I'm interested in your opinions about an incident at my workplace a while ago. Although I felt outraged, my response was apparently in the significant minority.
The patient was a 17 year-old street kid who had come in with cellulitis of the foot for IV anti's. I looked after him overnight and, as it was quiet and I had the time, we talked a bit. I found him to be polite, co-operative and surprisingly well-adjusted given his social and family situation (abusive/neglectful parents, foster care issues etc); no criminal history, no IVDU history, working part time with an eye to going back to school.
I came on duty the following night to a furore. About ten minutes before I arrived, a courier had delivered an envelope to the ward. It was addressed to the patient, and sealed.
One of the nurses (who, I think, wasn't actually looking after the patient) had assumed that the envelope contained dope and - after drawing the rest of the shift's attention to it - opened it. It did indeed contain a bag of fragrant, grass-like substance - about enough for two (not particularly generous) joints.
The nurse locked the bag up in the DD cupboard, and when I arrived was holding forth about the inappropriateness of the delivery.
I have two issues here - the first is that (as far as I know) opening another person's mail is an offence. I don't believe that she had any right to take that action, at least in this case. Had the courier arrived fifteen minutes later, I believe I would have taken the envelope into the patient and said "If this is what I think it is, be discreet." It's not like marijuana is going to interfere with his antibiotic therapy. In fact (and I think this may lead to some strong disagreement), I advised the patient to contact the hospital's patient advocate to make a complaint, which he decided not to do.
My second issue with this incident is what really interests me, though. I may have felt less indignant if the nurse involved had a moral objection to drug use, or some concern about an interaction with his meds/impact on his medical treatment.
However Jane (as I'll call the nurse) was not opposed to recreational drug use. Although I knew this because we were friends, she was quite open about her own recreational drug use. In fact, she had only the previous week had a planned "Ecky weekend" - taking ecstasy one night and coming down over the next two days.
I was therefore very taken aback by this hypocrisy on her part. So my questions are these:
What would you have done if the courier gave you the package?
Was Jane being a hypocrite, or am I too judgemental?
Am I being a hypocrite by having different standards of appropriate response for drug-partaking and non-drug-partaking nurses? I, incidentally, am one of the latter :)
Patients have the right to send and receive mail, and to personal privacy. The nurse could havewatched the patient open it to make sure there were no dangerous articles in it, and then could remove and lock up anything- if she thought the items were dangerous. She can't search the patient's belongings without their permission, and she can't open mail that has not been delivered to the intended recipient. The fact that the letter was given to her to give to the patient is a very weak defense, especially since she is in a position of trust.
What if there were no illegal drugs in the envelope, but there was private letter? (with a very home-grown smell :)) That would be an obvious breach of privacy. Just because the nurse happened to be right about the contents doesn't make her action legal or ethical.
Specializes in Med/Surg/Ortho/HH/Radiology-Now Retired.
"Jane" needs to be reported for BOTH opening the mail, ( it IS illegal to do so, regardless if it was delivered by a courier, or Australia Post! Most often Aust. Post contracts private couriers anyway.)). And... for her drug use!! You have a responsibility as a practising nurse who has knowledge of a fellow nurse taking drugs AND practising, to report her to both the nurses board in your state, and the hopsital she and you, are working in. I suggest you read your states nurses board legislations and rules etc. Then, read your hospital's policy on staff and consumption of drugs, alcohol etc.
As for the patient and his rights..... again, read your hospital's policy on that matter. You may well find there are rules against the possession of illegal substances within hospital grounds, including the wards!
... don't think any law was broken by opening the package (Americal law)... since a hospital is a private facility that any object brought in has the right to be searched...
This is where I was coming from.
But the hospital must follow its rules. I'm presuming those are in compliance with legal and regulatory requirements.
Patients have the right to send and receive mail, and to personal privacy. The nurse could havewatched the patient open it...
The above is way too broad. Patients are subject to the facility's rules. Please see the previous post.
Suspicious deliveries, personal actions, etc. are all legitimate concerns of the hospital.
A nurse watching a patient open an explosive... or a letter containing anthrax... is not a comforting image IMHO. Nor does it further the health of the patient or others in this large, public structure.
Specializes in Geriatrics/Oncology/Psych/College Health.
Not clear on what's intended with the above.
Can you clarify? Thanks.
In my own mind (which you can't read, darnit :)) I was making the "ends not justifying the means" argument. Specifically, just because she happened to be correct, does not excuse her from her wrong action in opening someone else's mail.
I didn't even touch the ecstasy part. Since this was in Australia, I don't know,as someone else said, if this is viewed differently. I strongly suspect that ppl at my hospital use (not necessarily x, but other drugs, and not on the job.) I have no proof. Would I be justified in my action to root through someone's purse based on my suspicions? Would I be justfied only if I actually found something incriminating?
