RN's w/chronic pain, using narcotics

grannynurse FNP student · Sep 30, 2005

When you out it that way, that really is a scary thought.

This remark is somewhat hurtful to me, Tom, as I suffer from chronic pain. It is possible for a chronic pain sufferer to function, while using a narcotic, and others being completely unaware of it, unless informed. Healthcare professionals should practice with the most current research-based information on the use of narcotic and chronic pain management. Current knowledge of the impact of narcotics, chronic pain management and state laws is indispensable.

Grannynurse :balloons:

Editorial Team / Admin · Sep 30, 2005

and

You can still work. I am a CLNC and have had a palliative care certification. There are many health care providers who have to take narcotic pain medication. I personally know quite a few who are since I have worked in a pain management clinic. It is not true that a person would be under the influence just because of narcotic prescription use. In fact, there have been studies that show there are more mistakes made by those who are in pain and are distracted by that.

Hello, jlamb,:balloons:

The original question was "work while under the influence". That is a very broad statement. If the individual's care of a patient is compromised due to being under the influence then, yes, the nurse can be held most liable for any and all acts that caused damages to the patient if directly related to the narcotic.

So, the nurse may be working and taking narcotics, but, is a direct liability if "under the influence".......which is exactly the words the OP used.

onelegswife · Oct 12, 2005

This is my second post on this topic. Wanted to share what happened to me last week. I started a new job last Mon. When the speciman was collected for the drug screen, I told them I take some meds that would show up. The DON took me to her office, ask questions, and listened to the answers. I was born with a fussed L5- S1. I now have OA and DJD in my lower spine and nerve damage to my left leg as a result of all this. I have been taking lortab for 5 years. I take 7.5 mg. q 6 hours and MS contin 15 mg at hs. My drug screen came back on Fri so the DON had 5 days to observe my work and knew I was not impaired. My levels were normal for what is prescribed so it was not a problem.The company I am working for is a nation wide corporation and their policy allows for RN's taking prescribed narcs as long as levels are not high and the nurse must use good judgement as to wheather or not they are impaired. I do not usually talk a lot about my med use but there are times when you must discuss it. When the drug screen comes back postive is to late. Since I first started needing narcs to control my pain, I have always told my boss as soon as the meds are prescribed. So far I have had no problems.

doodlemom · Oct 13, 2005

This remark is somewhat hurtful to me, Tom, as I suffer from chronic pain. It is possible for a chronic pain sufferer to function, while using a narcotic, and others being completely unaware of it, unless informed. Healthcare professionals should practice with the most current research-based information on the use of narcotic and chronic pain management. Current knowledge of the impact of narcotics, chronic pain management and state laws is indispensable.
Grannynurse :balloons:

Grannynurse, I wouldn't sweat it too much. It is obvious that Tom does not understand the effects of the sustained use of narcotics. Anyone who works in and understands pain management knows what you are talking about and realizes that someone that maintains the same dose of narcotic for a period of time is not impaired. Tom obviously does not work in pain management. I'm sorry for your chronic pain.

button2cute · Oct 13, 2005

I am currently, and have been, for 3 years, taking oxycontin for chronic pain. My question is, Is is legal for a nurse to work while taking pain meds? I am unable to work, or hardly move unless I get some relief from the pain. A nurse friend told me it is against the nurse practice act for a nurse to care for patients while under the influence of narcotics. Looks like I will have to stop working if this is the case. I have been a nurse for 27 years...what else could I do? What else would I want to do? answer to that last question is easy..I don't want to do anything else. Thanks for your time, and any help or suggestions.

Hello,

It is illegal to work with patients under the usage of narcotics, mind altering medications, and alcohol. You can perform in a position that is not dealing with the patients such as nursing supervisor, nurse manager and etc.

Another option is to return to school, obtain a MSN as an educator, adminstrator, research.

I have a back injury and I told the doctors that "I am a nurse and I cannot perform under narcotics or mind altering medications and to terminate them asap." I do not take them any more and it was easy to stop them. When I have a really bad day then I would take my narcs prn if the flexaril did not work. However, I would not work with patients during my shift and they would assisgn me to the desk or I would be ask not to come in. That was the better option because I was safe and the patients as safe.

I am in the process of obtaining another degree because I cannot lift anymore. I messed myself up like crazy.

In addition, you are first then everything follows. If you do not take care of your health then you will not be any good to your patients, coworkers and yourself. Address your health care needs and find a position that you can be safe. You work too hard and long to lose your license. Just find a job that will allow you to take care of your self and still bring home the bacon.

