Upset!!! write up and patients marijuana

ZASHAGALKA, RN · Mar 5, 2006

Absolutely nothing wrong w/ reporting it to doc and manager. Those are both within HIPAA and using the chain of command to provide the best care - or to decide this pt is too stupid to have his care provided by that team - the liability of sending someone into a house like that and all.

Out in the open pot plants? I'd of called the cops. Idiot. He knew you were coming and made no attempt to hide illegal activity? Nsg Dx: altered gene pool; volume depletion - actual.

Someone's rights - even their right to the so-called penumbra of privacy - ends where anothers begins. By placing his so-called right to privacy above his expected nurse's right to security and safety (and that's what having a pot plant in the open is - as we have all discussed the legal and license issues of such an act) compromised that nurse's integrity. HIS ACTIONS did that, not the nurse.

~faith,

Timothy.

powernurse · Mar 5, 2006

Yeah !!!!! to the nurses with a sense moral integrity. Hello! Aside from the fact that this pt is Non compliant by using an illegal drug, the use or ABuse of that drug is a potential safety risk to BOTH the patient AND the NURSE!

RNGINA stated that this pt has a psych dx.

ILLEGAL DRUG + SCHIZIOPHRENIA = TROUBLE

The pain thing is not an excuse.... there are plenty of LEGAL pain meds that can be PRESCRIBED by a PHYSICIAN who can determine if there are any potential drug interactions.

My husband died from cancer last year. He had mets to bone, brain, liver, kidney, lymph and lung.... He refused to accept anything but conventional methods for his pain ..... and they worked....

WHY is it that so many people look at marajuana as being " a little bit illegal" ?

HELLO !!!! NURSES !!!!

ILLEGAL is ILLEGAL !!!

Am I going to be concerned about gaining this pts trust??? He broke MY TRUST !!!

I had a pt one time that was a serious diabetic with Hep C. He too was a psych pt. I would arrive and he would have USED insulin syringes EVERYWHERE !! Sofas, tables, floor, in the fridge.... I mean EVERYWHERE....

I brought him sharps containers, read him the riot act, SPOKE TO THE DOCTOR and my DON. I just couldn't get through..... I knew this was a juge risk to me.

The doc begged me to stay on the case as this pt had just been released from the hosp after after being tx for astronomically high bloods sugars.

I was obligated to make an attempt with this pt regarding counseling etc

I told him he needed to clean up his act or we would discharge him or call crisis if we felt he was a threat to himself. The patient promised compliance and the next couple of visits he had cleaned up the house....

On about my fifth visit, he came to the door after about 20 min of yelling thru the window, "I'll be right there". I went in and he had a friend there. The place was a mess again with needles and his friend was leaning over an ottoman with a candle, a spoon, a mirror with white powder and a syringe..... this guy had track marks up and down ....

Now I cannot ever say that the pt was shooting up b/c I didnt see it....

HOWEVER, he did allow someone else to do so in his home and he admitted it in a pathetic appologetic sort of way....

I felt defeated, I desperately wanted to be the NURSE to make the DIFFERENCE in this guys life....

HOWEVER, my safety was PRIORITY at this point and I could not predict who would be in this guys house and what they would be doing.... I couldnt guarantee myself that I wouldnt get stuck with a needle or get into some kind of conflict related to drug activity.... And who are this pts friends.... 9 times out of 10 they are psych pts too..... so what effects do the drugs have on them?? then everyone is sharing needles..... IF I DIDN'T REPORT WHAT I OBSERVED I would be NEGLIGENT and could lose my license....

That said I reported ONLY what I OBSERVED and NEVER my SUSPICIONS.... What you observe is often enough to relay a good picture.

DISCHARGE non compliant pts or pts ABusing ILLEGAL drugs..... SIMPLY b/c it is the LAW !!!!

If the NURSE turns a blind eye.... SHE is as RESPONSIBLE for the situation and any consequences as her patient...

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WITH EVERY DIFFICULTY ~ THERE IS RELIEF......

