Nurse doing cocaine HELP

gypsyatheart · Jul 17, 2005

I practiced law for over 22 years, and served as counsel to hospitals and other health-care organizations. I have written drug-testing guidelines for hospital facilities on the west coast. In addition, I continue to read professional journals and cases regarding employment law. I KNOW what goes on behind the scenes in most health-care workplaces. You know only about the demands made upon your co-workers, in one specific facility that contractually required compliance with a request for immediate testing.
Most facilities have no such requirement.
I don't have a problem with random drug testing, or testing of applicants for unfilled positions.
I really don't see what my status as a nursing student has to do with the discussion. What's your point?

*I have been in nursing for 16 years, you have been practicing law for 22...OK good.

*You are familiar w/writing policy&procedure, HR guidelines, etc...good...you are familiar w/the Administrative function....good. This is where it gets tricky. There is a huge difference between administration and nursing...it's called "the politics of nursing". But that's a whole other thread and learning curve for you.

*What I experienced, as well, I'm sure, many other nurses, is not isolated to just one hospital. I have travelled to many different states, worked in many different hospitals as a travel nurse. It does not matter. If you are reported for doing drugs, one way or another you will be tested and busted, eventually. And I'm not just talking about rumors. The OP was in the comapny of the nurse in question and witnessed this behavior. This is not a rumor. And believe me, management will do what they need to in order to get the person testd and the help they need.

*I have never in all the years I have been employed as an RN not had to do a drug test, and my employment is contingent upon being "clean". And yes, most/all hospitals have this requirement.....

*What you're being a student has to do w/this discussion is that you may know how life inside the law works, but you definitely don't know anything about working as a nurse, the politics of nursing, life in the trenches, as they say. :rolleyes:

*Believe me, I do know what goes on behind closed doors, and my friend, sometimes, it ain't pretty. You are going to need luck in school and be prepared to lose some of the idealism you have....it is going to be a rocky road.

*Bottom line....this thread was/is about what a nurse should do after being party to another nurse doing illegal drugs....maybe you should visit a law forum and debate the finer points of law there; here in the world of nursing we have zero tolerance for a nurse abusing drugs....b/k sooner or later all hell is gonna break loose. :stone

Have a good day now.

targa · Jul 17, 2005

Sorry-you over stepped your bounds with your snotty "people who are uniformed" comment. YOU are uninformed, because YOU are a nursing student-while you may have "advised"; it is nothing like being an actual healthcare professional. Many of the people you are calling uninformed have years and years of experience relating to this topic-in an actual working, knowledgeable capacity, you comment shows that you are little too upset over people suggesting that IF this nurse is impaired, she shouldn't be caring for patients. I do not see why you are so upset over this idea-it really shows how uninformed you are about the realities of nursing.

You obviously have a reading problem, Ms. Fish. I AGREE that if she's impaired, she shouldn't be caring for patients. I've never written anything to the contrary.

You ARE uninformed about the legal protections afforded to employees. You evaded my direct challenge: just what is it about due process that you don't like? Employers can't make employment decisions, like who should be drug-tested, on the basis of rumor and innuendo. I don't need to have a PhD in nursing to understand that. I know enough about "the realities" of nursing to discuss this issue intelligently and responsibly. I've worked directly with hospital HR personnel and nurse managers about this very issue. You really don't know what you're talking about. You are responding on an emotional level ("oh my god, what about the patient?!?") which probably explains why you are probably not in nursing management, because your emotional decision to order a nurse to submit to drug testing on the basis of rumor, without more, would likely have adverse consequences for the hospital.

I fail to see how my student status impacts the weight and worthiness of my statements. Think before you write.

targa · Jul 17, 2005

If you are reported for doing drugs, one way or another you will be tested and busted, eventually. And I'm not just talking about rumors. The OP was in the company of the nurse in question and witnessed this behavior. This is not a rumor. And believe me, management will do what they need to in order to get the person tested and the help they need.

