Walked in on a pt rolling a joint

Published

Where it happened:

Pt's room in an LTAC facility.

What I saw:

Pt sat on the edge of the bed with a menu on his lap in "roll-a-joint" position.". He quickly removed "something" from the menu and placed it into his cigarette packet, which he then tucked away under the pillow on his bed. He then placed the menu on his table and sat back in the bed.

What I did not see:

Marijuana. Rolling papers.

What I know about the Pt:

Active AIDS. Cancer. Goes outside to smoke in his WC a lot. Enjoys IV morphine, Ambien, Ativan, and Norcos a little too much. He's a clock-watcher. Once smoked a cigarette in the BR of his hospital room while under the care of another nurse.

What I said:

Hey, it's a shame your doc cannot write you a prescription for "that," as I pointed to his packet of cigarettes. I give "it" here in the hospital in a capsule-form called "dronabinol." We discussed legalization of marijuana. I stated that he must not smoke in his room due the risk of fire, the fact that smoking is obviously not allowed within the grounds of the hospital.

What I did not say:

Hey, I see that you are rolling a joint with marijuana there.

What he did not say:

Yes, I was rolling a joint with marijuana.

My reaction and action taken upon the above discovery:

Nothing further than the above description of my implied knowledge of what he was up to and a genuine discussion of my true feelings towards legalization.

I'm just curious as to whether anyone else has experienced such an occurrence, anyone else's feelings towards this incident, and anyone's opinions on whether I acted well having been faced with this "ethical dilemma."

Specializes in OB.
Yes, the man has AIDS and cancer. I included this information under the "what I know about this pt" part. He is enjoying his narcotics "a little too much." Don't misquote me and then make assumptions as to my feelings towards this patient. He enjoys getting high in any form available to him. This is a statement and NOT a judgement. Narcotics, especially pain medication, are not indicated to get people high. Surely anyone who has been a nurse longer than a week knows that some patients "enjoy" getting high off narcotics. Again, this is not me passing judgement on a very sick man's actions; it is a fact.

Nope, sorry. He is dying. There is no such thing as "enjoying" his narcotics "too much." He is not getting high. He is getting deserved relief from his suffering. I would hope that anyone who has been a nurse longer than a week would understand that, but sadly, this is not the case.

If I were dying, I'd want to get high.

:: hummming along ::

"Don't Bogart that joint, my friend....

Pass it over to me...."

Well, you asked what I'd say. Didn't you? I forget. Oh, look at that! Wow!

Specializes in Peds/outpatient FP,derm,allergy/private duty.

I understand these little devices are safer than smoking plus they have the advantage of looking like little miniature space capsules.

Marijuana-vaporizer.jpg

I think you handled it alright.

Thanks. I really feel like I'm being attacked here in this thread, and this and a couple of other responses, which I "liked" reassures me that at least some people understood where I was coming from.

For the rest of you, I will do the best I can to respond in a gentlemanly fashion. I went out with my girlfriend and had a nice evening, so she is tolerating the fact that I'm gonna blow some time here doing this. However, I feel it necessary to help you guys understand from where it is I'm coming.

Specializes in NICU, Trauma, Oncology.

As far as your license/hospital reg worries. If you were asked to testify in a court under oath and they asked you if you knew this patient was smoking pot what would your answer be? Fact is you don't know, you didn't see any pot, the patient didn't divulge, etc. he might have been rolling or he might have been doing something else. According to your OP You don't know so I wouldn't worry too much about that. You did the right thing by reminding him about the indoor smoking policy. Anything else would be jumping to conclusions and makin assumptions.

You requested opinions . You received several from nurses that collectively have hundreds of years of experience.

Your individual rebuttals, speak volumes to me.

If your main concern is having knowledge of criminal activity.. just take it to your manager.

Let us know how that rebuttal goes.

I really have nothing more to say to you than please re-read this, "I'm just curious as to whether anyone else has experienced such an occurrence, anyone else's feelings towards this incident, and anyone's opinions on whether I acted well having been faced with this "ethical dilemma.""

I don't know if you will have to read this a couple of times to grasp exactly what I am asking for here, but I stated exactly how I responded to this situation. The way in which I responded, I feel, was the appropriate way.

No way am I going to report this to anyone in management. In fact, I didn't tell a sole in the hospital what I saw. I respect the fact that this guy is sick and I respect his right as a human being to enjoy whatever the **** he wants.

If you're looking for the exact part where your post seemed judgmental, other than the whole thing, the part about him enjoying his meds "a little too much" would be the most specific part, which by the way, is an opinion, not a fact.
The whole thing? Judgmental? Dude, you missed my point entirely. Sharing the information about him enjoying his narcs too much was to offer information that I knew about this patient. It was about as much as I was willing to share. Honestly, I expected someone to at least understand what a patient who enjoys his narcs too much was. Has no one on this entire forum encountered such an individual before? That blows my mind. I will go into detail later in response to some comments that were more relevant to this issue.

And like I said to someone else, besides the statement I made about him enjoy his narcs too much (which seems to have been the one thing that has gotten up everyone's nose), please please please show me where I judged this patient. Please!