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mmurphy · Mar 5, 2006

I am confused as to why you were "visiting" the patient at home. Was the visit personal, or part of your assigned duties?

Nickle · Mar 5, 2006

OP, I am still confused about why the doc is threatening to sue the agency. On what grounds? Can you please clarify for me? Or was it the patient who threatened to sue? Not sure I'm getting an accurate picture of what went on here. Thanks-

HeartsOpenWide, RN · Mar 5, 2006

In my state, Clinical Marijuana is legal so a lot of people grow it. I probably would not give it too much thought, other than like you said...how it could affect his 20 other meds. I do not think you should have been written up...what? do they think you were lying? On what grounds would this man have to sue? If he wanted to not get in trouble for having the plant (which one plant wouldn't even be a Misdemeanor in my state) I would think he would just pretend it didn't happen, deny it, but sue? Come on!

NurseEdward, BSN, RN · Mar 5, 2006

I would of confronted the patient right when I saw the plant. That way, there would be no way the patient would be able to make threats of sueing in the end. It would be out in the open. While, you are a guest in the patients home, I think I would of mentioned the pot plant to whomever is involved in his care. Smoking marijuana is not the same as smoking a tobacco cigarette and may interact with some of his meds. You did nothing wrong here. Good Luck!

rn/writer, RN · Mar 5, 2006

good job rngina.
as the nurse it is your job to ensure the patients safety. given what you said about this pts diagnoses, you were absolutely right to be concerned about the effects on his other medications or his illnesses. and the doc absolutely needs to be notified.
if this pt had been a diabetic obese status post bariatric surgery and you walked in and found no food in the house but ben& jerry's and jack daniels you would do the same thing in notifying the doc... and if you didnt then you would be negligent if your pt slipped into a coma.... after all you are the home care nurse not a visitor, guest or friend
remember non compliance is grounds for discharge not to mention so is posession of an illegal substance that hasnt been rx'd for medical reasons.

i can't ensure anyone's safety, either as a nurse or a human being. especially in their own home.

we're nurses, not parents or guardians. we don't own our patients. we shouldn't be trying to control them, but rather trying to motivate them to control themselves. if they choose to be non-compliant in any fashion, they have that right.

on our end, we can set whatever boundaries we choose, both personally and professionally.

where i question the op's account is that there is no mention that she spoke with the patient before reporting his "transgression" to others. if that's the case, she left the patient out of the loop as if he were a child. psych issues do not render a person incapable of making decisions. nor do they exempt him from being worthy of respect.

she should have spoken with him about her concerns and provided the information he needed to make his own decisions. this could have included the medical issues--drug interactions, physical effects, exacerbation of psych issues; the legal ramifications if someone else discovers an illegal substance in his home; and her personal/professional limitations.

these topics could be covered in a general manner without specifically mentioning the plant. the patient may need some time to think about what the nurse has told him and he's much more likely to take her cautions seriously if she speaks to him with more concern than judgment. if she comes off like she's caught him being bad, the most likely response is the kind of defensiveness that precludes connection and a "need" for future deceit.

there is a fine line between helping our patients to be accountable and narking them out. if the real concern is how smoking pot might compromise this man's overall health condition, the op's first line of defense should have been him.

if this pt had been a diabetic obese status post bariatric surgery and you walked in and found no food in the house but ben& jerry's and jack daniels you would do the same thing in notifying the doc... and if you didnt then you would be negligent if your pt slipped into a coma.... after all you are the home care nurse not a visitor, guest or friend

it's quite a leap from seeing a plant in the home (with no other indication that he is smoking pot) to the above scenario in which there is little alternative but to think the obvious. this kind of worst case thinking doesn't do anyone any favors. the first situation requires making a lot of assumptions, whereas the second seems pretty straightforward.

i'd be more worried about making myself vulnerable by making and acting on assumptions than by sticking to objective data. that's the difference between, "i think he's smoking pot," and "i saw a plant in his home."

