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."

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.

What are you afraid of, that he'll die?

How would you think I know?

"

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.

You must not be in a state where pot is legal, or medical cards are available for patients to smoke/vape/consume pot. I am, so it is a bit of a different scenario.

However, you did NOT see pot, him rolling up a joint, or anything that would indicate that it is what he is doing other than "assuming the position". You did not say, he did not say. Therefore, you can assume that this is what he is doing, but you do not know this for sure. He put "something" in his cigarette pack, it may or may not have been pot. This is not something that concerns your license, unless he is sparking it up in the bathroom, and says "this is pot". Or ya'll start tox screening patients--but even then, your license shouldn't be "on the line" over what you assume you see.

I would be more concerned about whomever his dealer is doing this kind of transaction on the property--for his sake if pot is illegal in your state. I am sure that he doesn't have money to pay fines, nor would enjoy any time in a jail. But you have no way of policing the parking lot if the patient is allowed to go outside to smoke cigarettes.

Bottom line, if I were actively dying or attempting to live with both AIDS and cancer, I think that I would be very much liking my narcotics a whole darn lot. This patient will not be "cured". This patient will more than likely die in the facility. There may come a time in the near future that this patient will require a morphine drip. So let him love however much he wants to those medications. You can only medicate per MD order. Smoke em if ya got em in the parking lot should that be allowed in your facility--who cares WHAT he smokes.

And perhaps he wants to shut the door of his room for privacy. And actually say "come in" when you knock.

There is a huge difference between an addict that then has to go outside the facility and live a life, have some function, do their thing and a dying patient who has little time left.

You must not be in a state where pot is legal, or medical cards are available for patients to smoke/vape/consume pot. I am, so it is a bit of a different scenario.

However, you did NOT see pot, him rolling up a joint, or anything that would indicate that it is what he is doing other than "assuming the position". You did not say, he did not say. Therefore, you can assume that this is what he is doing, but you do not know this for sure. He put "something" in his cigarette pack, it may or may not have been pot. This is not something that concerns your license, unless he is sparking it up in the bathroom, and says "this is pot". Or ya'll start tox screening patients--but even then, your license shouldn't be "on the line" over what you assume you see.

I would be more concerned about whomever his dealer is doing this kind of transaction on the property--for his sake if pot is illegal in your state. I am sure that he doesn't have money to pay fines, nor would enjoy any time in a jail. But you have no way of policing the parking lot if the patient is allowed to go outside to smoke cigarettes.

Bottom line, if I were actively dying or attempting to live with both AIDS and cancer, I think that I would be very much liking my narcotics a whole darn lot. This patient will not be "cured". This patient will more than likely die in the facility. There may come a time in the near future that this patient will require a morphine drip. So let him love however much he wants to those medications. You can only medicate per MD order. Smoke em if ya got em in the parking lot should that be allowed in your facility--who cares WHAT he smokes.

And perhaps he wants to shut the door of his room for privacy. And actually say "come in" when you knock.

There is a huge difference between an addict that then has to go outside the facility and live a life, have some function, do their thing and a dying patient who has little time left.

The guy was rolling a joint. He smokes weed outside the facility. I am totally cool with that fact. I'm not going to state this again. If someone is unable to read and understand what I have posted here, too bad. I give up. The fact that the guy was rolling a joint is not the issue/topic of this thread. Trust me he was. Do I care? No. Its really that simple.

No, I'm not in a green card state.

What are you afraid of, that he'll die?

There is no fear on my part. I trust my own judgement in situations such as this. I merely posted to ask if anyone else (anonymously, as I cannot bring this up to anyone I work with for obvious reasons) has experienced something similar and to try and get some feedback from other nurses on my actions (yeah, actions I took already. ...done...been done...happened).

I'm actually surprised and pleasantly surprised that everyone so far seems to have responded in a fashion that assumes weed is already legal. That's brilliant. Again, that's brilliant.

Thank you, and good night.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
There is no fear on my part. I trust my own judgement in situations such as this. I merely posted to ask if anyone else (anonymously, as I cannot bring this up to anyone I work with for obvious reasons) has experienced something similar and to try and get some feedback from other nurses on my actions (yeah, actions I took already. ...done...been done...happened).

I'm actually surprised and pleasantly surprised that everyone so far seems to have responded in a fashion that assumes weed is already legal. That's brilliant. Again, that's brilliant.

