I wanted to explain what happened to me...

rehab nurse · Sep 24, 2006

Correct me if I'm wrong, but I've seen several people suggest she might have a "drug problem".

Now, I am no expert, and please I mean no harm here or flames to anyone!!

This is what I think, as a back pain sufferer, and chronic pain patient myself for over 5 years. I now no longer work because without narcotics on a daily basis, I would be in severe pain. I need around the clock meds, and even then, I still hurt. I am awaiting disability, and will be moving back in with my parents and my two children.

Here are my thoughts. Lori has a diagnoed medical condition which requires pain meds she can take every 4 hours as needed. More than likely, she takes them every day, even if she avoids them before work for 12 hours. BUT, she doesn't have a drug problem if she takes her meds AS PRESCRIBED. right? Her employer knows she takes those meds, as does her doctor. A drug screen will show lortab in her urine for up to 3 days after her last dose. Now, again I will say I am NO EXPERT, nor do I work with drug screens. This is what I was told by my own MD. Maybe I'm wrong, and if so, I apologize. Please, no one take me wrong here. I am just trying to understand things better.

Why would Lori have a drug problem if she takes her meds as prescribed? A drug abuser takes meds not according to schedule, taking them by inappropriate routes (snorting, injecting) to get a high. Lori says she takes Naprosyn during work hours because she's SCARED of being targeted by someone at work for taking her OWN PRESCRIBED MEDS. I find this disheartening. Lori has severe back pain, and I feel so sad that those who are rx's pain meds are SCARED to take them even with doctor's permission. If her pain is uncontrolled, that might be worse than going to work with a lortab on board. Usually people who have been on narcotics for some time develop tolerance and don't get "high". they get pain relief. And her employer knew she had a script for those. Now, I don't know what their agreement was about taking them at work/out of work. And please, I am NOT meaning to be mean, or flame anyone here!!! I can't stress that enough. I am just trying to figure out what happened, how she can get back on her feet, and give her some support. I know some people believe a nurse should never go to work while on pain meds. I know some believe one can as long as it's acknowledged by employer, and it's ok by doctors, by employers, etc. And I also know some BON's forbid it. I know nurses who have worked and still do while taking narcotics. (Duragesic, oxycodone, lortab/vicodin, etc). They are working with permission from employer, MD's, etc.

I know I am rambling here. There is a big difference between a person who is a drug abuser and someone who takes meds for a legit reason, as precribed. I just wanted to say I know how it feels to be in pain, and that I feel for Lori who has to suffer at work in pain because she's scared to take her prescribed meds for pain. I also wanted to say for the poster who said she showed positive for Lortab despite "not taking it 12 hours before shift". Maybe someone here can inform me about drug screens. What I was told was that if someone takes it every day, it WILL show up on a drug screen, even if it was 3 days ago. So her test would be positive at 3am, even if she didn't take it since 11am the morning before her shift. maybe my MD is wrong, but i trust him.

okay, back to thread. please don't anyone take what I said personally, I am just stating my opinion, and what my knowledge is about DS. I acknowledge I am certainly no expert, so maybe someone here can teach me something!!! :)

Lori, I hope you are spending some alone time, and some relaxing time this weekend. And I hope you are not in pain, and that you go get a better job Monday. Hugs my friend.

rach_nc_03 · Sep 24, 2006

In addition, you acknowledge taking an Ephedrine to wake up, using Ambien and taking that in error along with it, and having a routine prescription for Lortab. Not only that, you say that the drug test was positive, and everyone here responded to your taking Ambien and telling HR that, but nobody seemed to notice that your drug test was positive for LORTAB- and yet you said that you never take it within 12 hours of your shift. Well your drug test was at 3 am. If you didn't take it within 12 hours of your shift, and the test wasn't done till 3 in the morning on top of that, then the half life would have put your level at too low to be picked up on a urine screen. Can't help being suspicious that you really do have some drug issues that you are in denial about.

do NOT imply that someone with a legitimate prescription for a narcotic for a CHRONIC PAIN ISSUE somehow has a drug problem because they take their prescribed medication. Just like the nurses here who have ADHD who say they have trouble performing at work well without their meds, people with chronic pain who take pain meds as prescribed- under the supervision of their doc- are often safer than if they DON'T take them.

