patient care while on prescription pain meds...

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Specializes in SICU.

First, for the mods, let me clarify that I am NOT looking for legal advice. ;) I have an attorney and I've also currently got a request for info in at my BON. My legal advice comes from my attorney. Rather I am looking for personal experiences to compare with my own.

Long story short, I was injured on the job almost two years ago while working in the SICU. My hip cartilage was torn, resulting in hip surgery and months of PT, off and on (when I could get Worker's Comp to approve it). I did return to work in a somewhat less strenuous position but after a month was in a LOT of pain. I had an Rx for pain meds but was told by my manager that I could not work and take pain meds at the same time because I had patient interaction. I am unable to take NSAIDs due to gastric issues from long term ibuprofen use in the months after my injury, and Ultram is not an option because it is contraindicated with another med that I take on a daily basis and that cannot be changed - so those options were out. I worked, and suffered, for three more months until I could no longer stand it, and my ortho took me out until I got "control of symptoms". My job fired me 4 months later. I remain out of work due to pain issues and the inability to walk for any extended period of time, or to sit upright for more than 15-20 minutes - both cause severe hip pain, despite me using a cane 24/7 when ambulating. With an attorney's help, I am battling WC for things like a TENS unit, PT, pain mgmt doc, etc. It's a total nightmare. (OT a bit - but I do recall several of you telling me long ago to get an atty ASAP, that I'd get screwed - silly me should've listened!)

My questions are this:

Have you ever done patient care (either bedside, or something like phone triage) while taking prescription pain meds, like Vicodin - and had management aware that you were medicated?

Have you ever worked with another nurse that was legally medicated with pain meds while caring for patients?

What is your opinion on nurses actively taking pain meds while caring for patients, either at the bedside, or in any type of position that the nurse is in direct contact with the patient regarding their health care?

Thanks for your opinions, and any other info you care to contribute! :D

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Specializes in Oncology/BMT.

I had problems with my bile ducts after having my gall bladder removed - which left me with severe right-sided pain at a moment's notice. I was prescribed Vicodin as needed for pain control while awaiting an ERCP. While at work with a patient assignment, I would take half of a Vicodin to take the edge off. This would allow me to still be alert and functional. I would not say it made me drowsy, more relaxed. I never told management this.

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Specializes in SICU.

So you don't think it negatively affected your ability to care for patients? What do you think management's response would be if they'd known?

Thanks for the response, and OMG I remember the pain of gallbladder disease... oy! :eek:

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Specializes in Nephrology, Cardiology, ER, ICU.

If you are on chronic narcotics, then you build up a tolerance to them and you are not impaired. However, if you only take prn narcotics, there is the chance you might be impaired.

These are just questions we can't answer. I'll be frank: with with pending litigation, do you want to be posting so many details on the internet?

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Specializes in jack of all trades.

Your best bet due to your medical condiditon is to find a position with little on hands patient care if any. Even though you are on prescribed medication I have known employers to report to the BON the nurse was "impaired" resulting in IPN, license suspension, etc. It's a very difficult situation as I also have chronic pain and require pain medication although I know I cant take them while doing patient care. It's a very fine line. Many nurses think that the BON cant take action if medication is "prescribed" legally and this is just very untrue. With your experience you may seek areas such as worker's compensation medical case management or other areas in the insurance industry. Chart review/auditing/coding maybe. I would never tell an employer my medications for this very reason. The first time an error or alleged error happens then it will be on you to prove you werent "impaired". Keep in mind you dont have to make an error to be report all they have to do is suspect you may be impaired during work. Hang in there.

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Specializes in SICU.
These are just questions we can't answer. I'll be frank: with with pending litigation, do you want to be posting so many details on the internet?

So as not to violate TOS, I made a concerted effort to phrase my post in such a manner that I'm not seeking advice (legal or otherwise) as to what *I* should be doing, so I'm not sure why the questions can't be answered?

I'm not asking people to interpret my experiences or give me advice about what to do - I'm asking about their experiences and opinions in regard to either with working while on pain medication with management being aware of such, or working with someone who was in that situation, so that I have some sort of a frame of reference in regard to me trying to find a job. Surely those who are willing to share can enlighten me with what they have experienced? As to posting details, I am comfortable with what's been posted because it's nothing but the truth and is information that all parties are completely aware of anyway.

