Can any RNs tell me if this is true

Tweety, BSN, RN · Jul 4, 2005

Nurse with chronic pain issues typing now. I am on Vicodin, after a back injury. I don't have a choice for another med b/c of allergies. However, I don't usually take anything before going to work. IF my pain is severe enough, I will take 1/4 of what is ordered by my doctor. Then take 1/2 of ordered dose when I get home. It's just enough for me to be somewhat comfortable. I have finally accepted that I will never again be pain free, but I still have to work to pay bills, feed the kids, etc, etc. Most of us in chronic pain, given the option would choose the pain free, medication free route, but we don't have that option. If there is something to help us continue working & being productive members of society, then we do it. I do agree, that nurses should not work if they are mentally impaired. When I FIRST started taking the Vicodin, it did make me sleepy & kind of spacey. Fortunately, I was on leave at the time. Now, it just takes the edge off of my pain. Other than that, lots of nurses still don't understand pain or pain management & probably never will.

I'm sorry about your pain. I certainly agree that nurses are far from understanding pain. Especially thouse of us fortunate to be pain free. A good nurse need not be punished and have their livlihood threatened because of pain.

I can't judge a person who works while taking narcotics, because I'm not the one in pain. If it were me (and it was me postop) I would just make sure to check to see what the BON says before advising others what to do, tolerance or not.

UM Review RN, ASN, RN · Jul 4, 2005

Please don't take offense at this. It actually might save you some problems down the road.

I have to ask: How are you getting to work? If you're driving under the influence of Vicodin, you might be considered "impaired" by the law. You can get a DUI for taking narcotics, whether they're prescribed or not.

If you can't drive, you shouldn't be doing patient care. Both take very sharp judgement skills.

JMO.

Editorial Team / Admin · Jul 4, 2005

I, too would not allow you to work while taking the drug. The supervising RN has the legal right to dismiss you, for the day without pay and terminate you if she chooses. If you protest, you will proabably lose your argument. Many nurses have been successfully sued for less than that and the institution views you as a liability when you use narcotics. Sleep deprivation (no narcotics involved) issues have been successfully sued as well and this is inline with "being under the influence". So do not jeopardize your patients; get another prescription for a non-narcotic; seek treatment for your back problems; swallow your pride and try not to hold the issue against the RN; and good luck in your future choice of nursing.

smk1, LPN · Jul 4, 2005

not anurse yet but just some thoughts for you to think about. If you are required to take these drugs on a regular basis, you will have to fill out a form describing them and what theyare for for school if you are accepted into the nursing program. THis may bar you from acceptance, so this is another thing to check out. Also I think it is a bit different for a licensed person to to accept responsibility for whether they are impaired or not, rather than having to accept the responsibility for another "possibly" impaired individuals work. Just a thought.

BabyRN2Be · Jul 5, 2005

I'm not a nurse yet, but I work in a hospital and I have chronic pain. For the moment, I do not want to discuss what type of pain, we'll just say it's severe, chronic pain.

I hope that one day that the general public will not look at people on chronic pain management as drug addicts. Once a person has been on medication for a while, mental impairment is less of an issue. The issue becomes one of physical dependence rather than psychological. Studies have shown that once a person who has chronic pain is stabilized on medication, he or she is less impaired than a person with untreated pain. Those working with untreated pain may be more impaired than a stabilized person receiving treatment.

I recently applied for a job who's employee health dept said it was OK to be treated for chronic pain with opiod pain meds, but those meds could not be taken 8 hours prior to a shift or anytime during a shift. My doctor looked at it and laughed. He said, "I betcha there are many employees working there with chronic pain who don't abide by that rule." Those weren't his words exactly, but that's the idea.

Fortunately, I can take the medication as once a day dosing and use medication for breakthrough pain within the hours, but if I was in pain at work, I was sunk. We couldn't work it out. I'm not working there.

If I didn't tell people that I was on chronic pain meds, people wouldn't know. They would not be able to tell that I even had pain, let alone that I was impaired. In all of my non-hospital jobs, it has never been an issue. My work is meticulous, people compliment my ability to be conscientous and I'm a hard, responsible worker.

Think of it this way, if treated, chronic pain is not an issue and a person wants to work, why deprive them of a chance to earn a living instead of drawing on disability, SSI, or welfare?

