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.

[skittlebear]

MunoRN said:

HIPAA only protects you from unjustified access to your medical records without your consent, an ROI is your consent. HIPAA does not protect you from being asked about your medical history. HIPAA is available online, if you know where that is stated I'd be interested to see it.

Where I work we also sign an ongoing ROI for both random drug testing and an agreement to notify HR if we are prescribed any "Potentially performance altering" medications, which is defined as any medication that contains warnings in the FDA approved labelling regarding "impairment". Employers do have the right to ask what medications you are taking, prescribed or otherwise. I have worked at 3 hospitals in 2 different states, all of which required us to notify HR if we were any medications that could potentially affect our work performance. One of these hospitals provided us with a list that included everything from benadryl to opiates. This is from a different state, but it pretty well describes the boundaries for employers.

In particular: "A controlled substance's use as part of a prescribed medical treatment is not grounds for disciplinary action, although it is paramount for the appointed authority in the facility to know the use is occurring.

Failure to disclose prescription drug use once a policy is in place which is discovered as part of a random or for-cause drug screen can and should be cause for disciplinary action."

I know it may be the law but I don't like that. As long as a doctor prescribes and states its okay to work and you can make sound judgement, it should be none of your employers business.

[Chin up]

MunoRN said:

HIPAA only protects you from unjustified access to your medical records without your consent, an ROI is your consent. HIPAA does not protect you from being asked about your medical history. HIPAA is available online, if you know where that is stated I'd be interested to see it.

Where I work we also sign an ongoing ROI for both random drug testing and an agreement to notify HR if we are prescribed any "Potentially performance altering" medications, which is defined as any medication that contains warnings in the FDA approved labelling regarding "impairment". Employers do have the right to ask what medications you are taking, prescribed or otherwise. I have worked at 3 hospitals in 2 different states, all of which required us to notify HR if we were any medications that could potentially affect our work performance. One of these hospitals provided us with a list that included everything from benadryl to opiates. This is from a different state, but it pretty well describes the boundaries for employers.

In particular: "A controlled substance's use as part of a prescribed medical treatment is not grounds for disciplinary action, although it is paramount for the appointed authority in the facility to know the use is occurring.

Failure to disclose prescription drug use once a policy is in place which is discovered as part of a random or for-cause drug screen can and should be cause for disciplinary action."

Did you read the disclaimer of your own document? Also, that was referring to impaired nurses. I am on my iPad and cannot post links. ( sorry, haven't got that far yet). But goggle, disability act. As I stated before, federal trumps state. Besides, in your document, it state, no disciplinary actions if an MD states you have a prescription and why. They are getting around, "doctor shoppers". No government authority gives permission to anyone who is impaired. You can't drive a car impaired. You can't operate machinery impaired. Your employer can't ask you what drugs you are taking, unless impaired. But, that is common sense.

[Chin up]

I know it may be the law but I don't like that. As long as a doctor prescribes and states its okay to work and you can make sound judgement, it should be none of your employers business.

you are right, it is not their business and they cannot ask you. Google drug free workplace for more info.

[MunoRN, RN]

Did you read the disclaimer of your own document? Also, that was referring to impaired nurses. I am on my iPad and cannot post links. ( sorry, haven't got that far yet). But goggle, disability act. As I stated before, federal trumps state. Besides, in your document, it state, no disciplinary actions if an MD states you have a prescription and why. They are getting around, "doctor shoppers". No government authority gives permission to anyone who is impaired. You can't drive a car impaired. You can't operate machinery impaired. Your employer can't ask you what drugs you are taking, unless impaired. But, that is common sense.

The disclaimer refers to the ADA, which states that if an employee has a disability, as defined by the ADA, then the employee can request accomodations, although in order to do so the employer would need to be aware of limitations and circumstances of the disability. Not all prescription medications are for conditions that qualify as a disability.

The document does state that there are no disciplinary actions for having and taking prescription medications, but that there can be disciplinary action if you fail to inform your employer that you are taking the medication. "Failure to disclose prescription drug use once a policy is in place which is discovered as part of a random or for-cause drug screen can and should be cause for disciplinary action."