Unless you give drug screens routinely, you can't know how long the lortab would show up in a DS, anyway- I've taken vicodin six hours before a screen and it came up clean, and had a positive screen once when I'd taken the last dose 18 hours prior. (And, by the way, these were both pre-employment screens, for which I supplied my prescription, and there was never an issue.)

Lori chooses not to take her lortab before a shift, and that's fine- but it's a CHOICE she has made, not an obligation, if she is able to function safely while taking it. My understanding is that most state BONs take this position as well.

I'm sick and tired of some nurses implying that everyone who takes prescribed narcotics to manage chronic pain are somehow ADDICTS. If you have an acute injury and you take vicodin for 2 weeks, maybe you're not going to be able to practice safely- but someone who is under a doctor's care for chronic pain management is most likely MORE impaired when they're not using their meds! If the law required us to avoid taking any medication that *could* affect us mentally, the nursing shortage would skyrocket. Heck, diabetics wouldn't be able to practice, as they might have a hypoglycemic episode. Oh, and nobody could go to work without getting 8 hours of sleep.

Sorry to rant, you guys, but this makes me :madface: .

Kymmi · Sep 24, 2006

I've read this entire thread and although I havent figured out how to cut/paste quotes from other posters I'd like to say a few things so I'll generalize.

Amy Gooch---excellent post and suggestions--can you be my life coach?

To the poster suggesting that a friend call and pretend to be a perspective employer---Im not sure that is such a good idea because I do believe that could cause alot of troubles for misrepresentation.

The the poster suggesting that that the Lortab would not have shown up in the drug screen if it had been 12 hours since Lori took it I think that is wrong because if you look up the amount of days that narcotics can be detected on a drug screen it is many. I know that Percocet can be detected up to at least 5 days post last dose.

Lori---I really think that you had the best of intentions by going into work however I do agree that you need to learn how to take care of yourself and do what is best for YOU first. The old saying that goes something like you cant make anyone else happy if you arent happy yourself also applies to taking care of yourself. A majority of nurses are so co-dependent that we worry about everyone else first and ourselves last and in the long run that is no good for anyone. I have wondered while reading this entire post why the DON would take such drastic measures against you if this was the first incident. Im not necessarily saying impaired incident but any kind of negative incident in general. I know what's done is done however even though the state is a right to work state I do believe that most employers keep a very good paper trail on any negative issues that may occur.

rach_nc_03 · Sep 24, 2006

rehab nurse- you and I must have been typing at the same time! you said what I was thinking, but you were MUCH nicer.

I have always been told, when applying for jobs, that having a postive UDS for narcotics because of a legitimate prescription COULD NOT be grounds for denying employment. Working impaired, for whatever reason, can. Personally, I don't think employers are doing anybody a 'favor' by allowing them to work while taking pain meds- if it's such a big problem, have better sick time and STD policies so people can actually take time off when they're injured.

RebeccaJeanRN · Sep 24, 2006

...I have wondered while reading this entire post why the DON would take such drastic measures against you if this was the first incident. Im not necessarily saying impaired incident but any kind of negative incident in general. I know what's done is done however even though the state is a right to work state I do believe that most employers keep a very good paper trail on any negative issues that may occur.

I agree with above plus I did know that I would possibly incur the wrath of many by suggesting a possible drug problem in my earlier post, so I'm not surprised at all the tongue lashing. But just please consider the bigger picture which raised red flags for me: the use of Ambien to sleep , the use of Ephedrine to wake up, the positive drug test for Lortab- and yes, I know that we don't know how often the use is for any of these...- but there also is the impairment on the job which was visible and which triggered a drug test. All these are just hints of something larger, that's all....just hints!, so I only made the suggestion. If that makes me horrible, so be it. There is also the fact that she could not be legally fired for just one positive drug test for use of a legal prescription- unless that particular prescription drug is illegal to have in your system on the job in that particular state.

[bTW, my background includes being a former Med Tech and working with the drug tests (although very long time ago & much has surely changed). And I didn't just invent the half-life info on Lortab, I looked it up first before posting.]

