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I was accused of being impaired at work

Nurse Attorney   (17,091 Views 43 Comments)
by Lorie Brown RN, MN, JD Lorie Brown RN, MN, JD (Advice Column) Writer Expert Verified

Lorie Brown RN, MN, JD has 30 years experience .

11 Followers; 7 Articles; 5,194 Visitors; 91 Posts

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Hi Lorie

I have had severe daily migraines since I was 7 and took my lawfully prescribed migraine medicine Fioricet for 20 years in the middle of the night before work, which lasts about 3-4 hours.  I was taken by security and took a drug test and passed fully minus the Fioricet which I proved my script.

My director still is accusing me of being impaired. I was not- and occasionally my migraines can make me look impaired. I was probably acting defensive very anxious/shocked I was being accused, but initially, his accusations were based on my eyes-they water and get bloodshot when I have a migraine and I had burned the first time (and last time) tanning artificially the night before.

I didn’t get to tell my story. I was sent home, drug test passed with MRO follow up for safety concern for a high level of Fioricet, occupational health followed up and my PCP wrote to not take the medication at work (which I don’t anyway) and cleared. I have been out of work for 3 weeks now still.

Now they are meeting the quality for patient services and safety Dr. RN. And I am still home.

Is an accusation of being impaired alone reportable to the board of nursing? Even after a drug test is taken and I am legally prescribed a medication?

Is this something they will fire me over and then report to the BON? What can I expect? What are my rights?

Thank you


Dear Wrongly Accused

I am sorry this is happening.  I too am a migraine sufferer. Anyone can report you to the Board for any reason.  So, yes, you can be reported for appearing impaired at work.

As far as the Fioricet is concerned, the Board is concerned with nurses taking controlled substances for a prolonged period of time. The reason why they are controlled is because they are habit forming. The Board has no way of knowing if you took your medicine at work or not. You may want to talk to your physician about ways to control and treat your migraines without using controlled substances.

As far as employment is concerned, most states are employment at will and they can fire you for any reason.   If you are reported to the BON, you should receive a call or a letter. Make sure your address is correct so you will receive the mail because you will only have a certain number of days to respond.

I hope you were able to keep your job and nothing comes of this.

Lorie

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This is BS. So you have just told her (Lorie) that they can report her for the disability and the medication she is taking, and get away with it. That is a reportable offense. Which mean any nurse or person that has a medical diagnosis that requires medication in the narcotic field, is subject to losing their jobs. This is violation of every disabilities act/law. Her test came back as a false - positive and the MRO should have kept that information separate- because she effectively passed her test and not a risk to anyone. Of course her Fiorcet levels would be high she has been taking it for years.... anybody taking medication for years would have high serum levels..duh... everyone that takes narcotics or controlled 1-2-3 medications are not addicted to them, most of us the medication works half way or half the time. That’s the life of a Chronic Pain-Er I have Migraines and a lot of other things that keep me in chronic pain, I am a RN also, I have reported many because of their stupidity not their ignorance. 

Stupid does not want to learn ignorance can.

bshenry Rn 

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subee has 45 years experience as a MSN, CRNA.

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No employer wants to explain in the scenario of a serious patient incident, why one of their nurses tests positive for a narcotic and was permitted to work anyway.  The ADA does not provide protection for workers who must use narcotics because the Drug Free Workplace Act supercedes the ADA.  If one is so ill they they must use narcotics chronically, they probably are too sick to be working directly with patients.  Don't bother flaminng me.  This is a really tough dilemma but after spending decades in a position of supporting nurses with dependency issues with the BON, there's no way to allow some nurses to work with positive screens and not give the same pass to others.  
 

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Persephone Paige has 15 years experience as a ADN.

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They can and they will report a nurse with a disability. We do not have the right to show up to work under the influence of a narcotic. If we are THAT sick, we should be home. Now, if we stayed home because of the disability and need for the narcotic and THEN were fired, that might present a better case for discrimination. 