That's right: management will take the information (and yes, it really IS a rumor... a report from a non-employee about off-premises behavior) and the nurse in question will be watched. And eventually she will be tested, after management compiles some HARD evidence of her declining performance and unusual behavior. You and I aren't that far apart. The end result will be the same: she'll be disciplined and offered rehab. We differ on the route taken... the right way takes more time, but the right way sticks when it is challenged. One really doesn't have to have a license and 10 years in an ICU to understand this.

targa · Jul 17, 2005

earlier in this thread, i was also one of the posters who readily agreed to get this nurse tested.
but after reading targa's post, if none of her co-workers have reported her, the she shouldn't be subject to drug testing based on the rumor mill. i officially change my answer as i now understand on how intrusive and violating it would be. if this nurse is a cokehead, trust me, her behaviors will be apparent in the workplace and then would be handled accordingly.
thank you targa, for shedding a different light on this scenario. i understand and agree with you. and yes, we should be aware of the legal implications of any given situation, esp in nsg.
leslie

Thanks, Leslie. I'm glad I was able to change one mind. It's a tough issue, but then, if it were easy there would be no disagreement. Peace!

gypsyatheart · Jul 17, 2005

The end result will be the same: she'll be disciplined and offered rehab. We differ on the route taken... the right way takes more time, but the right way sticks when it is challenged.
.

Right....the end result will be the same. And I'm not disagreeing w/you that the "right" way is the way things should be handled, all I'm saying is that sometimes the "right" way is not allways what happens....

Plus, in this instance, if I got a call from a nurse offerring concerns about one of my nurses doing drugs, ultimately, w/in the framework of doing things"right" that nurse would get tested. And that's what this thread is all about...what this nurse should do in this circumstance....the nrs mgrs will have every opportunity to follow the law once they are made aware of the situation.

oldnurse newnurse · Jul 17, 2005

further, departing from the legal analysis, i'm not convinced that witnessing a single incident of cocaine use is compelling enough to cause you and others to get on your high horse of moral indignation.
the reaction many of us had was that the cocaine-using nurse was not only doing something illegal, she was doing it brazenly in front of another nurse. lori was po'd that this unthinking/uncaring person put her on the spot. you don't have to get on a "high horse of moral indignation" to say this nurse has a problem. she works in an icu, for pete's sake.
people do things to themselves all the time: they drink, they smoke, they smoke pot, they take a few more prescription pain meds than prescribed, they engage in sex, etc. until 2003, when the supreme court tossed the law out on privacy grounds, it was illegal in texas (and some other states) for two men to have sex with one another. would you have advocated firing a gay nurse for engaging in oral sex with another man in a bathhouse? let's see... presume for a moment that that gay nurse was picking up std's and then not using sterile technique when he returned to work. was he placing his patients at greater risk than the nurse whose weekend cocaine use had metabolized before she returned to work on monday morning?
there are some big holes in this scenario. while this behavior may have been illegal, i doubt that an employer would mention stds specifically under conditions of employment and incorporate random or "for cause" testing in their policy as nearly all employers do now for drugs. second, not using sterile technique is grounds enough for closer scrutiny. and just for the sake of argument, there's a good chance that someone in a position to know about another's clandestine bathhouse activites might have a little something of their own to hide.
the fact is, the only consideration here should be the nurse's job performance. if she is performing her duties as expected, it is really none of your business what she does off the job. if her cocaine usage is heavy and she is becoming adversely impacted by it, that will soon become evident and she may well be fired (or forced into rehab) soon enough.
lori raised a concern that icu nurses have access to many narcs. this is a minefield for two reasons. one is that it sometimes takes months or years of judicious diversion for a person to get caught. meanwhile, patients suffer from being undermedicated. the other reason is the great responsibility that and icu nurse has. keeping track of complicated drips, vents, etc. can be taxing under the best of conditions. this nurse might not be coked up per se when she's at work but she can still be impaired by fatigue and clouded judgment r/t coke.
but in the meantime, we do not live in a "minority report" world where we punish people for what we think they might do. your feelings of moral superiority are disturbing.
we should not become a nation of tattletales. but too many people look the other way for fear of getting sued or making someone mad. there are situations that cry out for a response and that don't have anything to do with feeling "morally superior."
if i ever found myself with another nurse who was flaunting her illegal behavior and dragging me into the middle of it, i would be so angry. not just over the drug use, but over the assumption that i wouldn't react. for all any of us knows, this other nurse might be a very nice person. but her behavior and her judgment stink.
i wish lori would come back and give us an update.
miranda