Anyway, meant well and am still going to pray for this OP who surely needs it right now.

Kymmi · Sep 24, 2006

Im not implying that anything the OP or any other person who stated they used any narcotics for prescribed use as a addict. Im saying that it seems unusual to me that someone would be fired for a one time incident. Im also not implying that the OP has had previous incidents related to drug use. When I said negative incidents I meant anything that the employer would have issues with which would make them want to fire the employee instead of assisting them to get help. In other words other reasons in addition to this incident. I've worked with nurses at other jobs that have had a drug addiction problem and have actually been proved impaired and they have been offered suspension while they attended rehab and then returned to work under specific guidelines. We have one side of the story here and Im not attempting to say what has happened wasnt fair however we dont know the other side therefore we do not have all the facts.

km5v6r, EdD, RN · Sep 24, 2006

What part of Lori's post was not understood? She KNOWS what she did was wrong. It was a mistake of her taking the wrong medication when she was upset. Geeze.....

No the mistake was thinking she could go to work without sleeping for over 24 hours, leaving her sleep deprived. In trying to manage the sleep deprivation; which would cause impairment and lack of judgement; she tried to take a potent stimulant. To manage the side effects of the stimulant she then accidentally, possibly, took a sleeping pill. She is not even sure she took the sleeping pill but it is possible. Not to make Lori feel worse then she already does but the original mistake was to stay up for over 24 hours, spend an emotionally exhusting day then try to work another 8 hour shift. Having a full night of sleep before spending the day as she had, then going to work would have been difficult.

Lori, I learned the hard way that you can pour way to much into a job. You wrote once of being salaried and putting in 10-15 hours of overtime a week, working every holiday, feeling you could never call in sick. Been there done that. You are a wonderful nurse who truely cares for your patients. In a fair world, in years past, your kind of loyalty would have been repaid with the assistance/support you need right now. Unfortunantly it is an unfair, corporate world. An employer will use you for what they can get then throw you away when empty. The unpaid overtime you put in was wonderful for the company. The golden rule of treating others as you want to be treated doesn't exist in the corporate world. It is difficult for truely caring people to grasp that people can and will suck everything out of you if given the chance. For me, I gave absolutely everything to a company and job I truely loved. 50-60 hour weeks, taking tremendous amounts of call, making forms to ease pt care, ordering supplies, staying at the hospital for 48 hours at a time, teaching classes, I even paid my son to come in and help move supplies on the weekend when I wasn't being paid. I ended up setting a very high expectation. When I began having family problems and could no longer keep up the same pace I was reprimanded. I no longer "met standards". I still did far more then the other staff but I no longer could meet the standards I had previously met. I finally realized I was the only one that cared about me and would protect me. I am still a sucker for a sob story or unmet need but I am trying to do better at protecting myself and believing that I deserve time off and compensation for my work.

As far as why you left your last job; just say you were/are going through a very difficult family crisis and found the manager to be unsupportive. If questioned, acknowledge you made a mistake in trying to work during an emotional crisis. It is all true. Out of fear of defamation suits most facilities will only acknowledge that someone worked from this date to this date and if they are eligible for rehire. Take copies of all the forms etc you developed with you.

This incident has to have anilated your self esteem. Keep telling yourself the truth that you are a good nurse, you deserve better then you have received and you will receive better somewhere else. Also know you will be sorely missed.

Lacie, BSN, RN · Sep 24, 2006

As far as why you left your last job; just say you were/are going through a very difficult family crisis and found the manager to be unsupportive. If questioned, acknowledge you made a mistake in trying to work during an emotional crisis. It is all true. Out of fear of defamation suits most facilities will only acknowledge that someone worked from this date to this date and if they are eligible for rehire. Take copies of all the forms etc you developed with you.
This incident has to have anilated your self esteem. Keep telling yourself the truth that you are a good nurse, you deserve better then you have received and you will receive better somewhere else. Also know you will be sorely missed.

