Upset!!! write up and patients marijuana

teeituptom, BSN, RN · Mar 7, 2006

i recently was written up for going to see a patient who is on dialysis, has hypertension, and is schizophrenic. he had a marijuana plant growing in his home and i reported this to my clinical manager along with the md. the md confronted the patient about it and the patient denied it. my clinical manager wrote me up because she said that i should not have told the doctor because now he has threatened to sue. my rationale was that it could affect some of his 20 medicines that he was on. of course he denied it. do you think this was right???? i'm upset.
thanks!

and your point is. the last i looked this was still a free country. it might not be much longer with the reps in power, but for now its still free. you should have never violated that pts right to privacy with in his own home.

you should not only be written up, you should be fired. who set you up to be judge and jury over this pts life. you are there to help not to violate their rights.

Marie_LPN, RN, LPN, RN · Mar 7, 2006

Who set you up to be Judge and Jury over this pts life.

No one did, nor did they imply they even were!!! That's a bit harsh. :uhoh3:

CrunchRN, ADN, RN · Mar 8, 2006

That was a little harsh wording, but I have to say I agree with Tee. We are not cops we are nurses. it is their home. If you feel unsafe then leave and decline to return to that home. It is not even known if the patient actually smoked the plant. Maybe (doubtful) they just thought it was a pretty plant. I would still encourage the patient to discuss it themselves with their MD, and if I felt uncomfortable not care for that particular patient.

powernurse · Mar 8, 2006

If you feel unsafe then leave and decline to return to that home............................. if I felt uncomfortable not care for that particular patient.

If the nurse refuses to care for a patient without a valid explanation to MD and DON that is DOCUMENTED..... she is at risk for being accused of abandonment......

What is the hangup everyone has with the Nurse=Cops thing???? No one ever said we should POLICE our patients..... However in caring for your patient you are OBLIGATED to communicate with your healthcare team any pertinent info re: your patient.

If you have a pt on O2 whether in the hosp or in the home and you notice cigarettes lying around.....if you dont get any answers from your pt or you are uncomfortable with the situation (for your pts safety and underlying illness)..... Are you saying that you should keep this to yourself b/c "Oh Well" "The pt is an adult and it is his health, his business....."

Part of your job as a nurse IS getting into your pts business as it affects his health and well being....

If this had been a situation where the nurse saw a gun hanging around on a table and the pt had the same dx of schizophrenia......... all those nurses who dont want to "POLICE" their pts are going to say it wasnt their business..... b/c they never actually saw the pt holding the gun and the pt never stated he waould shoot himself or anyone else..... However is this a safe situation for anyone..... of course if you are UNCOMFORTABLE with this scenario you MUST relay your concerns to your team..... Otherwise..... goodbye license/hello abandonment lawsuit!

Marie_LPN, RN, LPN, RN · Mar 8, 2006

"The pt is an adult and it is his health, his business....."

Yeah that would apply until the O2 and lighting cigarette combo turned the house into a rocket.

I'll go ahead and say it now, because i know someone will eventually: just because the cigarettes are lying around doesn't mean the pt. is smoking them.

CrunchRN, ADN, RN · Mar 8, 2006

That is just the point - it is a judgement call. A gun is a very different situation than a marijuana plant and would of course be handled differently. People are acting as if there is one correct answer in the situation and there is not. Depends on the nurse, the agency, the state and it's BON and the laws of that state.

As to abandonment you can report that you will not go there because of illegal items and if they want you to specify then go ahead. Every decent agency should have a specific policy to deal with these issues so that the path is clear.

I still would not have reported a PLANT that is in the house. I would have talked with the patient, asked him if he smoked it, explained the interaction with medications, asked him to discuss it with his MD, advised him I was not comfortable coming to a house with illegal drugs, and let him make his own choices.

A plant that he may or may not smoke is not the same as a drug, heroin, syringes, coccaine, numchucks or a million other things that may be encountered.

Just my opinion - so go ahead and let me have it. I can take it!