Have a great evening,

Buttons

grannynurse FNP student · Oct 13, 2005

Hello,
It is illegal to work with patients under the usage of narcotics, mind altering medications, and alcohol. You can perform in a position that is not dealing with the patients such as nursing supervisor, nurse manager and etc.
Another option is to return to school, obtain a MSN as an educator, adminstrator, research.
I have a back injury and I told the doctors that "I am a nurse and I cannot perform under narcotics or mind altering medications and to terminate them asap." I do not take them any more and it was easy to stop them. When I have a really bad day then I would take my narcs prn if the flexaril did not work. However, I would not work with patients during my shift and they would assisgn me to the desk or I would be ask not to come in. That was the better option because I was safe and the patients as safe.
I am in the process of obtaining another degree because I cannot lift anymore. I messed myself up like crazy.
In addition, you are first then everything follows. If you do not take care of your health then you will not be any good to your patients, coworkers and yourself. Address your health care needs and find a position that you can be safe. You work too hard and long to lose your license. Just find a job that will allow you to take care of your self and still bring home the bacon.
Have a great evening,
Buttons

I'm sorry but you have been misinformed about the use of narcotics, in chronic pain management. Were I or any other person, who uses narcotics in our chronic pain management, were to tell you they were using, you would be hard pressed to realize it. Most nurses are unaware of those who use narcotics, on a regular bases, and confuse them with short term episodic use.

Grannynurse:balloons:

button2cute · Oct 13, 2005

I'm sorry but you have been misinformed about the use of narcotics, in chronic pain management. Were I or any other person, who uses narcotics in our chronic pain management, were to tell you they were using, you would be hard pressed to realize it. Most nurses are unaware of those who use narcotics, on a regular bases, and confuse them with short term episodic use.
Grannynurse:balloons:

Hello, Everyone

I sustained a back injury 15 months ago, I was left in pain for 19 days and I will never forgive my physician. I went to a pain clinic and my physicians placed me on narcotics. I lost three months due to the narcotics and I was taken off them. As I said in the previous post and I will not do patient care when using narcotics. I have narcotics for prn when I have break away pain during times that I over do it or the weather kills my back.

My family physician and I spoken about the narcotics and flexaril. I had her wean me off them. I see another pain doctor who works with my family physician and it is working out so much better.

My family physician is very knowledgable about pain and the pain cycle that occurs with acute and chronic pain. She explained to me the following:

If I am driving under the influence of narcotics and flexaril and had accident, she explain that I will be taken for everything.

A physician will not be able to "cover your butt" if you are in an accicdent, made a critical mistake on your job or operate machinery and caused damages than it is on you. No physician under oathe is going to say "yes, I gave her/him permission to drive, attend work or operate machinery while under the influence ot narcotics." If that physician says he told you to ignore the warnings than I would believe the physician is liable as well. therefore, his/her butt is on the line as well and he has more to lose than you do.

I adhere to the guidelines of my physician and the pain physician. I will not work with patients or come to work if I am taking the prescribe medication. I am a chronic pain suffer and I chose to control it by other methods. I made the choice for my work as well as my well being. I believe it is the best way for me to be able to function and my job. Therefore, I am not jeopardizing my work, patients, others who may be innocent to my carelessness and myself.

I know using small amounts of narcotics over a long period of time, your body begins to tolerate the dosage and sometimes an adjustment is needed. Your body adjust to the medication prescribe and you are able to function without the pain. I understand the theory behind small dosages over a longer period of time. In addition, you have to beware of the side effects and not enhance them by using other medications/drugs and alcohol. Therefore, the theory is great for some, not for others and each of us are individuals to make a decision four ourselves.

It is not for me, and it is my choose for myself. I cannot take that one in the million of a chance to lose everything and the things I am trying to build for a better life for me. I am speaking myself and no one's else.

Granny,

I admire and respect my family physician very well and she does not mislead, miscommunicate and misinterpret the laws for medications. She is very knowledgable and know the research for chronic/acute pain and the usage of medications for those individuals. I will listen to her advice about the law and I love my decision.

Granny, it is your choice in how you decide to manage your pain and life. I cannot make the choice for you. I know when I read your posts it was confusing. You would not drive while taking narcotics and you would see your patients because you have build a tolerant level for the narcotic. It is sending mix signals. You also stated that you are not on pain medications now. It you are a chronic pain suffer have you taken the holistic approach or you are saying that you are not experiencing acute pain and no prns are on board? And you are using the chronic pain medications for stablities. Therefore, you believe it is ok to work and you will not make a mistake.