Lori, as someone who has been through a very similar situation and dealing with the aftermath I have a great deal of empathy for your situation. Although I was not impaired and had all negative drug screens they still reported me to the BON. This all occured within 2 weeks of being severly assaulted in a domestic situation broken bones and all. I did all the steps I should have and still lost my job and was also disciplined on my licensure all based what the boards said was only "circumstantial evidence" of impairment. I couldnt afford an attorney either as they wanted a $2500.00 retainer. I ended up bankrupt and in the hospital for a month with major depression 3 months after the suspension. I suffered more from the so called "support" from my profession than I did from the actual abuse. Long story which I mentioned in another thread regarding drug testing by employers. Yes some do eat thier young in this profession then spit them out only to devour them again. It took me a long time to even consider regaining faith in this profession again. That was 16 years ago and it still stings at times but I promise you it does get better. Once I finally learned to quit blaming myself I saw the world and nursing in a whole different light. Many have no idea just how fragile our jobs and licensure really can be. The above quote gave very good advice regarding seeking new employment. It's always best to not speak of a previous employer in a "bad" light. Just express you had differences. Dont detail unless specifically asked to do so. Maybe consider seeking something in medical case management with the insurance industry like worker's compensation, etc. Corvel is national and doesnt require any on hands care. I did this for years and loved it as health problems with my knees prevented me from doing alot and I for the same reasons didnt want to take pain meds. As others have said "Take care of yourself first"!!!! I learned the hard way and now I do make myself the priority. It will make the biggest difference when you start putting yourself first. Also I did find a fantastic counselor to help me deal with the issues and to vent my frustration and anger. And I did have alot of anger afterwards. Dont let that get in the way of seeking new avenues. Prayers for your search and keep us posted on your progress please.

rehab nurse · Sep 24, 2006

rebeccajeanrn: hi there...i didn't mean to "jump all over you" about you posting the info on lortab. i don't know who you're referring to, but i hope it's not me. i said specifically a few times i didn't mean anything personal, and i didn't want to offend anyone.

that being said, i understand that the half life of lortab may be around 3 hours (give or take). but what i was suggesting was just this: that even if she only took one lortab, it shows up on a urine screen for days, not hours. i understand what you're saying, but even my pain md said that just one dose of any narcotic, and also illegal drugs, will show up in your urine and blood drug screens for days after. you probably knew that anyway, since you have experience with it being a med tech. i don't have any experience with that, just what my md told me and the same info available online.

please, i am not trying to offend anyone here, just clarifying things. i don't want to appear rude to anyone, however, chronic pain is a near and dear topic to me. and i know on this site we've actually had threads about the subject of nurses taking narcotics while working. most of them don't end well.

here is the chart i found on family practice handbook about how long drugs will show up on a tox screen:

alcohol (ethanol)

3 to 10 hours

hydromorphone (dilaudid)

1 to 2 days

amphetamine or methamphetamine

1 to 2 days
may also detect mdma

methaqualone (quaaludd)

2 weeks

barbiturates

2 to 6 weeks

methadone (dolophine)

2 to 3 days

benzodiazepines

moderate use: 3 to 5 days
heavy abuse: 3 to 6 weeks

morphine

1 to 2 days

cocaine

direct: 5 hours
metabolite (benzoylecgonine): 2 to 4 days

pcp (phencyclidine)

2 to 8 days
false positive with ketamine

codeine

1 to 2 days

propoxyphene (darvon)

direct: 6 hours
metabolites: 6 to 48 hours

heroin (detected as morphine)

1 to 2 days

marijuana (thc metabolite)

urine: use of one joint: 2 days
use three times per week: 2 weeks
use daily: 3 to 6 weeks
blood: 8 hours

source: moses s. toxicology screening, urine tox screen. family practice notebook; 2005 www.fpnotebook.com/psy123.htm

information on the half=life of lortab:

hydrocodone : following a 10 mg oral dose of hydrocodone administered to five adult male subjects, the mean peak concentration was 23.6 ± 5.2 ng/ml. maximum serum levels were achieved at 1.3 ± 0.3 hours and the half-life was determined to be 3.8 ± 0.3 hours.

i understand what people are saying about half-life. but really what counts is how long the med will show up in her urine, and that can be a few days. she could have taken the lortab days ago, and it still would have shown up in her urine.

