Considering a career change to nursing, but I take opioids for chronic pain

[jersey_emt]

I graduated in 2003 with a Bachelor's of Science in Computer Science. I have been working as a web programmer and database administrator for five years, in three different positions. After being with my latest employer for 2.5 years, I along with many others were laid off due to budget cuts caused by the economy. I am considering pursuing a career in nursing, but one potentially major obstacle (from what I have read in various posts here) is the fact that I take opioids daily for managing my chronic pain.

I was in a severe car accident four years ago, and have disc herniations in my lumbar spine in addition to a lumbosaccral radiculopathy on the right side. It causes severe pain in my lower back and down my right leg, all the way to the lower calf. I have been taking opioids daily for pain management, and am on a stable (my medication nor dosage has not been adjusted in many months) dose of MS Contin -- controlled-release morphine sulfate -- for around-the-clock pain control and Roxicodone -- immediate-release oxycodone hydrochloride -- for breakthrough pain. I am not impaired and can legally drive, and I have a letter from my pain management doctor stating that I have chronic intractable pain that requires the use of opioids, that I am tolerant to the medications I am prescribed, and that my alertness and reaction times are not negatively affected. I take my medications exactly as prescribed and I do not abuse them. I have experience in the medical field (which is described below) and I have a high amount of respect for opioid drugs -- their effectiveness as well as their addiction liability.

While in college, I joined the campus first-aid squad and obtained my EMT-B certification (120 hours of emergency care classroom instruction and 20 hours of clincal experience in the ER of a Level I trauma center) during my freshman year. I was elected a Seargent (third-in-command) my sophomore year, Lieutenant (second-in-command) my junior year, and Captain (chief officer) my senior year. Officers took part in drafting SOP's, disaster planning and management, and the like for the college campus of 8,000 students, faculty, and staff. I became a CPR instructor and a First Responder (40-hour class that sits 'between' basic first aid & CPR training and EMT training) instructor for new members of the squad. During and after college, I also worked part time as an EMT for a Level I trauma center in a medium-sized city and did general interfacility patient transportation, critical care transportation (the team consisted of an RN, a Paramedic, and an EMT-B), as well as responding to medical 911 calls in the city. So, I have quite a bit of experience in the medical field and know 'what it's like' to work in the field.

After obtaining my Computer Science degree, I began working full-time in an office-based environment. I continued to work part-time as an EMT for a while, but eventually quit that and joined the local first aid squad as a volunteer. Now that I am currently unemployed after being laid off as of no fault of my own, I am considering getting into nursing. I understand that RN's are in high demand, and will continue to be in high demand for the foreseeable future. And please do not take this the wrong way, but I also understand that male nurses are considered by some to be in even higher demand, for the borderline-sexist reason that men don't take maternity leave. Like I said, please do not take that statement the wrong way, it is simply an observation made while talking to friends and family who are nurses.

So, I have a few questions for you all:

1. What is the process for someone who has a bachelor's degree from a liberal arts college? Should I choose this path, I am looking to become an RN, not an LPN, because of the much higher potential for career advancement. I understand that their are 'bridge' programs for LPN's to become RN's, but I would like to avoid that step and directly become an RN.

2. Taking prescribed opioid medications seems to be a very controversial subject here. Some people seem to be blatantly ignorant of the fact that chronic pain patients who take opioids for long periods of time become tolerant to the side effects and are not impaired in any way. The only side effect that I do experience is constipation, which is controlled by diet and occasionally Miralax as needed. I feel it is important to re-stress the fact that I am not impaired by my prescribed medications and I have a letter from my doctor that states exactly that. Unfortunately, I will most likely need to take opioids for the rest of my life, so it is not something that will only be temporary. I am looking for advice and comments especially from nurses who are working in patient-care capacities who have chronic intractable pain which requires around-the-clock (not prn) opioids. But I of course welcome advice and comments from all.

Thanks in advance for your help. As I have stated, I am currently undecided on this potential career change and am in the 'research' phase. Any information, advice, or comments that pertains to switching careers to nursing or to me being a chronic pain patient is much appreciated.

-jersey_emt

[jersey_emt]

Again, I just wanted to thank in advance everyone who takes the time to read my rather long post and give their thoughts.