I beg the differences with you because I always know when someone is under the influence of medications, drugs and alcohol. There will be something out of the ordinary you will do that you would not do if you were not taking the medications. Also, vice - a - versa, I am batting a 1000 when I can pick a chronic user vs an acute user and a illegal drug user. Therefore, maybe some will not be able to tell or the majority will not be able to tell...and there a few in-between that will be able to tell.

I hope you are successful and no bad luck come your way during "hands on with the patient." I wish you all of the luck in the world and I hope you are correct in your choices for you.

Buttons

grannynurse FNP student · Oct 13, 2005

Hello, Everyone
I sustained a back injury 15 months ago, I was left in pain for 19 days and I will never forgive my physician. I went to a pain clinic and my physicians placed me on narcotics. I lost three months due to the narcotics and I was taken off them. As I said in the previous post and I will not do patient care when using narcotics. I have narcotics for prn when I have break away pain during times that I over do it or the weather kills my back.
My family physician and I spoken about the narcotics and flexaril. I had her wean me off them. I see another pain doctor who works with my family physician and it is working out so much better.
My family physician is very knowledgable about pain and the pain cycle that occurs with acute and chronic pain. She explained to me the following:
If I am driving under the influence of narcotics and flexaril and had accident, she explain that I will be taken for everything.
A physician will not be able to "cover your butt" if you are in an accicdent, made a critical mistake on your job or operate machinery and caused damages than it is on you. No physician under oathe is going to say "yes, I gave her/him permission to drive, attend work or operate machinery while under the influence ot narcotics." If that physician says he told you to ignore the warnings than I would believe the physician is liable as well. therefore, his/her butt is on the line as well and he has more to lose than you do.
I adhere to the guidelines of my physician and the pain physician. I will not work with patients or come to work if I am taking the prescribe medication. I am a chronic pain suffer and I chose to control it by other methods. I made the choice for my work as well as my well being. I believe it is the best way for me to be able to function and my job. Therefore, I am not jeopardizing my work, patients, others who may be innocent to my carelessness and myself.
I know using small amounts of narcotics over a long period of time, your body begins to tolerate the dosage and sometimes an adjustment is needed. Your body adjust to the medication prescribe and you are able to function without the pain. I understand the theory behind small dosages over a longer period of time. In addition, you have to beware of the side effects and not enhance them by using other medications/drugs and alcohol. Therefore, the theory is great for some, not for others and each of us are individuals to make a decision four ourselves.
It is not for me, and it is my choose for myself. I cannot take that one in the million of a chance to lose everything and the things I am trying to build for a better life for me. I am speaking myself and no one's else.
Granny,
I admire and respect my family physician very well and she does not mislead, miscommunicate and misinterpret the laws for medications. She is very knowledgable and know the research for chronic/acute pain and the usage of medications for those individuals. I will listen to her advice about the law and I love my decision.
Granny, it is your choice in how you decide to manage your pain and life. I cannot make the choice for you. I know when I read your posts it was confusing. You would not drive while taking narcotics and you would see your patients because you have build a tolerant level for the narcotic. It is sending mix signals. You also stated that you are not on pain medications now. It you are a chronic pain suffer have you taken the holistic approach or you are saying that you are not experiencing acute pain and no prns are on board? And you are using the chronic pain medications for stablities. Therefore, you believe it is ok to work and you will not make a mistake.
I beg the differences with you because I always know when someone is under the influence of medications, drugs and alcohol. There will be something out of the ordinary you will do that you would not do if you were not taking the medications. Also, vice - a - versa, I am batting a 1000 when I can pick a chronic user vs an acute user and a illegal drug user. Therefore, maybe some will not be able to tell or the majority will not be able to tell...and there a few in-between that will be able to tell.
I hope you are successful and no bad luck come your way during "hands on with the patient." I wish you all of the luck in the world and I hope you are correct in your choices for you.
Buttons

Buttons, if you believe and your physician has told you, that you are a chronic pain sufferer, after three months, he needs some refresher course work. As for the remainder of your comments, I drive, go to class and go to clinical areas. You do not know me nor my tolerance level nor my personal reaction to narcotics. You are making a big leap when stating you can pick out a chronic user vs a drug addict or acute user. I find it amazing that you pick on your fellow nurses but totally ignore physicians. As for your comment regarding driving or taking care of patients, you would be equally hard pressed to determine if I had a narcotic in my system and if I did not. Thanks for your wish of 'all the luck in the world', but I do not depend on luck but my skills as a nurse.