okay i work for the state of illinois dept. of health and human services and they do test the employees for std's. so i agree with the other young lady and the bath house situation. both are unsafe and in that case i am a brittle and i mean very brittle diabetic and in dec. '05 i will begin working in icu should i be discriminated against because at times my blood glucose level drops

targa · Jul 17, 2005

Right....the end result will be the same. And I'm not disagreeing w/you that the "right" way is the way things should be handled, all I'm saying is that sometimes the "right" way is not allways what happens....
Plus, in this instance, if I got a call from a nurse offerring concerns about one of my nurses doing drugs, ultimately, w/in the framework of doing things"right" that nurse would get tested. And that's what this thread is all about...what this nurse should do in this circumstance....the nrs mgrs will have every opportunity to follow the law once they are made aware of the situation.

Yes, and if you'll read one of my prior posts, my own suggestion was that the OP contact the unit manager of miss coke-head, and suggest that she keep an eye out for unusual behavior or declining performance, WITHOUT naming names. A complaint to the BON would be useless. Once a unit manager is aware of a potential problem, the problem will reveal itself in due time, if in fact there is one.

targa · Jul 17, 2005

What an interesting thread:

https://allnurses.com/forums/showthread.php?threadid=112202

Hmmm....

Works2xs · Jul 17, 2005

If you are innocent, as they say, what's the problem? The problem is there only when people of guilty of breaking the law.

Not to get too far afield, but this statement ALWAYS sends chills down my back.

There's a concept called "presumption of innocence". The requirement for this touches a few areas (I'm sure Targa will correct me if I'm wrong). In the realm of logic, there's no logical means for proving a "negative" (as in "I didn't do it"). The state has the burden of "proof" and the accused only needs to shed reasonable doubt to win.

So when a law enforcement agent, politician, or well meaning citizen pipes up with the "what's a innocent person's worry", the little hairs on the back of my head stand up. Their request is putting you into a situation for which you can easily be trapped into proving the unprovable. Targa's earlier comment regarding "putting a camera or two..." was a reference to this very sort of thing, i.e., if you have nothing to hide, then why would you be concerned?

The answer is obvious on its face. However, if you've still a doubt, another aspect of this is tied up in search and seizure law, e.g., needing probable cause to conduct such a search. Again, Targa is noting that the witness account amounts to hearsay and, as pointed out, this can easily be abused to harm the innocent. Thus the need for additional qualifiers such as "probable cause" for triggering such a search.

As to the discussion at hand, I think that both sides of the current discussion are correct. Why?

Folks keep referencing "random" screening being ok. That's no accident. A ploy that is often used is to test everybody so that you can't say any single individual was being scrutinized (why violating everyone's fourth ammendment protection makes it ok always struck me as odd...but that's another thread). Folks suggesting that some sort of report be made (annonymously or whatever) are basically attempting to precipitate the process of a "random" screen - knowing the suspected person is likely to be discovered. Contract requirments are maintained and legal protections are upheld - as noted, people caught in such dragnets are usually treated to an option for intervention vs. outright arrest.

So what it boils down to is that there are usually at least two systems at play in the work place. One is the way the rules say they have to be done. The other is the way things really work.

From a "rules" standpoint, Targa is correct. If you, as an employee end up in such a situation, you now know that there are some legal protections that you can bring to bear in order to protect yourself from unlawful activities. Even if you are "guilty" of the suspected activity, there are laws that can be invoked to protect yourself from ending up in the "stripey hole." If you've the legal chops for it, you can probably even work it out to where no record is even created.

From a "way things are done" standpoint, there are ways of working the "system" that can bring about a desired result. With this case, working the system might include providing the system a means for violating everyone's... er, ah.. randomizing the test just to catch the suspected violator. Once caught, the person typically ends up leaving the employ of that particular operation. Even if no actual legal sanction is levied, management's goal of removing the undesired individual from the workplace is usually accomplished. I'd even go so far as to suggest that management is betting on the employee's reluctance to expose themselves to legal action as insurance that civil action is avoided.