i don't know about lori's state, as i don't live there. however, it must be legal to take those meds, as her employer knew she took that for her back injury when she was hired on a year ago. and if it was against her bon rules, her employer could have reported her (and would have been mandated to report her) to the bon.

another issue, was something my pain doc told me when i asked him about working (in general, not just nursing) while taking narcotics on a daily basis for chronic pain. he said that the liability for the employer is great when they have an employee working on meds that have the potential to impair judgement. not just narcotics, but meds like topamax (which i took a couple times for migraine prevention) and others can really impair a person. it's not just narcotics or even meds that can impair someone's judgement. lack of sleep, as proven by lori's post, emotional distress (worrying about a terminal loved one) can all affect one's performance.

i agree, lori shouldn't have gone to work that night. she was exhausted, hence her needing to take an ephedrine (i think) to wake her up. she lacked sleep, was upset, etc. however, she was past the time to call in without discipline. and yes, i know it's more important to take the discipline and be safe at home rather than try to work. but i also know that a lot of nurses (and other professionals) have gone to work while maybe not gotten enough sleep, aren't feeling well, etc.

heck, we had a cena at my old facility that worked 14 doubles in a row...she wanted to buy a new hummer. the employer should have told her no, but they don't. they want a body to cover "the minimum staffing level". i tried to send her home, since on an afternoon shift on my unit, she kept dozing off in pt's rooms. (she worked 3-11/11-7) when i told her to punch out and go home, sleep in her care, whatever...she went and called the don and administrator on another unit and they told her to stay. i was the one disciplined for that. so, a whole lot of things in play.

lori, i pray that whatever happens, that at your next job you won't work so many ot hours for free. i know it's a typical "mid management" expectation, but it shouldn't be. learn from this, that an employer and a job isn't worth going through this anguish ever again. you're an rn and you can go get a job anywhere. you're a darn good nurse, and you have a heart of gold. any place would be lucky to have you. but, like another poster said...you are most important. do your work, but when your job is done, go home. take care of yourself first, because an employer won't. employers care about the bottom line only. and no nurse should have to put a job before their own health and well-being.

sorry for such a long post, just had a lot on my mind. goodnight, all. lori, i hope you are sleeping peacefully at this hour.

LoriAlabamaRN · Sep 24, 2006

Thank you to all who have come to my defense. I honestly am not a drug addict, I am someone who has a chronic back injury and cannot sleep without narcotics to control the pain. I take a third what I could, and all because of my own views and worries about what could happen. I've taken the same strength for four years now, so I doubt it could ever mess up my mind.\

Thank you Amygooch for your suggestions, I have printed and saved them and will be putting many of them to use. Financially I am sick to my stomach with fear.

I understand the comments I got regarding title loan. I will only use that as an absolute last resort. Thank you for enlightening me.

Thank you also to all those who have faith in my nursing abilities. I did feel as if I had no choice but to go in, we currently have a hospice patient who requires an RN be in the building at all times, so if I had called in it would have resulted in my DON having to come in at the last minute for the whole shift... I just couldn't do that. I didn't know Ihad taken the Ambien, i thought I was just working on no sleep like so many of us here have selflessly done.

I thank you so much for your support... and I am still here... I never expected so much interest and support and it has raised my spirits immeasurably...I plan to go to Goodwill in the morning to look for some sort of passable outfit to wear to this interview...

GatorRN · Sep 24, 2006

I agree with above plus I did know that I would possibly incur the wrath of many by suggesting a possible drug problem in my earlier post, so I'm not surprised at all the tongue lashing. But just please consider the bigger picture which raised red flags for me: the use of Ambien to sleep , the use of Ephedrine to wake up, the positive drug test for Lortab- and yes, I know that we don't know how often the use is for any of these...- but there also is the impairment on the job which was visible and which triggered a drug test. All these are just hints of something larger, that's all....just hints!, so I only made the suggestion. If that makes me horrible, so be it. There is also the fact that she could not be legally fired for just one positive drug test for use of a legal prescription- unless that particular prescription drug is illegal to have in your system on the job in that particular state.
[bTW, my background includes being a former Med Tech and working with the drug tests (although very long time ago & much has surely changed). And I didn't just invent the half-life info on Lortab, I looked it up first before posting.]
Anyway, meant well and am still going to pray for this OP who surely needs it right now.