Actually your responsibility as a nurse is the opposite, you're expected to keep information obtained about the patient in a nurse/patient relationship confidential unless there is an imminent threat to the patient or another person. You're free to report your concern that they are smoking in their room, specifically what they're smoking isn't relevant and isn't really an exception to the confidential nature of the nurse/patient relationship.
I'm also responsible for the patient's safety.

Consider this...I walk in and the patient is slamming vodka. Am I being a prudent nurse by slamming IV morphine and loading this dude up with ativan, ambien, Norco, etc. with the knowledge that he was also using other "substances"? I really don't think the board of nursing would be cool with me claiming, "well, hey, he was smoking weed, it's cool man. He's sick. He deserves to get high," or, "hey, he told me he was in pain, anxious, needed to sleep." No. They're gonna throw the book at me for pushing **** into a patient who I knew was using "illegal" substances."

Don't get me wrong here. I pushed his narcs. I'll explain why later.

Specializes in NICU, Trauma, Oncology.

"No. They're gonna throw the book at me for pushing **** into a patient who I knew was using"

That is the question. Was he using and did you know or have a very good reason to believe that he was indeed using or about to use. Sounds like maybe you may need to have a conversation with your patient and warn him of the contraindications of using any illicit drug in combination with his meds. I'm not a nurse though so I'm not sure exactly of protocol for that. But it would definitely be beneficial for the healthcare team and the patient if they were aware of recreational use, not to judge but in order to provide best care possible

So what if he's enjoying those meds a "little" too much? If your statement is not meant to be judgemental, why mention it at all? This poor man's life must be miserable. For cripes sake...with AIDS and cancer, it's doubtful he's going to live very long; if he "enjoys" pain relief and maybe even the buzz he gets, so what?

This post is full of assumption and speculation, neither of which serve the patient well.

Please name one "assumption." Please.

Maybe here..... OK. Let me start with the fact that I consider myself to be a very compassionate nurse. I don't know if any of you have experienced this before, given the responses to this original post, but most nurses have a problem with pushing narcs on patients who constantly call for "pain meds." I usually work IMU. However, for the last few months due to complaints, "dissatisfied customers" I have been called to this particular floor for "damage control." If you guys are also unaware of this, this is where a patient and/or family members have complained so much that something has to be done before the hospital loses the patient, the money, etc.

I give prn pain meds to patients who request them ON TIME all the time (unless of course I'm dealing with a code, a patient crashing, etc.). I do this after assessing the necessary things (I don't slam IV dilaudid into a pt who's bp is 70/40...I'll explain why to the patient), AND if I know pt the well enough, what they can handle, their tolerance, they will get what's available round the ******* clock guaranteed. This is why I get called in for "damage control" as well as the fact that I will take the time to explain what the hell is going on to patients and their family members. I take care of business. I do. And don't give me any **** about being a good nurse is more than pushing prn pain meds on time, because we are adults and know this is not the case. However, I feel it necessary to stress this point, as this is what I am being attacked about.

Don't judge me and don't question my integrity or compassion for this patient when you have absolutely no idea what is going on accept some very simple information I shared in the original post.

Yes, the guy likes his narcs "a little too much." I'll explain why later.

Has no one ever encountered a patient who likes their narcs a little too much? No one? Really? Where the hell do you guys work? Disneyworld?

But according to what you posted you do not have knowledge of an illegal activity.

You SUSPECT illegal activity.

The guy was rolling a joint. Believe me. Don't believe me. That's not why I posted this -in order to see if some person on allnurses.com believes me whether or not this guy was smoking weed.

I explained how I responded to the incident, and I explained how the pt responded to my statements about dronabinol. If you have any sense of how social interactions work with completely sentient human beings you will be able to figure out that this guy admitted to smoking weed.

I really didn't think I would have to post this, but after my pointing at his cigarettes and making the statement about, "HEY IT'S A SHAME YOUR DOC CAN'T PRESCRIBE THAT FOR YOU," (written in caps just incase anyone misses that a second time), he said, "Exactly, I should be able to blaze up right here the room." No, I didn't think this needed to be stated at first, as I didn't think I'd in front of the ethical nurse jury. He was smoking weed. Plain and simple.

Just ask yourself, what did he do about it?? what is he asking in his original post?

Please.

Bold and italics mine.

Generally speaking very ill and dying people are not judged according to how much they might "enjoy" their pain medications beyond whether or not they are meeting their comfort goals.

I did not judge him on how much he enjoys his pain meds. In fact, I want him to enjoy his pain meds. Seriously. If I could give the guy a "make a wish foundation" ticket to heaven, I'd give it. He got everything he needed and was not once in any discomfort due to decisions I made about whether or not he can receive/not receive his meds.

Have you ever had cancer or AIDS and experienced pain or other discomfort associated with those diagnosis? How much experience do you have with opiates?
I have not experienced either of these diseases, no. How is that question relevant to what I asked in my original post!

Experience with opiates? I have never taken them, no.

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