in this same situation, i might have nodded toward the plant and brought up my concerns without making any accusations directly. i might also have mentioned that seeing illicit things in a patient's home puts me in a spot i'd really rather not be in.

taking this approach leaves the door open for real communication, a possibility that is all but eliminated by precipitous narking. if the patient is going to be influenced by medical/legal considerations at all, he now has the opportunity to ask real questions and make his choices accordingly. this also lets the patient know that the nurse can be trusted but will not be a fool.

as for the cya worries, i think they have been blown out of proportion. if someone else goes into the house and blows the whistle on this guy, who's to say the plant was there when the nurse visited? and who's to say she recognized it? and who's to say the patient himself knew what it was?

in the end, we aren't "in charge" of our patients' health care. they are. and while we don't want to be complicit in assisting their downfall, we do want to be approachable and trustworthy enough that they see us, not as the enemy to be deceived, but as their assistants and advocates in achieving as much health as they can. some folks are going to make "bad" choices, and no amount of scolding or narking or shaming is going to change that (except, possibly, to make it worse).

it would be good to remember that few things require an all-or-nothing response.

BarbraJean · Mar 6, 2006

I think we as visiting Nurses walk a fine line. As someone stated we are guests in a patients home providing a service but there are rights & resoponsibilties are both parts. The Nurse is entitled to a safe environment. The client to have the freedom to do as he wishes in his own home. Having said that, Our Drug laws up here (Ontario) while similar As a palliative homecare Nurse I frequently encounter marijuana in homes. Unless there is a legal obligation to report it to Law enforcement, If the Nurse was uncomfortable report to a supervisor that she won't go back there & why & leave it in their hands. The downside is the most important aspect of the relationship the trust relationship is destroyed. But I feel the Nurse should never have been written up. Even though we all know patients don't Lie!

POE · Mar 6, 2006

Boy Howdy, what a hot button topic! If the powers that be knew in 1918 what they know now, maybe they would have promoted reefer as an incredibly safer alternative to the freshly outlawed ETOH. Organized crime kept from the tsunami of cash that party hungry younguns, bored/traumatized vets, and the others that life isn't life if it isn't altered bring/brought; cops that could concentrate on real threats to life and property that simple potsmoking doesn't engender ; amateur botanists not breeding max THC to minimize weight. But it didn't happen that way.

I've quietly slipped pot and pipes into the sharps container to keep a patient from having his health issue becoming a legal one. That keeps me a PATIENT advocate. Someone they can discreetly tell the ..discomfiting points to, knowing I will do what I can to help THEM.

If this was an issue for you, why couldn't you discuss with the patient that you needed to not see that, or anything like it, again.

Until america finally faces the fact that we're diverting far too many legal resources away from SERIOUS dangers, chasing stoners instead of violent criminals and law/tech savvy bankers and other terrorists, we face this dilemma. When it's you there, suddenly faced with something you're shocked or scared by, all of this second guessing is just that!

Try to remember, we're there for the patient. Not the cops, or administrators, or anyone else. If you feel their health is endangered, express your worries to them initially, your supervisor if you feel like you've been ignored or purposely placed in " a situation"

PICC ACE · Mar 6, 2006

MYOB on the POT. If you had no evidence that this patient was in immediate medical danger,there was no need to tattle to the MD. If the doc's personality is such that he'd threaten to sue over this,I really doubt that he's got a great relationship with the patient,so now the patient's trust is broken with both MD and nursing. If your rationale was truly medication interactions,you might have consulted a pharmacist and used the oppurtunity to educate the patient on the RPh's recommendations. The last patient I had for whom marijuana was an issue was also diabetic and on dialysis. When we had a conference to coordinate his care after d/c with his homecare rep,endocrinologist and nephrologist present,everyone knew about his marijuana use and dealt with it openly and nonjudgemantally-we worked with it as a given in his plans,not as some immoral or illegal behavior we needed to change. The consensus was that if that was the way the patient insisted on treating his nausea and neuropathy,so be it. The worst that ever happened is that his blood sugars would get weird but since his sister helped him with his shots and sliding scale,this was covered.Just my $0.02 from a Blue State,in a city where possesion is a misdemeanor....

