Nurse using drugs at work - ? violent

nurs4kids · Apr 8, 2001

thank God for your reply, mustangsheba. I too found this a bit excessive. I wondered if I just had it alot easier than I thought.

As for the reference to Ativan not being a narcotic. It IS a Schedule IV CONTROLLED SUBSTANCE. This is why it's "locked up".

Bottom line, if the medication has an effect on a nurses' work performance, then someone must intervene.

Originally posted by mustangsheba:
I find it interesting that she was expected to pass 70 meds to 23 patients in under two hours and do 83 treatments. Without knowing anything else, that sounds like a recipe for stress to me.

[This message has been edited by nurs4kids (edited April 07, 2001).]

[This message has been edited by nurs4kids (edited April 08, 2001).]

Zee_RN, BSN, RN · Apr 8, 2001

I think the issue here is the quality of work, not her use of Ativan. This opens a big can of worms--what about the nurse who uses Prozac or the many other antidepressants? Should we be concerned about her depression interfering with her job? What about the nurse on seizure medication such as phenobarbital? Medications that have been prescribed by a physician and are used appropriately should not come under the scrutiny of coworkers--assuming the physician has stated that she can work while taking this medication. (It may be recommended that an individual see how her body reacts to a medication before returning to work while using it.) I know nurses with panic disorders and the other related conditions that are better nurses because of their medication.

This does not mean that her errors should go unaddressed, of course. I would hesitate, however, to just blame it on the ativan, possibly leading to conditions of employment banning the use of certain PRESCRIBED medications.

theboss · Apr 8, 2001

Originally posted by nurs4kids:
thank God for your reply, mustangsheba. I too found this a bit excessive. I wondered if I just had it alot easier than I thought.

As for the reference to Ativan not being a narcotic. It IS a Schedule IV CONTROLLED SUBSTANCE. This is while it's "locked up".

Bottom line, if the medication has an effect on a nurses' work performance, then someone must intervene.

[This message has been edited by nurs4kids (edited April 07, 2001).]

thankyou nurs4kids this is what i ment controlled substance.

[This message has been edited by theboss (edited April 07, 2001).]

nurs4kids · Apr 8, 2001

oops..I reread the original post and Peggy didn't say she had all this to do in 2 hours, she actually had 12 hours to do this. The 2 hr was in reference to passing the meds which is a very reasonable time frame.

I still can't believe the response to this issue. We should be advocates for patient safety. I don't care if the nurse is taking Tylenol, if it's adversely affecting work performance, then something should be done. I've worked with nurses on Prozac and my babysitter is on Prozac- all of which do a wonderful job. BUT if at any time the drug OR the original problem start to interfere with job performance, then it MUST be addressed. Yes, we should be careful not to "jump the gun" and assume the drug is the culprit, but the problem still needs to be identified. Nurses depend on the judgement and "backing" of their coworkers. Not only do I not want someone with "altered mental status" caring for my child, family member, etc. I don't want them working beside me.

Originally posted by nurs4kids:
thank God for your reply, mustangsheba. I too found this a bit excessive. I wondered if I just had it alot easier than I thought.

As for the reference to Ativan not being a narcotic. It IS a Schedule IV CONTROLLED SUBSTANCE. This is why it's "locked up".

Bottom line, if the medication has an effect on a nurses' work performance, then someone must intervene.

[This message has been edited by nurs4kids (edited April 07, 2001).]

[This message has been edited by nurs4kids (edited April 08, 2001).]

A-Man · Apr 8, 2001

Controlled substance yes, but narcotic NO.

Narcotic refers to a specific classification of drugs under which ativan does not fall. Ativan is a benzodiazepine.

I just think this is important because everyone needs to be clear before educating patients on their medications.....

As for this nurse and her errors: these need to be addressed, as it would be with any other nurse who was or was not taking any medications. Your original post spurred some concern I think because you left out the details and simply implied "a nurse is taking ativan- what should I do about it?" With that being the only information, nothing "should be done about it," unless patient care is an issue, which it clearly is. That then, is an entirely different issue.

I would be very careful though about categorizing people by their medications, and would judge them solely on work performance.