My understanding of discrimination is that if two people are in the same circumstance and one is treated differently, that's discrimination. 

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not.done.yet has 8 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

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You have a right to treat your pain but you don't have a right to work impaired, whether the impairment is because of pain or because of opioid pain medication. Therefore if you are in pain enough to appear impaired, its a problem. If you take narcs that can still be impacting your judgement while at work, then they can and will question whether you belong at work. There isn't a test that can tell them one way or the other, so all they have to go on is physical appearance and behaviors. The culture of this is always going to bend in favor of the vulnerable patient, not the nurse. That is as it should be.

Living in chronic pain is a bitter and unfortunate twist of fate. It can and will hamper many things and unfortunately we don't have a good way of mitigating those impacts, whether that is career, the ability to drive, the ability to control pain and many other things. Yes, it is unfair and deserving of empathy and sympathy. I am sure it is a very bitter pill to swallow, being in pain and having restrictions imposed due to a condition you didn't want or ask for. It doesn't change the fact that there isn't a good way to prove there is no impairment. The extent of our assessment abilities at this point in time force probabilities to be considered heavily. High blood levels of opioid drugs, appearance and/or impaired behavior? Not likely to have a good outcome when it comes to working as a nurse. It is what it is. The policy MUST bend in favor of the patient. Fair? Probably not always, but that isn't the fault of the administration. What choice do they have?

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On 5/9/2019 at 8:21 AM, not.done.yet said:

You have a right to treat your pain but you don't have a right to work impaired, whether the impairment is because of pain or because of opioid pain medication. Therefore if you are in pain enough to appear impaired, its a problem. If you take narcs that can still be impacting your judgement while at work, then they can and will question whether you belong at work. There isn't a test that can tell them one way or the other, so all they have to go on is physical appearance and behaviors. The culture of this is always going to bend in favor of the vulnerable patient, not the nurse. That is as it should be.

Living in chronic pain is a bitter and unfortunate twist of fate. It can and will hamper many things and unfortunately we don't have a good way of mitigating those impacts, whether that is career, the ability to drive, the ability to control pain and many other things. Yes, it is unfair and deserving of empathy and sympathy. I am sure it is a very bitter pill to swallow, being in pain and having restrictions imposed due to a condition you didn't want or ask for. It doesn't change the fact that there isn't a good way to prove there is no impairment. The extent of our assessment abilities at this point in time force probabilities to be considered heavily. High blood levels of opioid drugs, appearance and/or impaired behavior? Not likely to have a good outcome when it comes to working as a nurse. It is what it is. The policy MUST bend in favor of the patient. Fair? Probably not always, but that isn't the fault of the administration. What choice do they have?

You make a lot of sense.

Now if only Social Security would see it this way and grant her Disability.  And I hope she has short-term and long-term Disability insurance.

I hope she has stopped all sugar and grains.  And probably dairy, too, should be stopped.  Also, go organic for produce and only pasture-raised and pasture-finished chicken, beef, pork, etc.  Nothing from factory farms.

Detoxing from all the pesticides, hormones, and antibiotics used in the typical American diet can only help.

Find out, OP, if you have any dental infections, and not just from a regular dental x ray.  There are some alternative Medicine MD's and Naturopaths and chiropractors who can diagnose and treat  other than the typical Western medicine/Big Pharma way.  Do explore this, it could help.

Get rid of mercury fillings.

Learn to use things like almond flour in place of wheat and other grains, especially corn.  It's all generically modified and seriously polluted.

Edited by Kooky Korky

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If this is the way things are going with Chronic Pain and not being able to work, then every state/commonwealth needs a Union to protect the nurses working there. The other problem is when your job sends you home for Chronic anything, you dont keep those short term/long term disability. Which means not only have you been sent home, but now the ability to pay your bills, get your medication, and live/survive has been compromised by those that do not have that problem. What I find amazing is the very people that say “In pain on medication you cannot work” are the very same people that when it happens to them they come around the bend looking for an understanding ear and sympathy... The Nursing field is brutal to the body and the mind... we do not support our own. It’s like the animal kingdom... Survival of the fittest and kick out the weak links.. It would be nice to know we as a species that claim to have a higher mind function would act like it.