If you feel my queries or any part of my posts are out of line, then please delete the thread. I've been hanging around these parts for nigh on 8 years and certainly don't want to cause a problem at this stage in the game! :)

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Specializes in Addictions, Acute Psychiatry.

I can tell you based on the people I know at two boards of nursing that both say if you are working with narcotics in your system, then you are working illegally and subject to the disciplinary or rehabilitation committee's decision.

Despite what the most recent study says (constant same dose long term pain meds may not impair, after all), there's no way to know if someone is going to binge amidst a steady dose. For patient safety (and we are treating the general public) most families do not want a nurse on narcotics caring for their loved one's. I wouldn't want it, either given the choice. If it's PRN, you're definitely impaired. If it's constant and chronic where the taker feels no effects at all (no "high" feeling) then they may not be impaired and also may not work as a nurse (based on these two BON's).

Because 5-18 percent of nurses are eligible for discipline (higher on units with high abuse incidence like the SICU), the board is required to default on NO and protect the public, as they have been charged to do.

Also knowing people who have gone the attorney route, etc. I can say because of this public charge and the default of NO narcs at work and political support regardless of party to the highest levels, one case cannot be the exception to open the floodgates of those balancing the fence.

I would consider this a career ending condition; just like a football player and their drug rules alike (unless you can get a nerve block and come to work clean).

Based on your condition, I would seek another career, as this condition seems to have limited your ability to work licensed in most states. It's no different than a football player who had a devastating injury who can no longer serve. They cannot work under the influence of any drugs, either.

For those taking meds off work hours, be sure it clears your system because you don't want to come up positive for a random or "with cause" drug screen. Most boards make this clear and if there are any questions, call your BON and ask for the disciplinary specialist (they know the process and can recite all the laws or they can bring your concern to the board for discussion).

I would never risk it; it's not worth a career ending mistake.

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Specializes in Addictions, Acute Psychiatry.

Perhaps a total hip redo would be in order so you can get off the meds (or if it's an underlying addiction issue which causes excruciating pain all by itself, buprinex is a wonder drug with no withdrawals).

If you can't sit up for 15-20 minutes, I'd hang up nursing altogether; sad to say.

Sounds like something drastic needs to take place, though. I personally haven't seen anyone who can take vicoden but can't take NSAID's because there's an NSAID in vicoden; that's just me.

Have you seen an addictionologist who also specializes in pain? I think that would be your best bet. They're trained and most know the exact laws and meds one can work with (they're the docs who treat docs).

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Specializes in SICU.

Vicodin has NSAID properties? It contains hydrocodone and acetaminophen - is there some sort of filler that makes it an NSAID? There IS an ibuprofen and hydrocodone version, Vicoprofen, but I don't take that. If Vicodin's an NSAID then that might explain my continued GI issues... and my pharmacist needs to clarify, because I have a "NO NSAIDS" on file at my pharmacy. I'll have to check that out more thoroughly. I CAN tell you that the months of ibuprofen use after my injury and while I was on light duty (taken so as NOT to be taking pain meds while working) left me with a severe case of gastritis. The post-op Naprosyn did me in, so to speak, with GI bleeding, and my doc said no more.

A total hip is not going to do me any good. The joint itself has been repaired and is perfectly fine. The issue is with the soft tissue - cartilage, muscles, scar tissue, etc - as well as nerve damage. I really don't think it's an addiction issue. I have a very close friend, a psychologist who happens to work in the addiction field with heroin and other addicts, and I've talked with him extensively about what I take, when I take it, etc. My husband eyeballs things, and I've been hyper-aware as well. I'd LOVE to see a pain management specialist, but the approval wheels turn slowly...

Damn, I sound like a mess! I promise I'm not a total freak just making excuses. I WOULD like to find my way back to some sort of gainful employment, AND be pain-free (or close to it) at the same time, near some level of my previous income. Surely that's not too much to ask... At any rate, to prevent further boredom for all - I will wrap this up by saying that I had a very lengthy conversation with my BON today and that answered a LOT of questions in regard to my situation. It's way complicated, but I will explain it all if anyone's interested. Just PM me, or ask in here.

Thanks so much for all of your replies. I appreciate the candor. :D

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Specializes in Nephrology, Cardiology, ER, ICU.

I am so sorry for the pain you are in. However, we are straying into the medical advice realm and per our terms of service, we can't go there.

We wish you the best.

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