Coming to work after taking a narcotic?!

[cherryblossom88]

A CNA injured herself (not on the job) ...it was her hand. She comes to work ,sits down and says "oh man I need another Vicodin, my hand is hurting...I took one before I left and I am feeling sleepy now , but Ill be okay" She says she had a script from her doctor. In my experience , Vicodin always knocks me out when I have had to take it for a broken bone or something....but anywoo do you think this is acceptable? What would you have done?

[DeLana_RN, BSN, RN]

I've always wondered about this... I have a friend, an ICU nurse, who has chronic back, hip and foot pain s/p work-related injuries; she cannot function without Vicodin. She told me that Occupational Health has cleared her to work as long as she has a current Rx (which she does, but still....) She says she sometimes takes one late in her shift - how can this be OK?! Her hospital normally has very strict policies, so this really surprises me.

DeLana

[GM2RN]

I've always wondered about this... I have a friend, an ICU nurse, who has chronic back, hip and foot pain s/p work-related injuries; she cannot function without Vicodin. She told me that Occupational Health has cleared her to work as long as she has a current Rx (which she does, but still....) She says she sometimes takes one late in her shift - how can this be OK?! Her hospital normally has very strict policies, so this really surprises me.

DeLana

You know, some people do have chronic pain and need drugs like vicodin to function, I get that. I'm not saying they shouldn't take them, necessarily. But it's tricky. Even if someone doesn't appear to be impaired and has clearance from work, I imagine the facility might try to throw someone under the bus if anything happened while an employee was "under the influence," so to speak.

Same with driving. All is well as long as no one gets into an accident, and even if they did, it's likely that no one would get in trouble as long as nobody got hurt. But let there be a law suit over an injury and I can guarantee you that the person taking the prescription narcotic will be the scape goat, even if they were not "impaired."

[Plasticgloworm]

Yet another NA trying to get away with as little work as possible.

It is SHOCKING that they verbalize they under the influence of a narcotic.. legitimate or otherwise.

Call the supervisor, have them escorted from the unit.

Hope you will get additional help, not likely.

There are many hardworking NAs in the industry. I don't think it's fair to say whether or not an individuals situation that you have no personal involvement in is valid or not. Your assumption is an insult to hard working support staff everywhere.

[Horseshoe, BSN, RN]

Whether some people who have developed a tolerance to vicodin over time due to chronic pain can work under the influence without being impaired is really irrelevant to this particular situation.

The OP describes what appears to be a new injury and a NA who does not have narcotic tolerance. She relates that the NA stated that she took a vicodin before work and is now "sleepy," yet plans to take a second one. If she wasn't impaired after the first one, you can pretty much use common sense to conclude that taking another one will definitely have that result. Between that and the fact that she has an acute injury which is causing pain resistant to one narcotic dose, she should have either stayed home or been sent home. Considering that she has already complained of being sleepy, she probably couldn't drive home safely and should have been sent home with a relative or been driven home by the nurse manager or other unimpaired driver.

[MunoRN, RN]

Narcotics unlike alcohol do affect everyone differently for a variety of reasons.

A good example of this is the habituation experienced by people on opiates for chronic pain, they experience the benefits of pain contol without the euphoria or other effects.

Anyway, the CNA should have been sent home, more so because she has what sounds like a serious injury.

Alcohol also affects people differently depending on factors including tolerance. Just because someone can be high functioning while drinking alcohol due to tolerance doesn't mean they could come into work that way.

People don't experience less side effects but sustained pain control with chronic opiate use. Opiates continue to exert their effects on all opiate receptors, not just mu pain receptors, with chronic use. An increase in dosage for better pain control due to tolerance will also result in a corresponding increase in adverse effects.