Resignation in lieu of drug test? Is random testing the answer?

Nurses General Nursing

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Recently, a nurse resigned instead of submitting to a drug test. The nurse was under suspicion for diverting. What do you think? Should a refusal and resignation be considered an admission of guilt and reported to the BON? Shouldn't a nurse, who is responsible for people's lives, live under the same rules as drivers?

A friend of mine used to be a DNS of a small hospital and had to deal with a woman who called hundreds of scripts for narcotics in order to divert before they caught her. The woman's own husband died of a narcotic OD. Not only did my friend insist on a drug test, but she tried very hard to get the government to bring criminal charges. She said it was very difficult to get that to happen, although the gal did get sanctioned by the BON, finally.

The union representing my hospital fights very hard each contract to forbid random drug testing. They give up on PTO accrual rates, and other stuff, but dig their heels in on random testing. Personally, I feel like random testing is the best deterrent, as obnoxious as it would be to have to submit to one.

Are we not doing enough to avoid and deter drug use in our profession, allowing problems to grow until they cause harm? Are drug using nurses often being allowed to quietly resign and move on to the next job? Waiting for a person develop an addiction is like waiting for a major accident to put in a stop sign on a busy corner.

Thoughts?

So how is this different from mandatory flu vaccines? Everyone going on about personal freedoms makes me wonder how they feel about being forced by the "corporate master" to inject a foreign substance into their body.

Flu vaccine is a bit off-topic and has been debated ad nauseam in many threads but since you asked how people view the flu vaccine in relation to personal freedom, I'll give you my opinion on the matter.

You're not being forced to take the flu vaccine. It may be a condition of employment but you are free to seek employment somewhere else or in a profession that doesn't require it. I realize and admit that it makes it makes it more difficult for you to find employment if you are completely opposed to taking the influenza vaccine, but it's not correct to say that you are forced.

As I do with most decisions I make in my life, I've done a cost-benefit analysis of the two issues (the random drug testing and the flu vaccine). I look at the cost and benefit for me personally and to my patients.

I work as a nurse in a country where the flu vaccine isn't mandatory for any category of healthcare professionals and where random drug testing isn't allowed. We have an egalitarian society in general and strong union tradition in the workplace and the power balance between employers and employees is more even then I imagine that you're used to.

As I mentioned the flu vaccine isn't mandatory but is offered free of charge every fall and I take it every year, as do most of my coworkers. Why you might ask, seeing as I don't have to. Well, for selfish reasons (I don't want the flu if I can help it), as well as for altrustic reasons (I don't want to pass it on to my patients who oftentimes don't have a strong immune system like I do and might have many comorbidities that means that a bout of flu might be life-threatening.

Even if I wouldn't mind the flu for myself, I would feel like a complete hypocrite if I accepted the Hepatitis vaccine in order to protect myself but declined the influenza vaccine and ran the risk of infecting others more vulnerable than myself. As I said, I've done a cost-benefit analysis and I find that the research/evidence shows that the benefits of having the influenza vaccine clearly outweighs the risks associated with it. On a side note, I find calling the vaccine a "foreign substance" a bit dramatic. I assume that you eat most days and it's likely that you've at some point in your life taken some kind of medication (OTC or prescription). We put foreign substances into our bodies every day.

So why did I arrive at a different conclusion regarding the random drug tests? Two reasons really. First of all, unlike vaccines, identifying who uses narcotics illegally and who commits theft falls in the realm of law enforcement. How and when law enforcement officers are allowed to carry out searches and seizures is meticulously regulated by law, as it in my opinion should be. I don't think that employers should be dabbling in this arena. (As I mentioned in my previous post, I think that it's reasonable to make an exception when a nurses', or other healtcare professionals', behavior indicates that s/he is working while impaired).

The second reason is that I don't believe that random drug testing is an effective means of solving the problem of drug use among healthcare professionals or identifying who might be diverting for other reasons than personal use.

There are many things that could potentially pose a threat to patient's safety. While nurses working impaired due to narcotics certainly is one of them, I personally believe that unreasonable nurse-patient ratios is a much more prevalent risk. Stress, fatigue and burnout in healthcare workers who are continuously being asked to do more with less is a problem that needs to be addressed. I mean that employers really have to do something concrete in order to address this and show that they're serious about minimizing risks to patients, not just pay lip service to the concept of patient safety.

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
You're not being forced to take the flu vaccine. It may be a condition of employment but you are free to seek employment somewhere else or in a profession that doesn't require it. I realize and admit that it makes it makes it more difficult for you to find employment if you are completely opposed to taking the influenza vaccine, but it's not correct to say that you are forced.

I think you could say the same thing about opting to work for an employer who mandates random drug testing. Our entire military is subject to random drug screens, as are all of those civilian nurses who work for the federal government. One could opt to not join the military, or not work for the government, if one is opposed to random drug screens.

Edited to add: I assumed that employers usually reserve the right to drug test, so I went back to read my current employer's handbook just now. They will drug test if there is suspicion of abuse/impairment or an accident on the job. My last employer (Army) just did randoms.

Specializes in Care Coordination, Care Management.

Really? There's no other word you could think of besides this? :facepalm:

retards
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I think it would be interesting to do a study comparing the number of nurses caught diverting in the US that does drug testing and Canada that does not drug test. I only know of one person in my entire career that diverted.

You may only KNOW of one person in your entire career that diverted; chances are you worked with several nurses who were diverting and didn't know about it.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I have no problem with random drug testing at all, but it should be for cause. Is he/she slurring words, not able to concentrate, having erratic behavior etc? If this becomes a pattern, then I think drug testing is appropriate. Why worry about it if you're clean? It's just pee

If it's for cause, it isn't random drug testing.

Specializes in SICU, trauma, neuro.

It's not so simple as those with nothing to hide, hide nothing. I take Ambien with a valid Rx, as prescribed, and never before work. However it is a controlled substance. I don't need ANYBODY but myself and my provider to know what medications I am on. I do consider that an invasion of privacy for someone who isn't suspected of diversion.

Plus, it requires my time. If it's done mid-shift, that's time away from my pts, and likely putting my workflow behind. More importantly though, I can't always leave when someone says to.. you know, bc I have critical patients who need me. When I can leave them is when I take my much-needed lunch break. If it's done on my time off, I promise you I really don't have time for work stuff. My life outside of work is planned with military precision. It has to be -- I'm that busy.

At least one or two states have tried random drug testing of welfare recipients under the thought that those who use drugs shouldn't get welfare and there is a strong public conception that many welfare recipients use drugs.

This was abandoned pretty quickly as only a fraction of a percent were positive. IIRC the cost to the state to do the testing far surpassed the savings of not giving services to the very few caught by testing. And that doesn't even address the privacy issue- that's just a statement on the (non) efficacy of such programs.

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