In the US, State of Texas, if I know a nurse coworker uses illegal drugs and I do not report it to the BON, I may risk charges myself. Don't know what the rules are in Oz however.
As far as opening the patient's courier'd package (is this considered mail since it came by private courier? ) it depends on local privacy laws/rights and hospital policy whether she was correct to search it or not. In the US I need permission to go through my patient's items and have been caught in a bind quite a few times with this little rule ...when I've suspected correctly the patient has narcs in their bags. I've had patients overdosing on narcs...getting pain meds from the nurse then dipping into their own stash as well.
If mine was a pych facility we would likely be allowed to go through bags, I understand...but not in my hospital general wards. All I can do is ask them if they have meds and or valuables with them and if so to please send them home. Catches us between a rock and a hard place sometimes.
I'm not sure what they do in detox but this patient was an inpatient medical patient. If there was a reasonable suspicion there were drugs then I guess I support the idea, but basically feel it wrong to open another persons mail. The op spent 8 hours with the patient. Perhaps someone else who spent the following 8 hours got another story that would warrant the suspicions, which obviously proved true!
I'm not a prude, I grew up in a drug infested area in NC that got a lot of north/south traffic. However, it is against the nurse practice act to smoke it. It's also against the law in most of the USA. So to the nurse who would deliver it to the patient without judgement and ask him to be discreet, I have a problem with that. We all occasionally compromise the rules of society to accommodate our personal beliefs, but as an RN I feel that deliverying pot to a patient might be breaking the nurse practice act.
I wouldn't risk my license and job to delivery mj to a patient just because of my personal beliefs that it's o.k., when it is clearly against the law. :chair:
larry you are wrong hypocrite is the exact term to use in this case-----HOWEVER---
I am not real "hep" but don't certain drugs change the vital signs...what if next nurse came on and found that the pt was unstable and had not idea what the cause was...this is a problem and one which only grow and grow...
Thank you all for your responses - they've given me a lot to think about, particularly regarding Jane. I must admit that reporting her drug use hadn't occured to me, I guess for a couple of reasons. The first is that, although illicit drug use is as illegal here as in the US, the attitude in general to it seems different. Certainly we don't have any kind of drug screening except for nurses who are on probation (at least not in my facility, which is public, and I'm not aware of it in other facilities in the state).
I had never considered whether or not I have a legal responsibility to report this kind of behaviour. Forgive me if this comes out internally inconsistant - I haven't actually thought about it before.
Like I said, if I believed it impacted on patient care I would without question notify my nurse manager or superviser. I think there is a difference between recreational drug use in one's own time, which does not affect the nurse's work, and drug use at work or which impacts upon their work. This impact would not necessarily be confined to their ability to practice - theft (of drugs or money), absences, and I guess type of drug would be factored in. I suppose I see it as analogous to alcohol use - some people don't drink at all, some people drink on occasion and in moderation, some people have weekend binges but are sober (if hung over) at work, and some people have a significant problem with alcohol which is impacting on their life and on their work. This, I hasten to add, is not an official policy or anything!
I said there were a couple of reasons, but now I've lost track of what my second reason was. I've been trying to track down what the law is in this regard, whcih might be how I got off track - the Australian Nursing Council's Code of Ethics contains six value statements. Number two is that nurses "accept the rights of individuals to make informed decisions in relation to their health care"; number five is "nurses fulfill the accountability and responsibility inherent in their roles" with a sub-clause referring to reporting unsafe and unethical practice. The ANC Code of Conduct covers similar ground. I'm trying to find an online copy of the Nurses Act for my state, but no luck thus far. I would have thought that Jane was in a good position to make an informed choice about her health choices, and references to the law are about practicing within the scope of one's ability.
Certainly this has provided me with a lot of food for thought. Thank you :)
larry you are wrong hypocrite is the exact term to use in this case...
Of course, you're entitled to your opinion. Believe you may be misusing the word.
The question posed was: "Am I being a hypocrite by having different standards of appropriate response for drug-partaking and non-drug-partaking nurses?"
Hypocrisy pertains to the faking of beliefs, feelings or virtues. Nothing in this definition relates to the above.
canoehead, BSN, RN
6,909 Posts
Patients have the right to send and receive mail, and to personal privacy. The nurse could havewatched the patient open it to make sure there were no dangerous articles in it, and then could remove and lock up anything- if she thought the items were dangerous. She can't search the patient's belongings without their permission, and she can't open mail that has not been delivered to the intended recipient. The fact that the letter was given to her to give to the patient is a very weak defense, especially since she is in a position of trust.
What if there were no illegal drugs in the envelope, but there was private letter? (with a very home-grown smell :)) That would be an obvious breach of privacy. Just because the nurse happened to be right about the contents doesn't make her action legal or ethical.