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Nurse using drugs at work - ? violent

peggy101 peggy101 (New) New

What do you do if you are aware a nurse is taking Ativan (her own) at work to function

Q.

Specializes in LDRP; Education.

NOTHING, as it is none of my business unless she compromises patient care.

Peggy,

You should talk to her first and see what is going on with her. Let her know about your concerns. You are the boss so it is your responsibility to be proactive and prevent any future harm if this person is endangering any patients. I am not a nurse and have only heard the term ativan so it is up to you to use good judgement.

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Nursing assistant

You need to intervene, preferably in a non-threatening and confedential manner. You could try to approach him/her on your own before going to management /c it. These are really tough situations to be in but the bottom line is that the nurse can't be on drugs while at work, period. I don't know what kind of facility you work in, but most hospitals have an EAP ( employee assistant program ) to deal /c situations like these. Management could get him/her counseling, or maybe rehab through this program, and there would be the possibility that the person could resume work if they have success /c counseling/rehab. I went to school /c a person who used heroin and I watched him try to get clean on his own several times. I finally got sick of seeing him polluting himself like that so I went to a professor that he was real close with and told her confedientially. I don't know exactly how she handled it, but he ended up graduating on time and on methadone (something he was trying to avoid). The thing that got me to intervene was that I thought to myself- if I were already a nurse would I feel comfortable/safe working side by side with a known heroin user, and then it was a no brainer. Good luck to you and to your collegue. I hope you both make the right decisions.

If she is taking it by order of her own doctor, then I personally feel this is a private matter unless you can see that her patients are being neglected or harmed in some way, in which case then I would go to the Supervisor and explain your concerns. I noticed you put "? violent" with your post. Does this mean she is behaving violently toward staff or patients or that you are concerned she could become violent? If she is behaving in a non-appropriate way, then you must take action immediately. You cannot sit back if danger could occur to someone else. Did she tell you she was on this? If so, maybe she was reaching out for someone to listen. Since only you know the full circumstances here, I would say, weigh everything carefully and then follow your heart and gut instinct. Taking a drug may only mean there was a problem for which she got help for. I know many nurses that need medications to control depression, anxiety, stress and even pain. This profession can do that because we see a lot of suffering and deal with a lot of stress. One caution though, I hope her need for the drug does not cause her to begin diverting from patients when her ordered dose no longer controls the symptoms. I have seen this happen also. Just some thoughts. I hope this helped a little.

Q.

Specializes in LDRP; Education.

You all are comparing ativan to narcotics and/or psychotropics.

Ativan is like valium, etc, used to treat anxiety/depression as Duckie stated. People who take ativan are usually not violent (you may be confusing ativan with haldol)

Unless she is compromising patient care, it is none of anyone's business what prescriptions this nurse is taking. What if she were taking prozac? You can't leap to conclusions about a person's functionality simply by their medicine cabinet.

lots a people take medications and are still able to function and perform without complications. i have seen many people in the er that take ativan and yes they to get violent.. you have to ask yourself is she harming the pts or herself at work? if she is putting the pts in danger then as a nurse it is our responsability to report it. pts 1st. and if not leave her be. also it could be that the dose of ativan is to much for her or maybe she is taking something else also.. there is alot to consider but i would have all the facts before assuming or reporting. ( 2 cents ) eek.gif

Thank you everyone for the response - unfortunate thing is she made many medications and treatment errors on the day she admitted to co-workers that she takes this drug at work - I understand that many people require treatment for depression, enxiety and stress - I am worried that she will do more serious harm - although omissions of her magnitutde are serious enough for me - put it this way fellow nurses - in a 12 hour shift this nurse omitted 83 treatments and 14 meds - and did nothing but pass about 70 meds to 23 residents - thats under 2 hours of med pass time - she did not do anything else for resident care that day. YIKES!! she is defensive and non-responsive when asked if we could help her in any way - denies stress or job related stress. She was asked if we could change her assignment and whatever we could do - she refused and now wants to put in a harassment complaint. She was removed from the schedule due to the errors and called the facility at 12 am and 12:30 am that night to demand phone numbers of administration - threatening to report to work if they did not call her before 7 am even though she had been removed from the schedule by her supvsr. That is scary behavior - yes??

Hello Peggy,

I think as others have said that if she is taking ativan it is physician perscribed and should not be an issue at work, however all of the errors are a concern. What is her work history like, is this a huge change in behavior, do you know how long she has been on medication? These are all things that management should look into. Anxiety can be very debilitating, maybe she feels now that she has admitted that she takes ativan she is like a fish in a glass bowl? Just a thought. I used to work in an OR before I became a nurse and one of the best nurses I ever worked with took ativan for anxiety and it did not effect her job performance. As for heroine in other countries people are given enough supply of heroine to function in their job positions, while getting them counseling and in programs to help them stop. I guess the point to saying this is that when used in conjunction with therapy medication could assist with improving function. EAP would have all of these resources as stated previously, and would be able to assist with this situation. I hope all works out for this nurse, you and your co-workers, and most of the patients.

Originally posted by peggy101:

Thank you everyone for the response - unfortunate thing is she made many medications and treatment errors on the day she admitted to co-workers that she takes this drug at work - I understand that many people require treatment for depression, enxiety and stress - I am worried that she will do more serious harm - although omissions of her magnitutde are serious enough for me - put it this way fellow nurses - in a 12 hour shift this nurse omitted 83 treatments and 14 meds - and did nothing but pass about 70 meds to 23 residents - thats under 2 hours of med pass time - she did not do anything else for resident care that day. YIKES!! she is defensive and non-responsive when asked if we could help her in any way - denies stress or job related stress. She was asked if we could change her assignment and whatever we could do - she refused and now wants to put in a harassment complaint. She was removed from the schedule due to the errors and called the facility at 12 am and 12:30 am that night to demand phone numbers of administration - threatening to report to work if they did not call her before 7 am even though she had been removed from the schedule by her supvsr. That is scary behavior - yes??

WOW THIS IS A PROBLEM! this person obviously has a big problem and while getting help should not be on the job to endanger pts, co-workers, and herself..NO IFS ANDS OR BUTTS!!!no one should be allowed to work while in this kind of shape...GETTING HELP OR NOT!!!ativan is also considered a narcotic that is why it is in lockup!!it is mind altering, may not be the right drug for her because obviously its not working or in this case also working to much!!!! eek.gif

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

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.

Originally posted by theboss:

ativan is also considered a narcotic that is why it is in lockup!!

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

I'm sorry, I'm new to the board and I just had to post. I have never, ever, ever seen ativan classified as a narcotic! According to the PDR, the correct classification is a tranquilizer, hypnotic and antimanic.

Narcotic it is NOT. Morphine, oxycodone, hydrocodone, codeine, fentanyl....THOSE are all narcotics/analgesics.

nurs4kids

Specializes in Pediatric Rehabilitation.

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

Specializes in Hospice, Critical Care.

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.

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. smile.gif

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

nurs4kids

Specializes in Pediatric Rehabilitation.

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).]

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).]

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!!

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.

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.

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