Now, if a person is taking Vicodin (or other opiods) on a prn basis, I believe that's a problem as one is not used to the drug nor may be cognizant of it's side effects. I can see why there are issues in these cases.

BTW, my mom was a nurse for many years and she worked with a CNA who was on Depakote. Apparently in this hospital there aren't any restrictions on this medication. My mom said that there were some days that she would have to repeat instructions over and over again to this CNA. She said that there were many days where she thought "the light is on, but no one is home." She said that other RN's thought that she was unsafe.

My point is, there are other medications which might impair a person's ability to think or react, but there are no restrictions on those medications. I'm sorry, this is my rant for the day. But I do understand where the people on the other side of the fence are coming from.

NannaNurse · Jul 6, 2005

Some here seem to love 'jumping' on others. If you are in the medical profession.........mainly a nurse or nurses aid.........you know pain. Some people tolerate pain better than others.

Personally, I wouldn't and I don't tell others that I work with 'when' or 'what' type of medication I'm taking..........it's called privacy. If you can't function while taking your medication, get it changed to something that will allow you to work. When I had extensive surgery earlier this year, my doc prescribed 3 Vicodin at a time........didn't hardly touch the pain and didn't 'bother' me either, so I stopped taking it.......didn't work!

What about all the nurses who do abuse drugs?? What about those who missaproprate medication for their own use?? Who are they? You really don't know do you? So how can you tell if someone is 'mentally impaired'?? Sometimes the impairment isn't caused by medications..........some are just really stupid.

rach_nc_03 · Jul 6, 2005

I'm sorry about your pain. I certainly agree that nurses are far from understanding pain. Especially thouse of us fortunate to be pain free. A good nurse need not be punished and have their livlihood threatened because of pain.
I can't judge a person who works while taking narcotics, because I'm not the one in pain. If it were me (and it was me postop) I would just make sure to check to see what the BON says before advising others what to do, tolerance or not.

I'd be curious to know if anyone has interacted with their state BON on this issue.

Before my last surgery for endometriosis, my surgeon put me on methadone 25 mg/day for severe pain. He was going back and forth between that and oxycontin- I'd been taking vicodin for eons, and it wasn't helping at all. When I say severe pain, I mean there were days I simply couldn't complete my drive home from school- I would pull off on the side of the road, crawl into the back seat of my car, ball myself up into a fetal position, and shake until I threw up, or passed out.

When he prescribed the methadone, i'd come to a crossroads: either get the pain under control, or quit school and my job. I didnt' have any sedation issues with vicodin- anyone who has chronic pain knows that goes out the window pretty quickly. I just wasn't getting relief. When I asked my dr about sedation from the methadone, he said, 'well, if you were next to me in the OR, you'd be in much better shape on methadone than you are right now.'

Methadone was the *only* thing that allowed me to finish school, and make it a few months until my surgery (which had to happen during spring break). Not once was I 'impaired' on methadone- quite the opposite. I was finally able to function. I could think clearly again! My grades went up, my attitude improved, and I no longer thought that death would be more pleasant than waking up every day.

In contrast, I was prescribed Topamax for chronic migraines (r/t the endo). I would literally forget where I was, and I would be driving down the road with no clue where I was headed. After a couple of weeks, I started to hallucinate; I called my neurologist and he put me on Lamictal, which hasn't given me any problems. Topamax is an anticonvulsant- as far as I know, there is no policy at my hospital for working while taking it, and i know people who function normally on it. I'm one of those who can't.

The attitudes of my instructors ranged from very supportive to condemnation- but the person who condemned my use of pain meds said he refused to ever take narcotics because he took them once and didn't like feeling 'drugged'. Well, you know what? Neither do I. And taking methadone, I didn't. My doctor is a specialist in pain management, and is well published on the subject- I trusted him to point me in the right direction on this topic.

I can't tell you how many times i saw nurses nodding off at work because they took benadryl for allergies, or stayed out too late drinking and came in hung over. Someone on long-acting narcotics for chronic pain is a *lot* less impaired than a nurse with too little sleep and a hangover- and heck, i'm zonked on benadryl myself, which is why I only take it before bed!

