHHHHHHHH, I could go on for days about the stupidness of this. It's not like I'm doing brain surgery on patients, ya know?

tracy2kay · May 4, 2008

Dear Lilgirl,

Thanks for responding, I am sorry you are going through these problems. I feel so depressed today, I interviewed for a telephone health coach position last week, thought the interview went well, and two days later got a rejection letter. I don't know why I am having so much trouble getting a job!! I am not an idiot, I have a BSN graduated magna cum laude and did a good job for 9 years at the hospital. I was charge nurse and did precepting almost continuously. I just don't know why no one wants to hire me! If I don't get something soon I will have to sell my house. This is so terrible..........

I love my cat! · May 6, 2008

Does anyone have thoughts on this: Is it unethical or unwise for a nurse working as a case manager (in a hospital) to use pain meds (long acting) when her job does not involved direct patient care? If the job involves mostly computer work?

I am so sorry you are having to deal with pain issues. It a horrible and frustrating condition to have to endure (and often terribly misunderstood).

My advice: Call your BON and as them about policies r/t the use of Prescribed Opioids and work.

For example, here in California, a Nurse can practice while taking Prescribed opioids. Patient and non-Patient care.

I called the CA BON a few weeks ago spoke with a Nurse Educator (I called because there are so many threads r/t working and Scheduled meds). She told me that it really comes down to individual facilities and their policies. So, talk with HR and see what policies they have implemented.

As I have stated before in another thread, I would advise you to NOT share the fact that you take pain meds with anyone you work with (except through the hiring procedure...if asked).

Why? Because out of ignorance, many people will become hypercritical about everything you do. Tired? Yawning? Drop something? Forget something? Late? Call is sick? It will always be blamed on the pain meds. and believe me, someone that knows that you are taking those meds will happily volunteer that information for the entire office/floor....only out of concern for you though

The funny thing is, it will be perfectly ok for someone not on pain meds to do the exact same things.

Yes, studies have shown that people can function better with the proper medication. There is also a study debunking the myth that individuals with chronic pain (and their use of opiates) have impaired/delayed reaction times when driving. (Will post that article later).

tracy2kay · May 6, 2008

Thank you so much for your response. Unfortunately I learned too late and didn't get the job that I really wanted (and NEEDED!); but I would've had to be deceptive to get that job apparently. I did file a complaint with the EEOC today and am curious what they have to say about it. I have a feeling that they will side with the hospital and say that the hospital has a right to hire whomever they want. I'm sure the stereotypes and prejudices will remain despite the evidence on their safe and effective use.

Tracy

Nursebarebari · May 12, 2008

I am currently, and have been, for 3 years, taking oxycontin for chronic pain. My question is, Is is legal for a nurse to work while taking pain meds? I am unable to work, or hardly move unless I get some relief from the pain. A nurse friend told me it is against the nurse practice act for a nurse to care for patients while under the influence of narcotics. Looks like I will have to stop working if this is the case. I have been a nurse for 27 years...what else could I do? What else would I want to do? answer to that last question is easy..I don't want to do anything else. Thanks for your time, and any help or suggestions.

You sound like you are going to be on the med for a very long time.

If the meds impairs your ability to think and act right, then you should not be working, otherwise, I don't see any why you or anyone should be concern about it. I don't know about the nurse practice act rule on this.

NJLaurenRN · Aug 2, 2008

i too am in a similar situation. i injured my back back in january. have been in pain since. in fact i feel the same amount of pain since day 1. went to employee health, now being treated thru workman's comp. they sent me to an ortho doc then to a pain management doc. had 3 epidurals. was on high doses of percocet and oxycontin. it in no way affects my judgement nor does it impair me. in other words i never feel "high", but i do however have some relief from pain. now after 3 epidurals the pain has decreased. so i decided to come off the meds. wow. i went thru such a bad withdrawl. almost like a heroin addict. gradually i tapered my meds down. i did work on these meds. my theory is if no one asked then they didn't have to know. the employee doc even prescribed my first script of percocet. it stays in your system for up to 5 days. if i was ever drug tested, who's to say that i didn't take them when i got home from work. so i feel that there's no way they can prove your on them unless you admit it. as a fellow RN i know what you are going thru. i would give anything to be back to normal again and not feel pain...

lostkitty_1 · Oct 8, 2008

I am a registered nurse also taking narcotics for pain. I have had 3 herniated cervical discs. Two (2) have been surgically corrected. I have constant pain in my head, shoulders and arms. I also experience numbness in my hands. I am presently taking Lortab for the pain but it is not fully controlled. Sometimes I take 2 lortab to curb the pain which increases the amount of acetaminophen taken, whick is not good. I turned down Oxycontin because I was afraid of the drug. I noticed that some are taking this medication with good results. Do you feel the addiction properties is as strong as has been stated? I too am also unable to work because of this problem and facing disability. It is hard to accept that fact. :cry: