Can any RNs tell me if this is true

CHATSDALE · Jul 6, 2005

i was given vicodin p surgery..needed for about a week...went to sleep within 30 min p taking i know that you can build up a tolerance to a med and some meds do good for some people and not for others

darvocet is one that is of absolutely no use for me..the water i take with it does me as much good for pain relief

i believe that a nurse has the right to send home anyone whom she believes is not capable of giving proper care...even someone who MIGHT not be capable

but i believe that termination is too harsh...i believe that a requirement of 6-8 hours prior to shift would be a proper time frame

been there · Jul 8, 2005

I am currently a nurse aide at a nursing home waiting to attend nursing school. The other night the RN supervisor made me go home because I am takeing vicodin (prescribed by my doctor) for my back. She said her license could be pulled because she is letting me work on a narcotic. Is this really true, also are RNs allowed to work on narcotics?? Because I know she has taking pain meds before at work. Thanks

Narcotics are not a good mix with patient care. The RN is responsible for anything you do under the influence of the medication and could well lose her license. I agree with another post, if you require Vicodin for pain you should not be working or driving.

dmwalla · Jul 9, 2005

I demur to my previous position. I'll give the general topic more thought.
Looking at my NPA, it does clearly state that the litmus test isn't taking a med, but 'being impaired'
One of the definitions of critical thinking is to be able to take a position and defend it, yet being open to new positions.
I'll open myself to a new opinion as my defense of my old opinion is clearly lacking in many key respects.
~faith,
Timothy.y

Hi everyone I'm brand new to your forum but already have a comment---PLEASE if I'm the patient in that bed someday-protect me with good nursing judgement and think of me 1st in your decision making process --overly cautious would suit me fine. :chuckle

Thunderwolf, MSN, RN · Jul 9, 2005

We need a specialist in pain management and/or a BON member to interject here with some additional insight...because the thread is going back and forth.

Any out there that can enlighten us more?

NurseKymba · Jul 9, 2005

Though I"m not part of my own BON, I did consult them when I had a chronic pain issue that required narcotic pain control measures. I was instructed that if I was impaired at work, it could affect my own license. I was also told if I was working undersomeone else's license while impaired, I could be endangering their license. They also clarified that a postive drug screen for an Rx was not necessarily impairment. They then added that most impaired persons have no idea that they are impaired b/c their own 'central processor' is impaired. Every facility and BON in our area have a list of impaired behaviors to watch for. These behaviors may or may not be related to ingestions - they can also be related to sleep deprivation, extreme stress, mental illness or other factors. When impaired, one cannot work in patient care - period.

I was instructed to inform my manager for guideance. My manager and I discussed the situation, and the need for me to come to work on narcotics at times. She felt that by being upfront, I was meeting the requirements of the BON. She also asked if she could tell a trusted employee who worked my shift so that if I was impaired, and didn't know it, there would be someone else who could let me and her know so she could come in and relieve me on my shift. I agreed to this as I was the charge nurse, so it wasn't like just anyone in the department could/would step in or speak up.

With this plan in place .... and verifying again w/ our BON, we were ensuring the need for patient safety as well as my own need for proper pain control we began. Fortunately, in the 3 years I worked there w/ frequent need for narcotic pain control, we never needed to put our back up plan in place.

As previously stated, each individual is different, as is each situation. But all decisions need to be made w/ the involvement of the BON (or at least referencing the NPA), the employee, and the facility. These decisions need to focus on patient safety - period.

Okay, my 2cents ......

bellcollector · Jul 9, 2005

I too have consulted with my state BON concerning the use of narcotics by nurses and STNA's on the job. Fortunately for me and those working in my state our BON is a progressive and forward thinking one. I was informed that they are part of a nationwide task force working on this very issue. According to them in my state it is against the law for the BON or anyone else to discriminate against a nurse or an STNA based on whatever condition makes it necessary for them to take medications narcotic or otherwise. It is also not required in my state to report use of perscription narcotics to the BON. It is however necessary to prove the validity if found on a drug screen. I was also advised that, as some have already correctly pointed out, it is not wisdom to make it public knowledge that you are taking perscription medication. Basically it is no ones business and tends to make you a target.

As far as STNA's being sent home by the RN the RN was completely with in her/his rights to send home a coworker anytime they suspect impairment. However unless they are management they do not usually have the authority to terminate you. After you are sent home it would be your responsibility to prove the appropriateness of your medication use as well as any behavior in question. It would then be up to management to decide what action is appropriate. In todays world it would be unwise for management or the RN to act against someone taking pain medication without pretty good back up proof that you were in fact impaired. In most cases if your job is put in jeopardy because you are accused of being impaired you would have some legal recourse. This would then require the excusing parties to prove their case. All that said if I as the charge nurse felt I had reason to believe an STNA working under me were impaired I would error on the side of caution and send them home pending further investigation by management.

military girl · Jul 9, 2005

ZASHAGALKA,

Don't you think that you are trying to walk on water? Have you honestly never taken something for pain before coming to work. You make it sound like you have no ailments.

