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I was accused of being impaired at work

Nurse Attorney   (531 Views 5 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 and works as a Nurse Attorney.

10 Followers; 7 Articles; 5,009 Visitors; 90 Posts


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.


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432 Visitors; 3 Posts

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 and works as a CRNA, retired.

1 Follower; 17,609 Visitors; 1,685 Posts

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 and works as a Med-Surg.

4 Followers; 1 Article; 3,506 Visitors; 656 Posts

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 works as a Professional Development Specialist.

4 Followers; 43,455 Visitors; 5,301 Posts

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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