So, I think everyone is actually in violent agreement. If there's obvious workplace impairment, some action needs to take place. The disagreements seem to revolve around when such activity should be involked. The strictly legal way has the unfortunate side affect of being "reactive", as in the patient(s) usually has to be subjected to some degree of harm or mistreatment.

If you want to avoid such a circumstance, then you have to "work the system". This also has a down side in that the sometimes innocent (or perhaps non-threatening) people can have their rights abused and/or lives are ruined.

Both options have plenty of warts to go around. Neither is cut-n-dry for universal application. That's why threads like these are important. They provide folks a more complete picture and offer views that might have been missed in the heat of the moment. 'Cause in the end, the OP will have to make the decision on her own.

rn/writer, RN · Jul 17, 2005

okay i work for the state of illinois dept. of health and human services and they do test the employees for std's. so i agree with the other young lady and the bath house situation. both are unsafe and in that case i am a brittle and i mean very brittle diabetic and in dec. '05 i will begin working in icu should i be discriminated against because at times my blood glucose level drops

the difference between a diabetic nurse and a drug-affected nurse is that one is free to make necessary adjustments and ask for assistance openly, while the other has to mask impairment and act covertly.

i'm diabetic, too. insulin-dependent to boot. i don't make a big deal out of it, but a few co-workers know the scoop and would not hesitate to cover me for a bit if i needed to do a blood sugar, take insulin, or eat something.

here are some other differences:

being diabetic is not voluntary. taking insulin is not illegal. my impairment is temporary and can usually be modulated quickly. i didn't sign an employment agreement not to be diabetic or insulin dependent. insulin and diabetic meds are a dependence without being an addiction. my life is better for the presence of the drugs i take.

i feel if the cocaine habit or one time use does not effect the work performance then leave the lady alone. but she should keep it to herself. she was a little bold!

see, this is the crux of the problem lori faced. what do you do when you become aware of a situation that is illegal, unethical, and potentially dangerous? look the other way? that's a quick road to either messing yourself up or deadening your conscience. try to approach the other nurse yourself? bad idea. few of us have expertise to offer in this area. and who knows if what kind of response you might get (revenge, threats, violence). and how will we know if the coke use affects another nurse's work performance is we aren't on the job with her. the truth is, even among co-workers, most of us are too busy to closely monitor someone else's perfomance. and there are impaired folks who can compensate to a point and it would take someone really looking hard to see the problems.

in this situation, i would have more questions than answers. i wouldn't know for sure whether this nurse had a serious problem or was simply, pardon the espression, blowing smoke. but here's the bottom line. it's not my call to make. does that mean i walk away and try never to think about it again. heck no. it means i pass on the info (anonymously if need be) to someone who is in a position to monitor the nurse in question and do whatever the situation merits. lori's report of what she saw and heard might not, in and of themselves, generate enough probable cause to order testing. but, her report should put others on notice that this person bears careful scrutiny.

you don't have to take on the responsiblity for the entire game to raise a flag on the play.

miranda

teeituptom, BSN, RN · Jul 17, 2005

As I posted before -- I have absolutely no problems with people using drugs.
I DO have a problem if those people who use drugs have their ability impaired and they are at work.
If you see me out on Saturday night and I wash down beer after beer - are you going to report me for alcohol dependency? Ofcourse not. But you will (and should) report me if I come in the next day badly hungover and impaired.
Simple.

Illegal use of drugs is exactly what it is, illegal.

and everyone should have a problem with druggies

whether at work impaired or elswhere

And if I see a fellow nurse washing beer after beer down, whether it impairs work or not, I would encourage them to get help and if that didnt work, yes I would turn them in as having a problem.

teeituptom, BSN, RN · Jul 17, 2005

Anything that she does outside of her job is nobody's business. But if she comes to work high or somesuch and it's affecting the performance of her duties, she certainly needs to be reported.
I agree with you Roy.
Z

I have to disagree here

Ive seen too many people with problems in their personal lives have it affect them one way or another while at work. Whether impaired or not.