Walked in on a pt rolling a joint

Nurses Relations

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."

Lol, I noticed I made almost the same exact comment as someone else before me, and too included the words speculation and assumption. It really is just that.

I am ultimately confused on how a dying patient (more than likely in a lot of pain) is judged for finding relief in the narcotics he is on. Is he really enjoying the situation he is in? Are you suggesting he shouldn't be on these medications? Sorry for all the questions but I am having trouble making sense out of this.

But you really don't have any real evidence right?You can bring it to the attention of the administrator if you feel morally obligated about your suspicions. The can decide what to do.
I would rather not and did not. The reason I responded the way in which I did was to protect myself as well as him. I let him know I knew what he was doing and then discussed legalization with him. It was a pleasant exchange. I'm glad I have I have no evidence.

As an administrator myself I did have a female patient light up in her room in an acute care facility. When I opened the door the smoke rolled out and she was actively smoking. You may NOT smoke in your hospital room. I confiscated the materials and locked them up. I let legal handle it in the morning.
Like I said, he was caught smoking in his room while under the care of another nurse a while back, so I knew this was an issue with him. After his comment about "blazing up in the room" I adamantly stated that smoking in the room is not allowed and explained why. Instantly he came with something along the lines of, "aahh...nah, nah, I was just joking about that. I know you can't smoke in the hospital." Like I stated in the OP, he goes outside in his WC to smoke.

If anyone missed this, I basically told the guy 3 things.

1. Hey, I know you're smoking weed, and it's totally fine.

2. Don't smoke in the room.

3. I'd rather not know about it.

"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

Like I said, if the guy was slamming vodka, I'd be approaching pushing a bunch of IV narcs on the guy a little differently. I don't need to be banging on his chest while explaining to the house doc why this guy is no longer breathing.

The guy has AIDS and cancer. I would encourage the guy to smoke weed, seriously. I continued to give everything he had available in order to make him comfortable and "happy."

Specializes in Critical Care.
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!

I get that you feel your OP was misunderstood, which is where a mea culpa and 2nd attempt to explain your position and clear the air comes in.

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.

I'm not clear on what it is you're suggesting you would do in that situation. As you've pointed out, your decision to give meds is assesment based, so how does that change here? If he's passed out, then obviously you would re-think giving certain meds. Knowing that he uses, and likely has used marijuana prior to you discovering this, means he's been tolerating the combination of marijuana with the meds you administer just fine for apparently some time now.

I didn't find your original post judgmental in general, and I think you handled it just fine. However, the "a little too much" comment did stand out to me, and I could not help but infer at least a little judgment from that statement. For me, someone dealing with those diagnoses gets a free pass on how much they appear to enjoy their meds, so it's really irrelevant to the issue at hand.

Specializes in NICU, Trauma, Oncology.

Does the fact that he is most likely smoking pot outside his room affect his care plan in terms of pharmacological activity of his meds? It might be wise to discuss this with the provider. Otherwise unless caught in the act it's not a legal issue at this point.

I'm a bit confused as what you are asking for since you seem to be attacking every response given.

Does the fact that he is most likely smoking pot outside his room affect his care plan in terms of pharmacological activity of his meds? It might be wise to discuss this with the provider. Otherwise unless caught in the act it's not a legal issue at this point.

I'm a bit confused as what you are asking for since you seem to be attacking every response given.

Nah, I actually "liked" most of the responses. I just felt it necessary to "defend myself."

Eh...I understand the OP. I think your words are being picked apart. I personally never saw your statement as being judgmental. I just saw it as a way for you to candidly express to other nurses, whom you thought would get it, that he indeed wants his narcs on time, every time. (Of course, rightfully so). I, like the OP, am not sure why this post went "south" so fast but I did want to say to you that I totally get it, so you're not completely alone here.

I get that you feel your OP was misunderstood, which is where a mea culpa and 2nd attempt to explain your position and clear the air comes in.

I'm not clear on what it is you're suggesting you would do in that situation. As you've pointed out, your decision to give meds is assesment based, so how does that change here? If he's passed out, then obviously you would re-think giving certain meds. Knowing that he uses, and likely has used marijuana prior to you discovering this, means he's been tolerating the combination of marijuana with the meds you administer just fine for apparently some time now.

Like I stated, if the guy was slamming vodka, sure I'd have approached pushing IV narcs a little differently and expressed why to the patient.

I do feel my OP was misunderstood. I only shared that info "likes his meds a little too too much," as I figured most nurses would understand what I was talking about and wanted to share what I "knew" about the patient. An attempt to describe him as an individual, if you will.

Whether or not I'm going to continue giving these meds to him based on the fact that he is getting "high" off them is not something I felt did not need to be discussed in this thread. I wanted to keep it on topic. Of course, the guy deserves to be as comfortable, high, whatever as ******* possible given his physical condition, and I have absolutely no problems with this whatsoever. I will keep him as comfortable, high as I can without killing the guy.

I apologize for any misunderstanding. I really didn't think it was necessary to get this personal with how I deal with patients in this condition. Evidently, I have had to.

Either way, I'm out for the night.

Thank you to those who stayed on topic and "got it." :)

Lastly, I don't feel it necessary to post the incidents that lead me to the "likes his meds a little too much" statement, as I figured most seasoned nurses would know what I was talking about. Again, this doesn't mean, in my opinion, that he doesn't deserve them. It was just a statement to explain the kind of patient he was.

Eh...I understand the OP. I think your words are being picked apart. I personally never saw your statement as being judgmental. I just saw it as a way for you to candidly express to other nurses, whom you thought would get it, that he indeed wants his narcs on time, every time. (Of course, rightfully so). I, like the OP, am not sure why this post went "south" so fast but I did want to say to you that I totally get it, so you're not completely alone here.
Thank god. I thought I was going crazy. :)
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.

What people may/may not understand is that your feelings (or what somebody thinks you think), didn't enter into the fact that you gave good care. I took what you said to mean that 'hey, have any of you guys seen this (I for one was surprised to hear this happened) and 'hey, do you think I handled this(unusual) situation alright?'. I didn't and don't see anything wrong.

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