Can a nurse come to work after taking a benzodiazepine?

[Smackdown]

If a nurse is prescribed a medication like Xanax, Klonipin, Ativan, etc for anxiety.....can they legally work as a nurse under the influence of this medication? I searched my state's boards of nursing website and could not find anything.

[purplesteth]

I thought we were supposed to be nice to each other?  It's not very cool to wish unemployment on someone, just because you don't agree with their point of view. Let's focus on viewpoints, NOT people! 

[elkpark]

While I have neither the time nor the interest to do a serious lit search on this subject, here are the official position statements from two US state BONs that state explicitly that nurses who work while impaired may be

subject to disciplinary action by the board, that a legitimate prescription is not an acceptable excuse for impairment in the workplace, and nurses are responsible for being aware of whether any RX meds they are taking may be affecting their performance at work.

The concern that Vanillanut, Annienurseangel, and I have (if I'm not putting words in anyone's mouth :)) is that if anything went wrong at work, if a nurse made any kind of significant error, whether or not it was directly a result of a nurse taking legitimately prescribed psychoactive drugs, and the nurse involved was found to have a psychoactive drug in her/his system at the time (since drug testing of nurses after an error occurs is v. common in the US -- I don't know how that works in the UK), that nurse could find her/himself in the position of trying to prove to the BON (and, in a worst case scenario, in civil court in a malpractice suit) that s/he wasn't impaired at the time, which would be v. difficult to do. Granted, it's a "long shot," but it could happen.

Vanillanut, Annienurseangel and I are simply noting this possibility and saying that that's not a risk we, personally, are willing to take. If other nurses are comfortable doing so, I certainly don't condemn them for it -- that's their choice to make. However, I think it's important that nurses be aware of all the possible risks they may be taking with their licenses and careers in a situation like this, so they can make informed decisions.

[Horseshoe, BSN, RN]

I'm sure that some nurses can take these drugs without being impaired and others will not be able to. Who makes these callls? The nurse? Isn't it part and parcel that in a state of impairment, judgment is often impaired as well as it relates to one's competency? I sure have seen a lot of intoxicated individuals who are CONVINCED that they are just fine to drive. They believe it to their soul, yet they are not 100% on their game.

That would be my only concern about it. The person taking the medication (particularly if it's new prescription and no tolerance has developed) may not be the best person to judge how impaired or not they are.

Any time I've taken a benzo, I've gotten really drowsy and a little "off," but neither have I taken them on a routine basis, and that may be the key.

Thought provoking question for sure.

[tyvin, BSN, RN]

Where I live it is illegal for the employer to ask what meds you're on and the BON has no position on this matter. I know many nurses on many types of meds for various reasons and as a charge the only nurse I have ever turned in for impropriety is a nurse who kept showing up to work with alcohol on her breath.

I understand that in some of these states it is the law and must be adhered to but in my opinion it is coming very close to a police state. Reminds me of the term big brother and makes me wonder what's next; because you know once you let them in the door, they will want to see the whole house.

[medpro32]

It needs to be disclosed to your employer. There may be an HR policy against it.

It does not, and should not EVER be disclosed to your employer. For your employer to even ask about medication/medical condition in a pre/post employment setting is illegal.

Why give an employer a reason to not hire you or scrutinize you if some med count is off?

If you ever take a drug test AND it comes up postive on the test, you will need to demonstrate a RX for it. Testing positive and being under the inlfuence of a benzo are two different things. Chronic users can test positive for 20 or so days from last use.

You simply need to know when you are impaired or not and dont work inpaired. Your medical issues are private and should be kept so.

[TheCommuter, BSN, RN]

Your medical issues are private and should be kept so.

Prior to an offer of employment, most employers will require the applicant to submit a urine sample for analysis. If benzodiazepines, opiates, tramadol hydrochloride, or other prescription medications are detected in the urine, the employer will want to know if the nurse actually has a prescription for the stuff that is in his/her system.

I totally agree that our medical issues should be kept private. However, the people who employ us often find out this info one way or another. If the nurse refuses to submit a urine specimen, (s)he now looks suspicious and will probably not be offered employment. Pre-employment drug testing is a mandatory part of the hiring process at many workplaces.

[elkpark]

I understand that in some of these states it is the law and must be adhered to but in my opinion it is coming very close to a police state. Reminds me of the term big brother and makes me wonder what's next; because you know once you let them in the door, they will want to see the whole house.