Grannynurse:balloons:

CrunchRN, ADN, RN · Oct 13, 2005

I must agree with grannynurse. I am extremely lucky that I do not have chronic pain, but have met many who can function and be productive in a totally normal way when managing their problems with an experienced pain control specialist.

Buttons,

There are differing intensities of pain and I do not think it is fair to use your experience to reflect on others. Also, I think people with a chronic illness have the right to treatment and to earn a living as long as they can do that safely. Many people can do that safely with chronic medications, others cannot. Those that can do have rights to have a life.

Please open your heart and mind to their plight.

button2cute · Oct 13, 2005

I must agree with grannynurse. I am extremely lucky that I do not have chronic pain, but have met many who can function and be productive in a totally normal way when managing their problems with an experienced pain control specialist.
Buttons,
There are differing intensities of pain and I do not think it is fair to use your experience to reflect on others. Also, I think people with a chronic illness have the right to treatment and to earn a living as long as they can do that safely. Many people can do that safely with chronic medications, others cannot. Those that can do have rights to have a life.
Please open your heart and mind to their plight.

Crunch, I am not picking on granny and if you read what I wrote it was not putting her down. I spoke me and how I am handling my situation. It is Granny's choice to handle her situation her way. In addition, I wish her luck that she never gets herself into a dangerous situation. I cannot speak for her about her situation at all.

Granny feels people are attacking her and I am not. I simply explain to ther that I beg a difference that I can tell if someone is on narcotics, illegal drugs and alcohol.

Granny, seems to be promoting her decision about the usage of narcotics on the job and especially working with other people. I say it is an individual choice of treatment for their chronic pain and not everyone can do what granny is doing. It is about the individual, the best treatment plan and how a person deals with her physicians and herself. I chose a different way than Granny does that make me a bad person or a chicken? No, it does not.

Granny, shoud have known that people have their own choices and consequences to deal with each day. She is vvery lucky to tolerate her medications because not everyone cah.

I never called her a drug addicted or said anything negative to her. I am saying to her to be careful and take precautions if her medications are a new dose. Therefore, I can say in my heart to her....just be carefull.

Granny, listen to what I was saying, about the usage of narcotics may impair your judgements. Not everyone is like you and can tolerate medication.It is an individual choice of treatment, employment as well as their comfort level on narcotics. Not for me to make the choices for everyone and it is up to the idividual.

Stop trying to place negativity into my post. I repeatly stated it in my post that it is choice for others to make for themselve.

Granny, stop the attacking.....I guess you did not read my post to make the statement that my physician made a descision I am a chronic pain suffer after three months. I was injured 15 months ago ....a Back injury ...herinated disk C5,6,7; t 11 & 12 are herniated; and L1 -L4 is herinated and the tail bones are fracture. Nerve pain constantly as wesll numbness in my leg. Therefore, I am a chronic pain suffer. Not three months.....re-read the post and do not make assumption it was three months.

Granny, if you put yourself out there and do not explain yourself throughly than everyone will take off on your statements. If you do not want to be precieve negative than change your approach, teach your thoughts to others and not automatically assume negative thougts that people are attacking you. People are voicing their concerns for you and anyone who is taking a

narcotice during work hours. People are sue happy these days ahd you want to protect yourself from them. Therefore, it would be nice to for you to read all of the information in the post prior to making assumptions (especially about my family and pain physicians.

Oh, I was in rehab for a year trying t restore my back and it was unsuccessful. I need more time for my back to heal. I am currently doing rehab for cardio. Iam working out three hours a day walking on the treadmill, elipitical and recliner bicycle for cardilo. Therefore, that is my choice and treatment for me.

