Can any RNs tell me if this is true

suzanne4, RN · Jul 1, 2005

You should not be working in any capacity doing direct patient care while taking narcotics. If you are requiring that much pain med, you definitely should not be working with back problems.

Sorry, I know that this is not what you want to hear.

geminiskittels · Jul 1, 2005

You should not be working in any capacity doing direct patient care while taking narcotics. If you are requiring that much pain med, you definitely should not be working with back problems.
Sorry, I know that this is not what you want to hear.

Maybe I shouldnt be giving direct patient care but I really have no choice but to work with back problems. I have 2 kids to support and no other alternative income.

But what I am asking is can she really lose her license for letting me work on narcotics? I find that very hard to believe.

ZASHAGALKA, RN · Jul 1, 2005

yes, she can.

The RN is responsible for everything you do.

It's called delegation. If any task is delegated to you, the nurse is ultimately responsible.

And if the nurse knows that you are 'under the influence' of a narcotic and that, as a result, your judgement is impaired, if you make a mistake, (s)he is responsible both directly for the mistake you made, but more importantly, indirectly because she delegated a task to someone she knew to be impaired.

You, as an aide, work completely under the authority of the RN. The RN, in turn, is responible for the work you do.

If I knew you were under the influence, I'd send you home (and probably terminate you). If I knew another nurse was under the influence, I'd report it (and see to it that they were terminated). That may sound cruel, but it is the law. The Nurse Practice Act in my state and most states makes it very clear that working impaired or allowing someone to work impaired is cause for revokation of license.

Sorry,

~faith,

Timothy.

Thunderwolf, MSN, RN · Jul 1, 2005

Uhhummmm....I get the impression that folks are going under the assumption that the original poster "is impaired" by the very nature of her taking a "prescribed medication", which in this case is a narcotic.

Geminiskittels, are you impaired "mentally" from the medication...the key word here is "mentally impaired"? If not, if it is a legally prescribed medication by your doctor and you perform your duties no differently from your cohorts, your employer may be jumping the gun. If you have documentation that it is a prescribed med, and even with a dirty urine "for opiates" (because of the med), the release of your services may be unwarranted. I would check with your nursing board. If you are impaired mentally from the prescribed narcotic, you may then need to talk with your doctor in looking at other medication alternatives. Taking a narcotic medication in an appropriate fashion does not equate to addiction or mental impairment. Hope this helps.

johnjrb · Jul 1, 2005

I know a couple students in my class who take Ritalin for attention deficit disorder. Ritalin is a narcotic should this be allowed?

ZASHAGALKA, RN · Jul 1, 2005

I know a couple students in my class who take Ritalin for attention deficit disorder. Ritalin is a narcotic should this be allowed?

Ritalin isn't a narcotic; it's a stimulant. And for the people who need it and for who it works for - it has a paradoxical effect in that it calms them down, thereby allowing them to focus.

And I disagree that it's acceptable to work under the influence of a drug so long as you aren't 'mentally impaired'. That's a judgement call and from my mind's eye, the judgement that should be exercised is extreme caution. I would exercise that judgement with EXTREME PREJUDICE in favor of my patients - I would make you leave.

Under this argument, an alcoholic that blows over the 'legal' limit might indeed be not only unimpaired, but would be impaired if sober and withdrawing. But this isn't what the discussion was about and I am not making a direct comparison.

The prescription might be legit and acceptable and I wouldn't dismiss someone with such a prescription for failing a urine test, BUT - I'd make darn sure it was clearly understood that using such a drug during or before work is completely unacceptable. If you are under the influence of a narcotic - legal or not - you shouldn't be working in any capacity that could endanger the public.

Would you want your airline pilot taking vicodin during the flight for his/her back????????

Here's my question. If your back is this bad now, how on earth are you going to be a nurse? Mind you, if you answer by doing something not at the bedside, like telephone triage, then why doesn't that rationale apply now?

~faith,

Timothy.

pricklypear · Jul 1, 2005

geminiskittels -

I'm not going to get into the argument about whether you should be working on Vicodin. But, I just wanted to suggest that if you have to work with a bad back, and need non-narcotic pain relief - ask your doctor for some toradol. It works as well as narcs on most surgical patients. If it doesn't work as well as the Vicodin, at least you will have some relief at work without putting your job at risk. Sometimes severe pain can be just as mind altering (if not more) as narcotics. Good luck:)

DustinRN · Jul 1, 2005

Toradol isn't recommended for more than five straight days due to its risk for major side effects. Its dangerous effects are directly proportional to the dosage and length of treatment.

Trauma Columnist · Jul 1, 2005

The key word here is impaired. I work with some staff that have chronic pain issues and they are on duragesic patches or oral narcotics. However, they are not impaired because they have a tolerance to this medication. Good luck. If you truly have a disc injury or a permanent incapacitating back injury, patient care is going to be difficult. Not impossible, just difficult. You might want to discuss this with your doctor. Take care of yourself.

ZASHAGALKA, RN · Jul 1, 2005

The key word here is impaired. I work with some staff that have chronic pain issues and they are on duragesic patches or oral narcotics. However, they are not impaired because they have a tolerance to this medication. Good luck. If you truly have a disc injury or a permanent incapacitating back injury, patient care is going to be difficult. Not impossible, just difficult. You might want to discuss this with your doctor. Take care of yourself.

I disagree. Narcotics are mind altering drugs, tolerance or not.

But. Even if you argue that this isn't a cut and dried issue but rather a judgement call (and I'm inclined to think that it's cut and dried), but even if you disagree, that judgment doesn't lie with you but your supervisor - especially if you are working under that supervisor's license (and as a CNA, you are).

Your supervisor is completely within his/her right to send you home. Your supervisor felt like there was an attached legal obligation to immediately remove you from direct patient care. I'm inclined to agree.

I'm not trying to be a jerk. You asked if your supervisor was blowing smoke about his/her license being at risk. The answer is - no,. Even if YOU think that there is no mental impairment - that's simply not your call to make.

You did say that she does the same thing. I completely agree that makes him/her a hypocrite. But that doesn't mitigate you doing it.

~faith,

Timothy.

bellcollector · Jul 1, 2005

It so completely does make a difference if you are impaired by the drug or not. In my state one can work while taking narcotics for the relief of chronic severe pain. I have worked with nurses in chronic severe pain who are untreated and I have worked with nurses with severe chronic pain who are recieving treatment. Believe me I would take the nurse with controlled pain over the nurse with uncontrolled pain any day of the work. According to my BON I am entitled to the same measure of pain management as my pts are. The fact is once one has been on treatment(narcotic) for chronic pain management they are not addicted but rather physically dependant and tolerant to the drug and are not impaired. It would be discrimination to not allow someone with a chronic condition to work because of the treatment they are recieving. If however they are reacting badly to the medication then I would send them home advising them to call their MD for evaluation for a different medication they would not be terminated that is not legal. It is shocking to me how many of our own co professionals would deny us the very treatment that brings about the highest level of functioning for us. After all that is suppose to be the goal for our pts to provide them with what it takes to maintain the highest level of independant function possible.