Marie_LPN, RN, LPN, RN · Mar 8, 2006

Some people leave their guns laying out on their nightstands, though, so, really, a gun wouldn't be much different, except for the safety of a person that's working there. Just because it's laying out wouldn't mean he's thinking of suicide, or shooting someone else.

CrunchRN, ADN, RN · Mar 8, 2006

"Some people leave their guns laying out on their nightstands, though, so, really, a gun wouldn't be much different, except for the safety of a person that's working there. Just because it's laying out wouldn't mean he's thinking of suicide, or shooting someone else."

Granted, but a gun can kill me pretty easily, but a plant is much less likely to cause ME harm. As I said before that is why we are really talking about is judgement calls with no correct answer for every person in every situation.

Filthy house with a newborn preemie and bug's crawling around? I would absolutely report that to CPS, physician, agency. I would work through the agency though unless they refused to do the right thing.

These are many of the reasons I would probably never (never say never) choose to do home care!

Marie_LPN, RN, LPN, RN · Mar 8, 2006

Granted, but a gun can kill me pretty easily, but a plant is much less likely to cause ME harm.

Which is why i said "except for the safety of the person that's working there".

powernurse · Mar 8, 2006

Some people leave their guns laying out on their nightstands, though, so, really, a gun wouldn't be much different, except for the safety of a person that's working there. Just because it's laying out wouldn't mean he's thinking of suicide, or shooting someone else.

VERY TRUE... however if you were intimidated or concerned in any way regardless of whether it is a gun, drugs, unhealthy food, untidy home, unfit living conditions etc.... you should have the RIGHT to communicate your concerns with the MD or DON.

This discussion really boils down to 2 things:

1) Did the original poster have the RIGHT to communicate what she OBSERVED in the home? After all SHE DID NOT REPORT THE PT TO THE POLICE....she simply communicated to the MD what she observed....

2) Isn't the nurse REQUIRED to COMMUNICATE & DOCUMENT in such a way that other members of the team would be prepared to appropriately care for the pt with a CLEAR PICTURE of the FACTS (not the nurses opinions but the facts and exactly what she observed is fact not opinion)

If it had been a gun lying around and we take the position that "I am a Nurse NOT a COP" and "He never said he would kill himself or others" and the next member of your team encounters him in a different mental state with a different outcome.....perhaps the CNA is in cleaning up and accidentally picks up the gun with some laundry or something and it goes off (extreme scenario I know :uhoh3: ....but what then?) and then they learn that you knew of the weapon but didnt communicate it to your team..... well then?

I know this is probably opening Pandoras box :uhoh21: for a whole new "HOT" :angryfire: topic.... but it is good to hear all sides and discuss these issues b/c they CAN happen.

soulfullady · Mar 8, 2006

Does this pt have a medical marijuana card? If so, he has the right to have up to two plants in his home, and since doctors cannot give the marijuana to the pt without losing their license, they can only accept the fact that the pt has the legal right to have such a plant in his home. IMHO, it's a plant, not a meth lab......Maybe this plant helps him with the painful physical and mental aspects of dialysis like no other 20 plus meds can provide:zzzzz ...

savanah · Mar 8, 2006

I agree with the nurses that stated that this nurse violated her patients' privacy. Several years ago I took care of my 36 year old brother who had metastatic liver cancer. While he was on a Trial Study for a new Chemotherapy agent, he developed dibilitating side effects, one of which was hiccups, which would last anywhere from 24 to 36 hours, also he had the usual severe anorexia, nausea and vomiting that goes along with taking toxic substances. The doctors tried many medications, none of which would stop the persistent hiccups. The only thing that worked was smoking pot. It also helped with the nausea. There are two sides to the coin. One, that marijuana is illegal and two, it has been found to be very beneficial for cancer patients. The nurse should have just asked the patient to please put the plant somewhere not in her sight and that should have been that. As home care nurses we have the opportunity to see and hear alot of things that may be objectionable to our view on things. It does not give us the right to violate our patients trust in us. I saw first hand how marijuana eased some of the suffering my brother was going through and if I had to go through what he went through I would do the same thing.