Yes, I agree with you that it is a liability to come to work with a narcotic in your system. But as the person who posted this thread stated, she is a single parent with no other income. And to say if she can't handle things now, how is she going to do so as a nurse is a slap in the face.

zas

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.

bellcollector · Jul 9, 2005

I would also like to add that I think Timothy appears to be taking a bit of a beating considering he made it clear he was open enough to rethink his previous postion. Lets be professional enough to give people respect who are open enough to respect the thoughts and opinions of others.

waynesbororn · Jul 9, 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.

waynesbororn- Recently I was employed by the state and if you write down all of your medications when they do your urine and drug screen they will let you work. Not until I recently went on Duragesic 50 did I need to stop working. That was because I couldn't work at nights ,because my vision and thoughts were impaired at night. They would have let me work if I had not been on restricitons from my Doctor for lifting and not being able to provide patient care and could have worked my shift. Yes, the RN is responsible for you but if your DON and other office personnel let you work I would think that would fall on them. When I took Vicodin I felt that my judgement was not affected and did the work that I was responsible for.

LadyMadonna · Jul 9, 2005

ZASHAGALKA,
Don't you think that you are trying to walk on water? Have you honestly never taken something for pain before coming to work. You make it sound like you have no ailments.
Yes, I agree with you that it is a liability to come to work with a narcotic in your system. But as the person who posted this thread stated, she is a single parent with no other income. And to say if she can't handle things now, how is she going to do so as a nurse is a slap in the face.
I know most doctor's are very leary about prescribing narcotic pain meds for anyone long-term. This lady will likely be weaned off the medication and sent to a pain clinic of some sort. Still, if the pain is that severe it will certainly make being a nurse ten times more difficult (even though, in general, a nurse's job is easier physically than a CNA, it is mentally demanding, which can still be a problem if a nurse is on a narcotic) If I suffered from severe chronic pain that required pain meds. I think I would look into a field that would be easier on the back.

Carmeceia911 · Jul 10, 2005

One reason that will affect any supervisor's judgement is an employee taking a narcotic. The difference is, is the employee addicted? As a CNA, you bath patient's, help them to the bathroom and feed them. Having worked as a CNA, I know that this job can be a challenge. You have a huge responsibility to your patient's as well as your family. You do not want to lose your certification. As long as you are taking a narcotic and working, you are putting your patient's at risk. Understandably, It is a major concern. The narcotic vicodin is very easy to become addicted too. You may need to talk to your doctor as the other's in this forum has suggested. We can only offer our advice but only you can come to a conclusion. Something I would suggest you do is, talk to your doctor about a pain procedure called Radio Frequency. This procedure is for people such as yourself with back problems. It can be done without having General Anesthesia. They give you a mild sedative which allows them to take your back pain away temporarily or permenantly depending on the severity of your pain. Good Luck! :icon_hug:

rach_nc_03 · Jul 10, 2005

I too have consulted with my state BON concerning the use of narcotics by nurses and STNA's on the job. Fortunately for me and those working in my state our BON is a progressive and forward thinking one. I was informed that they are part of a nationwide task force working on this very issue. According to them in my state it is against the law for the BON or anyone else to discriminate against a nurse or an STNA based on whatever condition makes it necessary for them to take medications narcotic or otherwise. It is also not required in my state to report use of perscription narcotics to the BON. It is however necessary to prove the validity if found on a drug screen. I was also advised that, as some have already correctly pointed out, it is not wisdom to make it public knowledge that you are taking perscription medication. Basically it is no ones business and tends to make you a target.
As far as STNA's being sent home by the RN the RN was completely with in her/his rights to send home a coworker anytime they suspect impairment. However unless they are management they do not usually have the authority to terminate you. After you are sent home it would be your responsibility to prove the appropriateness of your medication use as well as any behavior in question. It would then be up to management to decide what action is appropriate. In todays world it would be unwise for management or the RN to act against someone taking pain medication without pretty good back up proof that you were in fact impaired. In most cases if your job is put in jeopardy because you are accused of being impaired you would have some legal recourse. This would then require the excusing parties to prove their case. All that said if I as the charge nurse felt I had reason to believe an STNA working under me were impaired I would error on the side of caution and send them home pending further investigation by management.

I was so happy to read your post and know that the nursing profession wasn't being completely duplicitous- yes, we do everything possible to alleviate the pain of our patients, but lord knows we can't endorse the same thing for our colleagues!

Three cheers for your state BON.