Thank you, and good night.

It is not my job to judge a patient on their personal life and the legalities of their recreational use of drugs. As a nurse I a obligated to keep my personal opinions to myself (even though I do believe that medical marijuana should be available to patients). In reality you actually "saw" nothing and have no proof.

You "saw" the patient have his menu place in a specific manner which, in your experience, is similar to the process used in rolling a joint (lets use specific lingo here) You DID NOT see any illegal substances and you DID NOT see any papers which, by the way, are not illegal to possess.

What do you have here? Not much really. You have suspicions. Nothing more nothing less. I'm willing to bet that the administration already knows that he has some behaviors that are not exactly

"appropriate" in a community setting such as an LTACH. That being said the patients room is their domain...their "home" in a manner of speaking and therefore they are protected by privacy laws. A facility needs to be very careful about search and seizure with privacy laws and personal belongings.

[h=3]Health Care Law Monthly - Alston & Bird LLP[/h]Now if the bag of marijuana was in plain view and you saw him physically rolling the joint this places the illegal substance "in plain view" which enacts a different set of policies and laws.

I look at situations like this and a benefit versus risk harm versus no harm. If it was heroin I would have a different view that smoking pot as the benefits of medical marijuana for a patient such as this, for me, is clear and if I have no real evidence...a statement of "You know you aren't allowed to smoke indoors and if you get caught it is still illegal no matter how sick you are." followed by..."You do realize I see this again I will have to report this to the administration and authorities."

Hey, for what its worth, I understood your OP and didn't take it as judgmental either. In fact, to me you sounded very empathetic to the patient, but I am still only an ADN student, so what do I know? People close to me have been patients in need of medical marijuana, but they lived in states that "made it difficult." Its a shame you didn't get the kind of responses you were looking for because I was excited to read them. I thought it would be interesting, but unfortunately the thread didn't go that way. :(

Specializes in Critical care.

I won't even do inventory belongings for our ICU pts. I tell the family to take stuff home. If any nurse ever tried to go through my belongings as a patient I would be really angry.

Specializes in LTC Rehab Med/Surg.
What are you afraid of, that he'll die?

Most of us don't know each other personally. We don't know the history of the nurses who post here.

I once had a dying hospice patient with cancer. This was LTAC. PCA pushed by the family, plus IVP Ativan on the dot as ordered, even though the patient rarely awakened. Just moaned. I had zero problem with everything I did, including giving that last dose of Ativan. Until the family accused me of killing the patient. I was in disbelief that this family who demanded I give every single drug I could, in their pain, accused me of such a thing. Let me tell you my blood ran cold. I saw my nursing future go down the drain.

We can argue about "she was going to die anyway". "I didn't kill her, the CA did". What do you think a person who has no hospital/drug/nursing/medical experience would think?

You can bet the farm I'm a whole lot queasy, when it comes to end of life care and drugs.

I understand completely what the OP was asking. I understand their question, and the concerns about turning a blind eye to questionable activities that occur on their watch. When the patient attempted to roll the joint in plain sight, he made the nurse an accomplice. It doesn't matter it the OP walked in unannounced. Doesn't matter if the patient was caught unaware, or if he just didn't care who saw him. Once the nurse knows, the situation has to be addressed.

I also know what "liking his narcs a little too much" means too.

Saying it or thinking it, doesn't mean I've judged. As far as I'm concerned it's as descriptive as reporting that the pain meds given are not effective. An observation.

Specializes in Oncology; medical specialty website.
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.

no one was attacking you. Just stating differing opinions.

except most people responding weren't commenting on the OP's question....I think its understandable if the poster feels exasperated

If I was the nurse, I would have notified the patient of the smoking policy and I would have notified management as you stated Marijuana is illegal in your state.

Just like I would have done the same if the patient was using any other legal drug in the hospital.

I definitely think you are judgemental and should have handled it more professionally.

Did you ask the patient did he enjoy " getting high off narcs" or is that YOUR opinion ?

I thought you handled it well, I don't see the problem with reminding him of the no smoking policy...getting caught smoking pot in the hospital will most definitely kill your high. As for him enjoying his pain meds a little too much, who cares? I can't blame him for loving the morphine, I was admitted to the ER for awful systemic infection. Even though my pain level wouldn't drop below a 7, I didn't have a care in the world. I don't think you were judging the patient, I think you were just giving a thorough description of his personality/habits.

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