I'm not directing a rant at you, tweety- i just liked your suggestion to check with your state BON to see what the policies are. I want to add to it, though....and i'm not talking about the occasional PRN rx for vicodin after a surgical procedure: if you have chronic pain that your physician is treating with short-acting drugs like vicodin, you need to be reassessed, and possibly referred to a pain specialist. Finally getting effective treatment gave me the ability to live my life.

geminiskittels · Jul 6, 2005

I talk with my doc today and told him I wanted to try something else. He gave me ultram to try. I am going to give it a few weeks and see how I feel on it. I really hope it works because I want to pursue nursing and I don't want the fact that I have to take pain meds stand in my way. So I guess heres hoping

Tweety, BSN, RN · Jul 6, 2005

Rachel, I can't say that I've interacted with the board on this. Basically, if there isn't a complaint or incident, the BON isn't going to know about your personal medical history.

I see many sleep deprived night shift nurses who act impaired than probably those on pain medicines. Also, many people don't think they are impaired, such as those "who only have a few drinks and drive" and in the eyes of the law they are.

Obviously if the choice is between functioning pain free and taking pain medicines there isn't any choice. I would be very nervous if I had to do that. What if there was an incident totally unrelated to impairment, such as a med error, a complaint or a mass drug testing of the unit and all eyes turned on you. It would be a mess. A defensible one, but a mess.

If that was the only option I have. That's a chance I would have to take.

I think most BON's probably take these things on a case-by-case basis when there's an incident, but it's vague otherwise.

Tweety, BSN, RN · Jul 6, 2005

My point is, there are other medications which might impair a person's ability to think or react, but there are no restrictions on those medications. I'm sorry, this is my rant for the day. But I do understand where the people on the other side of the fence are coming from.

Thanks for sharing. I'd like to think we're moving to apoint where chronic pain medicine use isn't frowned upon as "addiction". It's a difficult concept that a person takes what is known to be sedation/mood altering and not be sedated/mood altered. So you have to at least appreciate some people's concerns.

I would like like to think that anything that restricts a persons ability to think or act, be it drugs, mental health, etc. is not congruent with the goals of the BON and would have consequences. But you're right if it's found to be a narc. the consequences are more severe.

Best wishes.

bloviate · Jul 6, 2005

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.

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So does xanax or ativan for some people. So do anti-depressants.

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And I disagree that it's acceptable to work under the influence of a drug so long as you aren't 'mentally impaired'.

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Read above. Ritalin is a stimulant. It also can be a drug of abuse. Same for xanax. Same for ativan. Same for some other drugs INCLUDING opiates. They all cause some sort of effect on the body AND mind. Nicotine for that matter causes some changes in brain chemistry and has other effects on the body. Lot's of nurses smoke. Impaired? Under your definition yes.

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I would exercise that judgement with EXTREME PREJUDICE in favor of my patients - I would make you leave.

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These all or nothing statements you've made here give me a glimpse into your personality and it's not a comforting glimpse.

The lady has CHRONIC pain. She deals with it. She deals with it by sometimes taking opiates. I don't see a huge problem here.

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Under this argument, an alcoholic......

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But we're not talking about booze here. Again, the lady was talking about chronic pain and light doses of opiates to ease the pain.

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The prescription might be legit and acceptable and I wouldn't dismiss someone with such a prescription......

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But earlier didn't you say that you would make sure they'd leave, be terminated etc etc.

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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.

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Shouldn't that decision be made between the lady and her physician? I think most people are reasonable enough to know when they're not able to work. That is unless your dealing with an impaired provider which is a completely different thing.

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

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Are we pilots? :stone

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ZASHAGALKA, RN · Jul 6, 2005

Keep reading bloviate.

I did state that I would give the topic more thought and then stepped out of the way. In fact, I stated specifically that I now demurred (stood opposed) to most of the comments you re-bloviated.

But I DO want to point out that this thread became a topic about whether working on narcotics for chronic pain management puts your license at risk.

The ORIGINAL thread was about whether working on narcotics for chronic pain management as a CNA could put the RN's license at risk.

How a nurse chooses to deal with this issue is between themselves and their board.

But I stand by my original point that, if you are working under MY license, and I am responsible for YOUR actions (which is the case with delegation), then the decision to work is not only between YOU and YOUR legal authority, that decisions also involves ME.

When it comes right down to it, I have the absolute right to decide under what circumstances anybody works under my license. Because I assume the responsibility for delegated work, I retain the right to decide the basis for that delegation.

~faith,

Timothy.

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