[sissiesmama, ASN, RN]

Jersey - Hello. I may not be of any help to you. I live in Louisiana, and my dh and I are both RNS here and have been for almost 20 years each. I do know quite a few nurses that I have worked with over the years that, like you, have suffered an injury and have to suffer through chronic pain. These nurses do work, and their management and Employee Health are aware of their problem. I have never worked with of these nurses who have seemed impaired and/or given cause to investigate them. I know this doesn't account for every nurse, but just ones I have worked with.

I have had to retire about 2 years ago after having a lot of trouble with labile HTN and cardiac arrythmias, v tach, bigeminy, and on and on. My BP could get up as high as 240/140 even after taking my routine meds. Since leaving work, my MD has placed me on some routine po meds for anxiety, they are trying to figure out what part of my physical symptoms may be exacerbated by stress.

From reading your post, I can see that you have such a wide base of medical and nursing knowledge, and you will definetly be an asset to your patients and fellow co workers when you are finished. I hope you are able to go into nursing if that is what you would like. I had always wanted to be an EMT, and started EMT basic training the same time I was enrolled in LPN school, but did not have time for both. I had always missed the fact that I didn't go back. The last several years, I worked in ER/Trauma and loved it. I have always kept the hope that if the MDs working with me that I may be able to try EMT school if I am able to go back.

Good luck to you, I hope you are able to succeed in your desires.

Anne

[traumaRUs, MSN, APRN]

I don't think the problem is going to be your stable use of opiods but rather are you going to be physically up to the job? Do you have lifting, pulling, walking restrictions? Working 12 hours on your feet can be brutal even for those of us in excellent health. Do you still do EMS work? Nursing is as physically stressful as that for most of us.

[sissiesmama, ASN, RN]

Right Trauma - So much of what we have to do every day can be taxing and can take its toll on anyone, physically and emotionally. Not every body can do it.

Anne

[jersey_emt]

Thanks for the responses!

sissiesmama -- I would definitely suggest giving EMS a try. It's a very rewarding experience being the first professional medical caregiver to someone's injuries or medical emergency. Depending on your local laws and emergency services budgets, you may be able to obtain an EMT-B certification at no cost to you by joining a volunteer emergency squad first. In NJ, you can join a volunteer squad, and then take the EMT-B course -- here it's two nights a week and one Saturday a month for four or five months -- free of charge. Many states and counties have similar programs. Also, if after some time as an EMT-B you find that EMS is something that you do enjoy, there are bridge courses for RN's to become paramedics (EMT-P). There were a handful of people that I knew that worked full-time/nearly full-time as an RN and one shift a week as a paramedic.

traumaRUs -- Good point...thank you. The opioids I take for pain control bring my pain levels way down -- sometimes even essentially pain-free -- and allows me to live a normal life. They work amazingly well for me, vastly improving function. And like I said, side effects are minimal (just mild to moderate constipation) as I have been on a stable dose for a long time. The MS Contin and Roxicodone simply just melt the pain away and do not affect me otherwise.

Being on my feet for 12 hours would of course be tough on really bad days, but 95% of the time it wouldn't be any problem. I do light to moderate aerobic workouts three days a week (walking a few or biking several miles, etc.) to keep myself active and in moderately decent shape.

I do have lifting restrictions of maximum 50 pounds however. I can lift more, but do not as it can potentially worsen my injuries even with proper lifting technique. Would this be a major obstacle? I have worked with a couple of disabled nurses but I am not sure how my situation compares as I am not disabled.

Thanks again for your help!

[Tweety, BSN, RN]

I understand the get that you are not impared in anyway and that you have a high level of funcitoning. However, please think long and hard before joining a profession that has a high rate of disabling back injuries. We all think that it's not going to happen to us, but it happens all too often.

You're going to probably hear from a lot of chronic patient patients and nurses who went into nursing, but I think it's very ill advised, given the rate of healthy people who have back injuries.

You are also going to have to give your medical history and weight restrictions to the school and employer, and I wouldn't be surprised if you were rejected for liability reasons.

Best wishes in whatever you do.

[sissiesmama, ASN, RN]

Hey jersey - Thank you SO much for your helpful advice for me. I do appreciate it. Yes, I have always yearned to be in one of the ambulances, I have gone at times as a transport nurse moving patients to a more acute level facility, and that is one of thw two things (that and nursing) I have always wanted. I guess I'm the typical ER/adrenaline junkie, but it has always been a dream of mine. I know it sounds silly, but still...

Thanks! Anne, RNC