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Oh and yes diet plays a part in Migraines as does body weight, hereditary, and allergies to food and environmental elements. Some of these cannot be helped, controlled a bit, not a cure at all. Again those that don’t speak about what they do not know, instead of what they do. As Nurses we should be educated enough to know the difference between plain ignorance and stupidity. How do those of you with no empathy teach your patients how to handle their chronic pain? You tell them to quit there job and apply for Disability... because Disabilty does not care about Chronic pain either.. they tell you “find a job that part time-you can still work...

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not.done.yet has 8 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

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6 minutes ago, Zaphina said:

If this is the way things are going with Chronic Pain and not being able to work, then every state/commonwealth needs a Union to protect the nurses working there. The other problem is when your job sends you home for Chronic anything, you dont keep those short term/long term disability. Which means not only have you been sent home, but now the ability to pay your bills, get your medication, and live/survive has been compromised by those that do not have that problem. What I find amazing is the very people that say “In pain on medication you cannot work” are the very same people that when it happens to them they come around the bend looking for an understanding ear and sympathy... The Nursing field is brutal to the body and the mind... we do not support our own. It’s like the animal kingdom... Survival of the fittest and kick out the weak links.. It would be nice to know we as a species that claim to have a higher mind function would act like it.

While I understand what you are saying, you are failing to consider the impact on the patient of a nurse impaired by pain and/or meds. In our line of work, there is more to consider than simply the impaired nurse and their ability to work. There are some jobs, unfortunately, that have certain criteria that have to be met in order to do them. Nursing is one of them. You have to have a certain amount of physical dexterity. You have to be without mental impairment, whether that be from opioids or from pain interrupting your ability to think.

Most people are not lacking in compassion for this. It simply becomes an incompatibility and the impaired nurse may need to find a different type of job that is able to make reasonable allowances.

I hear the anger in your replies and I am sorry for your suffering. Do not make the mistake of assuming that you are the only person who has struggles with pain or other issues that impact gainful employment.

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On 5/7/2019 at 4:43 AM, Persephone Paige said:

They can and they will report a nurse with a disability. We do not have the right to show up to work under the influence of a narcotic. If we are THAT sick, we should be home. Now, if we stayed home because of the disability and need for the narcotic and THEN were fired, that might present a better case for discrimination. 

My understanding of discrimination is that if two people are in the same circumstance and one is treated differently, that's discrimination. 

How do you pay your bills while your fighting a discrimination case. Narcotics do not make everyone that impaired, I mean people read a book. Learn something just because it sounds like the status quo- do not repeat it.

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1 minute ago, not.done.yet said:

While I understand what you are saying, you are failing to consider the impact on the patient of a nurse impaired by pain and/or meds. There are some jobs, unfortunately, that have certain criteria that have to be met in order to do them. Nursing is one of them. You have to have a certain amount of physical dexterity. You have to be without mental impairment, whether that be from opioids or from pain interrupting your ability to think.

Most people are not lacking in compassion for this. It simply becomes an incompatibility and the impaired nurse may need to find a different type of job that is able to make reasonable allowances.

I am not forgetting anything, as a Chronic pain/ migraine sufferer, I can do my job better than those that are not on anything. No, it is a lack of compassion. So I need you to post the jobs that give for those allowances, so other can apply... since they are out there. I cannot find one of them.. you work a job within the realm of whatever, the minute the job finds out of your pain, you are out the door. Regardless of whether you made it to work everyday, never slurred a word, stayed late to help out when needed, and went above and beyond for the patient. What is the comment for that?

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The person you are working next to, can impair your ability to think.

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