I understand those concerns and share them to some extent, but I think it's also worth taking into consideration that we're talking about licensed professionals here rather than ordinary citizens. Members of licensed occupations are legitimately held to a higher level of scrutiny and accountability than members of the general public. There's no civil right to have a license to practice nursing -- it's an earned privilege, and part of earning the privilege is agreeing to live with the additional obligations and responsibilities that come along with the license (again, IMO).

[sdeal]

Yeah, thats a sticky situation. If anything at all goes wrong, whether related to being under the influence of the medication or not, they will likely consider you to have been practicing under the influence of a medication and go aftr your license. If someone is so anxious about their work place that they have to self medicate, perhaps they should consider finding a new work environment or career!

[Esme12, ASN, BSN, RN]

It does not, and should not EVER be disclosed to your employer. For your employer to even ask about medication/medical condition in a pre/post employment setting is illegal.

Why give an employer a reason to not hire you or scrutinize you if some med count is off?

If you ever take a drug test AND it comes up postive on the test, you will need to demonstrate a RX for it. Testing positive and being under the inlfuence of a benzo are two different things. Chronic users can test positive for 20 or so days from last use.

You simply need to know when you are impaired or not and dont work inpaired. Your medical issues are private and should be kept so.

The are different employment laws that vary state to state. Before deciding NOT to disclose.......talk it over with an employment lawyer in the state you are going to be employed. It is NOT illegal to ask but it is illegal to discriminate. When you fill out the "Employee Physical" history that are required by most employers to be sure you are "physically fit" for the position. In most offer letters it is stated....."upon completion and passing of the pre-employment physical". If you lie....and are later outed for whatever reason......you have given them reason to fire you but also reason to refuse workmans comp in the event of a needle stick (they require drug testing in the case of a work related 'accident') because you lied and were impaired.......

I agree testing positive and being under the influence are completely different as just because you take the drug doesn't mean you can't function.......that is why earlier I said it was a convoluted subject and difficult to know what to do.......seek legal advice.....but DON"T LIE

[medpro32]

Prior to an offer of employment, most employers will require the applicant to submit a urine sample for analysis. If benzodiazepines, opiates, tramadol hydrochloride, or other prescription medications are detected in the urine, the employer will want to know if the nurse actually has a prescription for the stuff that is in his/her system.

I totally agree that our medical issues should be kept private. However, the people who employ us often find out this info one way or another. If the nurse refuses to submit a urine specimen, (s)he now looks suspicious and will probably not be offered employment. Pre-employment drug testing is a mandatory part of the hiring process at many workplaces.

You should wait until the test results are back to reveal this info. Not all employers run a "full panel" drug test. Some do a five panel that looks for street drugs only. Also, depending on the dosage and how often you use a legal drug, you may not have enough in your system to test postitive.If you fail a test do to use of legal drugs, the testing facilitied medical officer will contact you and that is when you produce your RX.

Testing facilitied no longer ask you what mediciation you take before the test. This could be seen as an employer trying to skirt laws around asking medical background questions.

Drug testing is a tightly regulated field by the federal goverment.

Once again, why reveal potentially damaging information to an employer when you don't have to?

[MunoRN, RN]

Private employers are only prevented from discriminating based on race, sex, age, and religion. Other than that they can discriminate however they please, including not hiring someone based on the medications they take. This is often based on a medication or medical condition's effect on job performance, but it doesn't have to be, an example being employers who won't hire smokers because it raises their group health insurance costs. There is no legal protection for private employers asking you about your medical history and not hiring you because you refuse to divulge your medical history.

[thehipcrip]

MunoRN said:

Private employers are only prevented from discriminating based on race, sex, age, and religion. Other than that they can discriminate however they please, including not hiring someone based on the medications they take. This is often based on a medication or medical condition's effect on job performance, but it doesn't have to be, an example being employers who won't hire smokers because it raises their group health insurance costs. There is no legal protection for private employers asking you about your medical history and not hiring you because you refuse to divulge your medical history.

This is not true. The Americans with Disabilities Act prevents employers from asking about medical conditions and disabilities before a conditional job offer has been made. The employer can ask you if you can do the job, how you would do the job, and even ask you to demonstrate how you'd do the job as long as all applicants are asked to demonstrate during the interview process.

But an employer is prohibited from asking what legally prescribed medications an applicant is taking or any question that would elicit information as to whether an applicant has a disabling condition like anxiety before a conditional offer of employment is extended.