Thank you,

Buttons

grannynurse FNP student · Oct 13, 2005

Crunch, I am not picking on granny and if you read what I wrote it was not putting her down. I spoke me and how I am handling my situation. It is Granny's choice to handle her situation her way. In addition, I wish her luck that she never gets herself into a dangerous situation. I cannot speak for her about her situation at all.
Granny feels people are attacking her and I am not. I simply explain to ther that I beg a difference that I can tell if someone is on narcotics, illegal drugs and alcohol.
Granny, seems to be promoting her decision about the usage of narcotics on the job and especially working with other people. I say it is an individual choice of treatment for their chronic pain and not everyone can do what granny is doing. It is about the individual, the best treatment plan and how a person deals with her physicians and herself. I chose a different way than Granny does that make me a bad person or a chicken? No, it does not.
Granny, shoud have known that people have their own choices and consequences to deal with each day. She is vvery lucky to tolerate her medications because not everyone cah.
I never called her a drug addicted or said anything negative to her. I am saying to her to be careful and take precautions if her medications are a new dose. Therefore, I can say in my heart to her....just be carefull.
Granny, listen to what I was saying, about the usage of narcotics may impair your judgements. Not everyone is like you and can tolerate medication.It is an individual choice of treatment, employment as well as their comfort level on narcotics. Not for me to make the choices for everyone and it is up to the idividual.
Stop trying to place negativity into my post. I repeatly stated it in my post that it is choice for others to make for themselve.
Granny, stop the attacking.....I guess you did not read my post to make the statement that my physician made a descision I am a chronic pain suffer after three months. I was injured 15 months ago ....a Back injury ...herinated disk C5,6,7; t 11 & 12 are herniated; and L1 -L4 is herinated and the tail bones are fracture. Nerve pain constantly as wesll numbness in my leg. Therefore, I am a chronic pain suffer. Not three months.....re-read the post and do not make assumption it was three months.
Granny, if you put yourself out there and do not explain yourself throughly than everyone will take off on your statements. If you do not want to be precieve negative than change your approach, teach your thoughts to others and not automatically assume negative thougts that people are attacking you. People are voicing their concerns for you and anyone who is taking a
narcotice during work hours. People are sue happy these days ahd you want to protect yourself from them. Therefore, it would be nice to for you to read all of the information in the post prior to making assumptions (especially about my family and pain physicians.
Oh, I was in rehab for a year trying t restore my back and it was unsuccessful. I need more time for my back to heal. I am currently doing rehab for cardio. Iam working out three hours a day walking on the treadmill, elipitical and recliner bicycle for cardilo. Therefore, that is my choice and treatment for me.
Thank you,
Buttons

I will share with you my history. In May of 1988 I underwent a percutanous discectomy, one of the first done in SW Florida. This was after injurying and herniating my L4-5 disc in January. I was perfectly fine for four days, when I reherniated the disc. It took until October 19, 1988 for my WC insurance company to authorize a repeat myelogram. And surgery was performed on November 29, 1988, after more haggling. My surgeon told me to forget ever going back to bedside nursing (and I also had to give up my re-enlistment in the military). On January 30, 1989 I saw my surgeon for my eight week follow up and was told I needed to return in two weeks. He also told me I could most likely return to my full time job, as a WC major and senior case manager, at that time. Something happened on that day, I will not go into but I have never returned to bedside nursing. Needless to say, twelve months following my surgery, I was diagnosed with chronic pain and failed back syndrome. There are times when I need to take narcotics. There are times I do not. I do not engage in any activities that would put others or myself at risk. You have made your decision. I have made mine. And I have never, not once put any patient,or any person, my daughter, my three grand children in any danger.

I am well aware of the current legal climate. I am also well aware of the fact that individuals react differently to narcotics. And people react differently to levels of pain. I am not negating your level of pain nor belittling you. I am questioning the knowledge of your family physician but he is your physician, not mine. Like another poster said, one does not know when someone is using a prescribed medication, not even a police officer. And the only time he may ask, is when and if you have shown signs of being impaired. I have never been field tested for a DUI/DUM. And I have never been stopped by a police officer for driving while he suspected I was under the influence of a medication or alcohol. The one time I was pulled over, it was for having a headlight out. That officer asked me where I had come from-164 miles south of where I was living and because I was upset, asked me if I had been drinking. I had not and told him so. He insisted on doing a field test. I refused, which is my right and asked for a breath analyzer, for some reason he refused and I asked for a supervisor who administered the test. Neither he nor his supervisor ever questioned me about narcotic use, which I was not taking at the time.

My point is that no police officer, no physician, no paramedic, no nurse can look at someone and determine if they are taking narcotics on a regular bases. I have seen patient that are classified as being runk when they in fact are not but suffering from a metabolic disorder. I cannot pass a field test because of poor balance. I now carry a letter from my neurologist stating that I cannot and why. There are also people who take one dose of a narcotic and are out for the count.

All I am asking you to do is not to judge me or anyone else based only on your personal experience. I am asking you and others to be a little more open minded that there are those who use narcotics on a chronic bases and show no apparent signs of being under the influence. Nothing more, nothing less.

Grannynurse:balloons:

bethin · Oct 14, 2005

When I'm in severe pain I am the worst aide that you've ever seen. When I'm with a pt. all I can think about is lying in the fetal position and crying. This past weekend at work I took half a vicodin for the first time(at work) and didn't get high or feel any other side effects. After taking the medicine I was a much, much better aide. My mind was on the pt. and not myself. My philosophy--don't ask, don't tell.