OK, I refrained from responding to the other post, but I have to add my two cents now. It infuritates the he** out of me when ppl who are diagnosed with chronic pain that a qualified physician feels warrants pain meds is referred to as a "drug addict!!" :angryfire:

Insomnia is a very real issue for some ppl, myself included, that sometimes requires the use of a sleep aid. We all understand the effects of sleep deprivation. Which is what I believe Lori was suffering from when she was accused of being impaired. Her physician prescribed these for her. Taking a prescribed medication does not make her a "drug addict!" Besides that, she isn't even sure if she took an Ambien or not. If you recall she posted this as a possibility due to the locale of the bottle the next day. Btw, Ambien in not always oblong shaped. It depends on the manufacturer as to what the pill looks like. They can be small and round as well.

Ephedrine is a diet aid. Yes, it is also a stimulant. But if we, as nurses, weren't chastised for calling off of work when we needed to, the need to take such an aid to stay awake would not be necessary. Lori felt a heartfelt obligation to her grandmother, her employer, and her residents to go in to work. In hindsight, I'm sure she wishes she had called off.

I, personally, did notice the drug screening tested positive for Lortab that she was prescribed. I also noticed she said she didn't take it 12 hrs prior to having to work. This was a choice she made. I have no reason to believe that she would go back on her choice. As far as your statement about the half-life of the Lortab, and that it shouldn't have been in her system if she hadn't taken it recently, you are wrong. Half-life means the amt of time required by the body to inactivate or metabolize half the amt of the substance taken in. This does not mean the amt of time it's in your system. Lortab or the metabolites of Lortab can stay in your system for 3-4 days depending on your specific metabolism. Therefore, there is no definitive proof that she was impaired by them at work. It only confirms that she had taken a Lortab in the previous 3-4 days. Again, this does not make her a "drug addict!"

Someone who takes a prescribed narcotic for chronic severe pain does not experience the drowsiness, dizziness or light headedness from taking it. If taken regularly you develop a tolerance and do not have these effects. If someone were to take a narc once in a blue moon for an acute injury these effects would be a reality, because they have not developed a tolerance. People need to remember that nurses are human and have real life conditions/issues, and deserve to earn a living just like everybody else. To say that someone who has taken narcs long term is impaired, is wrong, quite the contrary. Someone suffering from severe pain would be more at risk of making a mistake if all they could think about was the pain and inability to move.

A "drug addict" abuses drugs for a high. For someone with real pain, taking a med make the pain tolerable, allowing them to function somewhat normally, not get a high! There is a huge difference. I used to be one of those nurses who assumed my pts were drug seeking when asking for their pain meds on a regular, to the minute bases. I now understand the error in my old ways of thinking. I think all nurses should be required to take a class on pain management. We, as nurses, are doing our pts a grave disservice by allowing them to suffer needlessly and not treating their pain appropriately. We are also doing our coworkers a disservice by jumping to the wrong conclusions. We need to look out for each other, not try to destroy each other.

I would be the first person to say something if I believed that a co-worker was impaired and practicing unsafe care. But I would ask that person what was up before jumping to the wrong conclusion and jeopardising their livelyhood/license. If the person who called in the DON had asked if everthing was allright, Lori could have explained her situation and perhaps called someone in to cover her shift, and this whole mess could have been avoided. Let's not wrongly label somebody as a "drug addict!!" :nono:

I'm sorry for getting off topic here, but as you can clearly see, this subject struck a nerve with me. I'll stop ranting now and shut up.

Lori, Good luck with your interview Monday.

suzy253, RN · Sep 24, 2006

{{{Lori}}}

Again, I am so sorry to hear what has happened to you. I can't imagine what you are going through right now. Good luck with your interview tomorrow. You'll be in my thoughts and prayers. Please hold your head high and hang in there. Keep us posted! Much love to you!!!