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."
Actually, I answered this in haste last night, partly due to frustration and feeling like I had to defend myself.
The fear I had was say this guy gets caught smoking a joint (outside the facility) or gets caught by another nurse in possession of a controlled substance, gets reported, ****, maybe the nurse freaks out and calls the cops because she saw a patient doing "drugs!" If this happens and he says something stupid like, "Oh nurse Anonymouss666 knew about it and told me it was ok," I'll be having to answer for it. Of course, I would deny seeing anything.
This is why I stated that I didn't actually see the weed and why I stated how I basically told the guy that I knew he had weed but in a round about way. As I stated in my OP, he basically told me he was smoking weed, in a round about way. Our discussion on legalization and hospital smoking policy established that one, I am cool with the fact he smokes, and I will continue to push his meds as requested/order, and two, that I am not cool with him smoking anything in his room. Also, they way in which the two of us discussed what went down established that I'm quite happy to just pretend like I didn't see anything (if someone else feels it necessary to state that I didn't see "anything" once again, god help you and your reading comprehension skills).
The fear I just mentioned above -being questioned about my knowledge and not acting on it if this dude drops me in it- obviously was not enough for me to "drop this guy in it."
Actually what confuses me here is how the op ask for opinions on a "ethical dilema" and then states they don't care, never had any doubts about it in the first place. 95% percent of patients tend to like their pain meds too much, not a big hairy deal. It doesn't sound like you actually saw too much one way or the other, so I'd just play ignorant, while reminding the patient that smoking of any kind is not allowed due to fire risk.
Specializes in NICU, PICU, Transport, L&D, Hospice.
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.
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.
I don't understand the need to mention that he "enjoys" his pain meds a bit too much. What was the point of that comment? What was the intent? How do you know that it is a bit too much enjoyment? How do you know it is enjoyable beyond the comfort and pain relief it provides? If you have never experienced any of his discomforts or other, how can you quantify or qualify the dying patient's response to the interventions in those terms unless he says to you, "I really enjoy that opiate" or similar? You can either simply describe what you observe, hear, etc or you can surmise and extrapolate based upon your personal/professional opinion and experiences.
You are supposing that the patient was rolling a joint. You said so yourself. You saw no papers. You saw no pot. The patient admitted nothing. In a court of law you have squat to offer other than observation of activity that could be and probably is related to rolling a joint, but is NOT actual witnessed behavior of rolling a joint.
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 ?
This is honestly more the kind of response I was expecting to receive from this forum.
And quite honestly, I am surprised that you have not been jumped yet in this thread for stating that you would report this to management.
I am grateful for your honesty, though, as this is exactly for what I was asking in my OP.
I would be very grateful if you would demonstrate how I am "judgmental," because as far as I can see, I really have said nothing more about this guy than what I did in the OP. I only recently stated my opinions of his smoking weed as it I felt was necessary in order to defend myself from what really did feel like an onslaught of false accusations (If anyone one missed it, I am cool with the guy smoking weed). Originally, I just didn't feel it necessary to give my opinion on his actions in order to ask the questions I did.
As for the statement I made about him liking his narcs a little too much, in order to justify this statement to the extent in which to keep a few of you happy, I would have to describe a number of events, comments made by the patient, his general attitude towards life and his meds. In my opinion, this would be painting the guy in a certain light, and I did not wish to do that. You don't need to know this in order to answer the original questions.
If I had been asking about whether or not I should continue to push IV narcs, etc. on a patient that is this way or that way and has said this and that, etc. I could understand comments regarding this issue -the narc comment I made. However, this was not the issue at all. That part of this entire situation and that part of this patient's care has been handled, so you need not worry about it. The statement about liking his meds a little too much is something I would pass on in report, and you would receive the appropriate information relevant to that situation. I am not here giving you report, and you do not need to know anything more about this particular patient than what I shared in the OP in order to answer my original questions.
If you take issue with the way I worded the narc comment, then all I can say is that you completely missed point.
And if you have never dealt with a patient who enjoys his narcs a little too much, then I don't know where you work, have worked.
Is it necessary for me to say that I think he is a nice guy? No. However, when I give report on a patient, if they are a nice guy, I will give that information in report. If the patient is an ******* (and if someone posts claiming that they have never experienced a patient who is an *******, we as nurses should not judge patients, etc. I really am going to lose it), I will give this information in report. Why? Because patients are people, and yes some people are *******s. Sorry.
It makes me sad that I now feel it necessary to state this, but I am not calling this guy an *******. I rarely give report and state that the patient was an *******. In fact, when I am given a patient who is described to me as an *******, they normally aren't. Sometimes they are, however.
This is extremely tiring. I seriously hope we don't have to rehash this crap again. Thank you to everyone who responded.
OP, how someone that is dying "can be enjoying narcs a little too much" really???
There should be a sticky or some rule in this forum that if you intend to post here and mention a patient, please first give a thorough report on the patient, keep every single detail objective, as no one wants to hear your take, your assessment of the patient...... Jesus Christ
I don't understand the need to mention that he "enjoys" his pain meds a bit too much. What was the point of that comment? What was the intent?
I just included it under the heading "what I know about the patient." I threw a few things in there. I left some things out. I really don't think it was a crime.
If someone could paint me the ideal picture of how one is supposed to describe a patient on this forum when posting, I'd be grateful (that was a joke).
As for the rest of your questions, I will ignore them. I think If I have to explain this situation any further, I'm going shoot myself in the head (this was also a joke).
I am just so grateful for the people who posted who are obviously able to read something and understand it. I really did think I laid it out pretty clearly. I put headings, bolded stuff, and all that. :)
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?