Employers can and do ask what medications you are taking as well as what medical conditions you may have. If you want to be a school bus driver but have a history of syncope, then you are required to inform your employer or prospective employer of that condition, failing to do so is grounds for termination. If you apply for a job as a pilot your employer will ask what medications you are on and not hire you based on a long list of banned meds including benadryl. As the linked document states, employers can place employees in different roles while taking prescribed medications, regardless of actual impairment or need for the medication, including if the medication is for a condition covered by the ADA.

[MunoRN, RN]

you are right, it is not their business and they cannot ask you. Google drug free workplace for more info.

I googled "drug free workplace" and saw nothing saying they cannot ask you. Can you cite anything in particular?

[ZippyGBR, BSN, RN]

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!

who is 'they' ? the facility ( trying to cast doubt on their culpability)? the registration authority? some wise orifice lawyer ? lizard headed aliens? conspiraloons ? Senator McCarthy? this is where good professional representation comes into it rather than the mob masquerading as a Union ...

and who said anything about self medication ?

and why are people scaremongering rather than referring to relevant information from the registration authorities and advising people to contact Occupational Health , withholding information from OH is not clever , equally line management regardless of whether they are clinicians or not are not entitled to any health information beyond specific answers to specific questions they pose in an Occ health referral.

[ZippyGBR, BSN, RN]

Labs usually don't care what you have prescriptions for, they are only obligated to perform the test and report the results, it's up to your employer to validate positive results with a prescription, changing the result to negative would be falsifying the results. Even when you have a prescription, an employer can choose not complete the hiring process based on your drug screen.

HIPPA doesn't protect you. Part of a pre-employment drug screen is a Release of Information form which allows the lab to send the results to your employer. The lab is not liable for providing accurate test results to your employer so long as you have signed an ROI.

the employing manager should not be seeing any of this, only Occupational Health ....

Employing managers who are health Professionals are some of the worse people for recognising where the boundaries are and it has resulted in the dismissal of some senior people in UK Organisations because they would not accept this fact.

[MunoRN, RN]

the employing manager should not be seeing any of this, only Occupational Health ....

Employing managers who are health Professionals are some of the worse people for recognising where the boundaries are and it has resulted in the dismissal of some senior people in UK Organisations because they would not accept this fact.

Where I work the "appointed authorities" are Occ Health and Risk Management, your Manager is not notified unless it has been determined that you need to be placed on "light duty" (removed from direct patient care temporarily).

[Chin up]

I see nothing on their prohibiting employers for asking an employee if they take any medications that might affect their job performance. It does outline drug testing policies, which is essentially a very scientific way of asking an employee if they take any such medications. If it's "none of their business", how can they drug test?

The drug Free Workplace regulations are concerning illegal and not prescription drugs. If you are convicted from possession, manufacturing, distributing or injesting, illegal drugs, you may or may not be tested. Not prescription drugs.

[thehipcrip]

The ADA protects the privacy of those with recognized disabilities, not everyone who takes a prescription medication.

Employment drug screening includes many legal drugs as well as "illegal" drugs. For any inquiry there needs to be a justified reason relating to job performance where the need to know due to risk for harm to others exceeds a person's right to privacy, any direct patient care positions have long since been established potentially harmful jobs if the employee is impaired and overrides the 4th amendment when it comes to Federal jobs, private employers have never had to abide by the 4th amendment.

The point of the ADA to prevent discrimination on the basis of disability in part by *not* requiring any individual to reveal whether they are disabled or not. The courts have ruled that since there are so many drugs that are specific to certain disabilities, requiring employees to name the drugs they have been prescribed would allow the employer to deduce that an employee has a certain medical condition. In other words, having employees name the specific legal medications they are taking is the same as asking them if they have a disabling condition, which is a direct violation of the ADA, and therefore prohibited.

[Chin up]

The point of the ADA to prevent discrimination on the basis of disability in part by *not* requiring any individual to reveal whether they are disabled or not. The courts have ruled that since there are so many drugs that are specific to certain disabilities, requiring employees to name the drugs they have been prescribed would allow the employer to deduce that an employee has a certain medical condition. In other words, having employees name the specific legal medications they are taking is the same as asking them if they have a disabling condition, which is a direct violation of the ADA, and therefore prohibited.

exellent!! thanks!

[Chin up]

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!

.....why we have a disabiltiy act...to protect from thoughts such as these.