[This message has been edited by A-Man (edited April 08, 2001).]

peggy101 · Apr 8, 2001

Thanks again everyone for your input - I clearly see there is an issue here with this nurse - Just wanted to hope that maybe it was isolated. regardless of her medication use. I always feel distressed when I see a fellow nurse in crisis. Just wanted to hear I was not "jumping the gun" - the errors and this degree of neglect is serious. Sorry I was not clear from the get go. I think the patient neglect is heartbreaking and there is no way to ever change the fact that all those residents did not get treatments or medications in those 12 hours of work. There were several supervisors on duty who asked her on several occassions if she needed help - she said no I am fine. I know she is not safe to practice - especially due to the phone calls to the facility the next day at that hour with those demands and threats. She is obviously unstable. Very sad that she came to this. I think I was hoping the ativan use was the cause of her poor performance because that would make more sense than just pure neglect by choice.

Further research has shown she passed 56 meds to 18 patients in 12 hours. error total was: 35 medication omissions and 88 treatment omissions in 12 hours. Has anyone ever seen such a magnificent dereliction of duty? I did research "hostile workers" and unfortunalty she fits the bill. Many nurses who work with her are afraid at this time. They are stressed and they are receiving support by management. So difficult to watch this happen to another nurse. I was hoping we could help her - as it is our nature to do so as nurses. But we have to remember that at some point it is out of our hands and the patients have to be our first priority...FYI - the board of registration does state that "practice of nursing while impaired by substance abuse is grounds for discipline" obviously there needs to be evidence of "abuse" of the substance - or impairment from use of any substance. They define a "substance as "Any drug that requires a prescription." And further state it to mean a drug, substance, or immediate precursor in any schedule or class listed in the regs. Obviously people can take meds as ordered without it impairing their ability to function - others can not. Rumor has it that this nurse is, sadly, an alcoholic as well - but I never noticed it on the job. I just never heard of a nurse admitting to something like that while working. I know that this is bad - but again - just wanted to share and hoped I was wrong somehow. Our job is so hard as it is - adding additional stress only makes it worse. I am warmed by all of the patient-centered support from you all. Nice to see so many nurses who put the Patient first. That's the bottom line - yes!!

lpnandloveit1 · Apr 8, 2001

I think we need to recognize the difference between using a medication and abusing a medication. Not everyone who uses ativan is impaired. If the nurse recognized that she was Impaired (using I'm taking ativan as an excuse for poor nursing) Then someone has to intervene. I would ask administration to intervene and that way the floor nurses don't have to fear the wrath of "the ativan nursed". It sounds to me like she is on the wrong medication anyway if she is that impaired at work I hope she isn't driving a car. I would consider myself impaired if I was taking diphenhydremine so advil is soooooooo out of the question.

mustangsheba · Apr 12, 2001

It definitely sounds as if she's working impaired. She needs to be relieved of her duties, not in a punitive way but so she accepts that her performance is not up to standards. We all agree that patient safety is the priority. I would be very careful about the ETOH information. It's so easy for someone to raise the question when there is no basis in fact. As you mentioned, Peggy, you haven't noticed that problem.

codebluechic, ASN, RN · Apr 12, 2001

Since we're on this topic, has anyone ever dealt with a co-worker who was found to be stealing narcs? We've suspected for some time and she was finally caught. I am wondering what the procedure is for this as far as treatment goes.

Louie18 · Apr 13, 2001

Now ain't that just something.

The beginning of this story had two pertinant facts if I recall.

The only thing that didn't fit right with me was th mention of an eating disorder.

As I scanned each post became worse and worse until at the end we were talking about violence and junkies etc.

Man, the lady took Ativan, SO WHAT!

However, she mentioned it to you, WHY?

I would say with the mention of her also mentioning to you she had an eating disorder red lights should have flashed in everyones head.

There is a book called the "Pain of Obesity."

I read it, but none that I have given it to have read it.

If you never do another bit of reading I would highly recommend this book.

Obesity is a topic possibly safe to toss around here what'd'y'all think?

Louie

Chris-FNP · Apr 13, 2001

Some of you people need to get a life. Its Ativan!!! Its a mild Benzodiazepine for anxiety, as well as other common conditions. Maybe this nurse is going through a tough time right now. Mind your own business. Its not like he or she is stealing morphine from the patients and giving them normal saline instead!!!

Chris