powernurse · Mar 6, 2006

POINT #1 ~~~~~ MYOB on the POT. If you had no evidence that this patient was in immediate medical danger,there was no need to tattle to the MD.............
POINT # 2 ~~~~~The last patient I had for whom marijuana was an issue was also diabetic and on dialysis. When we had a conference to coordinate his care after d/c with his homecare rep,endocrinologist and nephrologist present,everyone knew about his marijuana use and dealt with it openly and nonjudgemantally-we worked with it as a given in his plans,not as some immoral or illegal behavior we needed to change.

The problem with many of the posts in this thread is that they carry the same contradictions as the above poster.....

This issue is NOT whether or not NURSES are COPS!!!

The ISSUE IS ~ Are NURSES OBLIGATED to communicate with the MD and other members of the team with regards to Nurses/patients safety?

While it is TRUE that is impossible to GUARANTEE anyone's safety entirely.... It is part of the Home Health Nurses RESPONSIBILITY to the patient to strive for what is best for that patient and KEEPING SECRETS from other members of the HEALTHCARE TEAM is NOT CONDUCIVE to PROVIDING THE BEST CARE and protecting your MORAL INTEGRITY as well as your license.

Nurses are PROFESSIONALS.... we need to remind ourselves of what the true objectives for our patients are....

WE NEED TO ACT LIKE THE PROFESSIONALS that we are and COMMUNICATE ALL PERTINENT INFORMATION to the team RATHER THAN TRY TO PLAY SUPERMAN....

This is NOT about TATTLING:nono: :nono: ..... it IS about COMMUNICATION!

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WITH EVERY DIFFICULTY ~ THERE IS RELIEF

rambisisking · Mar 6, 2006

How can our patients be honest with us if they cannot trust us to maintain their privacy? Don't you think that you could have made a more positive difference in this person's life if you had maintained an honest, trusting relationship with him rather than jumping to conclusions about his drug use and possibly sending him to jail? How can it be better for this human being to be in jail because he smokes a joint now and then (assuming that he is smoking it).
It's no wonder that we have an epidemic of untreated drug abuse because no one is willing to discuss their drug use, even with their doctors, for fear of being turned in and going to jail .
It all boils down to who reaches these people first....doctors/nurses or police. If our healthcare professionals decide to make themselves policemen, then who would they be able to turn to for help? How can a drug abuser receive the help they need in order to make their lives better if we all negatively pre-judge them and send them to jail?
Imagine a world where diabetics and cancer patients were incarcerated rather than treated if their diseases where illegal. Addiction is the only disease known to man that is treated by our legal system rather than by our healthcare system.
Finding a marijuana plant in one of my patient's home would be a signal to me to open my lines of communication and trust in order to move forward with counseling and drug treatment rather than trying to get them busted and incarcerated.
Many nurses are so quick to claim how open and non-judgemental they are, when in fact, many of them jump on their high horses and "better than thou" attitudes when it comes to drugs of any kind. Many just are not willing to accept the scientific data that proves addiction is a disease that can be treated, not to mention that many studies show that the active ingredient in marijuana has been shown to reduce pain and nausea.
I think that our society would be better served through education about addiction (marijuana in particular) rather than allowing our legal system to manage the care of addicts.

HERE-HERE! Again it just scares me how many nurses have forgotten what our roll is in health care. What is your goal? What is your goal? We are human beings treating other human beings, plain and simple. We are not any more in controll of them than we are our friends and family. Do you need to consult a manual in order to deal with friends and family? My God, I hope not. Hopefully you just deal with them as one human being to another without the thought of any Power over them. Children excluded, of course.

Like Gypsymoon said, It all boils down to who reaches these people first. You , We, have the perfect opportunity to be those people who are there to reach them first, my God, it's laid in our laps. But instead of using the tools we have at hand to further the trust and communication between 2 human beings, we allow the confusion of Power over another to drive them further away from help.