This is your assumption. That someone "likes their narcs a little too much" when they are terminally ill is absolutely false. There is a HUGE difference. So OP THIS is where you are making judgements and assumptions.
No, I do not work at Disney, nor do I fart rainbows and chase unicorns. My type of nursing are the "undesireables" meaning all of the peeps that no one else wants--the drug addicts, the mentally ill, the hospice patients, the HIV/AIDS patients. I enjoy my high risk groups--it is what makes me love nursing. And I will tell you after multiple, multiple years that in fact there is absolutely NO SUCH THING as what one would consider an addict who is terminally ill and in the process of dying. There is a thin line between a functional addict, an addict who by their disease process can not function, and a terminally ill person who then needs narcotic and other medications to not be agonized. And there is a huge difference between "slamming dilaudid" and giving an IV push medication for pain control.
So it is a matter of knowing the patient population for which you are caring for. You are a nurse, and by your own admission a compassionate, caring one at that. Therefore, you must be acutely aware that people who have both active AIDS and cancer need some sort of plan of treatment so they are not withering away in a bed. That would be inhumane. (and a huge throwback to the mid 80's when AIDS was in its infancy).
And because OP you are in damage control, then you know all of this. If the bottom line of your questioning is that this patient population, and those similar are challenging, then yes, I hear you, they are. But it also drives my passion to be a nurse, and perhaps with some ethical debate it may change your passion as well.
I'd be grateful if you could, with all these years of experience you have and wonderful writing technique, describe what you mean exactly when you say "slamming dilaudid"?
Is whether he enjoys his medications "a little too much" really germane to the discussion? Not a bit. It is, in fact, a judgment, and not an objective finding, and so, OP, you are being called out for it.
As I stated before (in post #40), I think you handled the situation just fine, and I didn't find your original post judgmental in general, but that comment did stand out to me, too- simply because your assessment of how much a dying man enjoys his medications doesn't seem relevant.
The more you dig in your heels and deny it, the less sympathetic I am toward you.
Actually, I answered this in haste last night, partly due to frustration and feeling like I had to defend myself.
The fear I had was say this guy gets caught smoking a joint (outside the facility) or gets caught by another nurse in possession of a controlled substance, gets reported, ****, maybe the nurse freaks out and calls the cops because she saw a patient doing "drugs!" If this happens and he says something stupid like, "Oh nurse Anonymouss666 knew about it and told me it was ok," I'll be having to answer for it. Of course, I would deny seeing anything.
This is why I stated that I didn't actually see the weed and why I stated how I basically told the guy that I knew he had weed but in a round about way. As I stated in my OP, he basically told me he was smoking weed, in a round about way. Our discussion on legalization and hospital smoking policy established that one, I am cool with the fact he smokes, and I will continue to push his meds as requested/order, and two, that I am not cool with him smoking anything in his room. Also, they way in which the two of us discussed what went down established that I'm quite happy to just pretend like I didn't see anything (if someone else feels it necessary to state that I didn't see "anything" once again, god help you and your reading comprehension skills).
The fear I just mentioned above -being questioned about my knowledge and not acting on it if this dude drops me in it- obviously was not enough for me to "drop this guy in it."
Maybe I'm misunderstanding you, but seem to be suggesting that there might be some risk, such as to your license, by not reporting to police that a patient has admitted to you they use an illegal drug. If you were to discover through your nurse-patient relationship that a patient has or does use illegal drugs, and you called that cops, that's where you could potentially risking your license.
Is whether he enjoys his medications "a little too much" really germane to the discussion? Not a bit.
Strange how it seems to be the most germane aspect of this thread, though....
I don't think the fact that this occurred in an LTAC hospital to be particularly germane, but I included it in my OP.
It is, in fact, a judgment, and not an objective finding, and so, OP, you are being called out for it.
As I stated before (in post #40), I think you handled the situation just fine, and I didn't find your original post judgmental in general, but that comment did stand out to me, too- simply because your assessment of how much a dying man enjoys his medications doesn't seem relevant.
The more you dig in your heels and deny it, the less sympathetic I am toward you.
I'd be interested in the reaction of those with your point of view on this particular non-germane isse if I had describe a patient as someone who "enjoys his baths a little too much."
How can he "enjoy his bath a little too much"? He is dying! He deserves to be clean! How can you judge him on how much he is enjoying his bath!?!
I really don't think I would need to explain how a patient may enjoy a bath a little to much regardless of how deserving he is of his bath, as I would assume that any nurse would be able understand what that meant.
Anonymous666
138 Posts
Actually, I answered this in haste last night, partly due to frustration and feeling like I had to defend myself.
The fear I had was say this guy gets caught smoking a joint (outside the facility) or gets caught by another nurse in possession of a controlled substance, gets reported, ****, maybe the nurse freaks out and calls the cops because she saw a patient doing "drugs!" If this happens and he says something stupid like, "Oh nurse Anonymouss666 knew about it and told me it was ok," I'll be having to answer for it. Of course, I would deny seeing anything.
This is why I stated that I didn't actually see the weed and why I stated how I basically told the guy that I knew he had weed but in a round about way. As I stated in my OP, he basically told me he was smoking weed, in a round about way. Our discussion on legalization and hospital smoking policy established that one, I am cool with the fact he smokes, and I will continue to push his meds as requested/order, and two, that I am not cool with him smoking anything in his room. Also, they way in which the two of us discussed what went down established that I'm quite happy to just pretend like I didn't see anything (if someone else feels it necessary to state that I didn't see "anything" once again, god help you and your reading comprehension skills).
The fear I just mentioned above -being questioned about my knowledge and not acting on it if this dude drops me in it- obviously was not enough for me to "drop this guy in it."