Jump to content

work while on narcotics?

Specializes in ob high risk, labor and delivery, postp.

i injured my back at work two years ago, so have the usual (it seems) hassles with worker's compensation delaying my treatments and trying not to pay me. I've all ready been to court twice to fight for my benefits and won both times (thank goodness). I will probably be there again soon because they are sending me for another IME (independent medical exam) this week. That is actually an exam where a doctor employed by the insurance company does a cursory exam then says whatever it is the insurance company wants him to say. My lawyer says that they generally keep tormenting people until they give up or settle the case. Unfortunately all this is costing me part of my decreased income, plus adding to the stress.

Anyway..that's not my point.

I'd like to hear from nurses who have chronic pain. I've pretty much done everything I can to get better and its just not going to happen. The next step is starting on a long acting morphine to at least control my pain. I will still need to be "light duty" at work although for me this means I usually have a normal assignment and just have to get people to help with anything I can't handle. Its hard because sometimes I feel like I'm put in unsafe situations when a delay (like waiting for help to come) can result in a worse outcome for the patient. I'm trying to deal with this, too. My pain management doc is keeping me off work at present while he tries to adjust my medication to keep me comfortable but lucid. I checked all ready with my state board of nursing and they don't have any rules prohibiting my working. Neither does my hospital.

They are both vague though..kind of putting everything back on me..while the board "does not take a position BEFORE any given situation..each nurse needs to take responsibility for their own practice and make the decision to not work if impaired". This was pretty much the answer I got. In other words, CATCH 22! Once they clear me to work, I really won't have a choice, since I need the money. I just wonder, other than obviously being mentally vague, will I know? That's kind of like intoxicated people feeling like they're fine to drive because their judgement is impaired isn't it? Certainly I will do everything I can to make sure I am not impaired and work..for my safety as well as my patients well being. I question, though, what if I make a mistake, will it be automatically blamed on my being on medication and used against me? I don't want to lose my license certainly.

I'd just like to hear from anyone who has been in this situation, how you handled it, or anyone who know anything about this. Please include what state you're from, since that might make a difference. Thanks!

moonchild20002000

Specializes in OB/GYN,L&D,FP office,LTC.

You may want to check with your state BON. I know in my state you may not

work while taking narcotics.

woody62, RN

Specializes in icu, er, transplant, case management, ps.

Each BON has its own rules about working or driving while under the influence of narcotics. Most will not allow you to work or drive under the influence. That being said, there are those who work and drive while taking narcotics, without ever haing a problem. I have never taken a narcotic and driven. I have never taken a narcotic and worked. And I have worked and driven in severe pain. You have to check with your own BON and make up your own mind.

Woody:balloons:

Hoozdo, ADN

Specializes in ICU, Research, Corrections.

I was recently injured on the job - herniated 3 cervical discs in a bad fall. I recently had an appt with a pain management Dr and addressed this issue. The official stance in my state is that it is between me and my employer. The doc told me he has airline pilots, doctors, and nurses in opiate therapy for severe, unrelenting pain. I found the airline pilot to be quite surpising. I still have weeks of recovery and probably cervical disc fusion in my future and I am hoping that will solve my pain. I may have to make this choice in the next few months. I do have a TENS unit that is pretty effective with my pain - so one of my options would be no narcotics at work and wire myself up with the TENS every shift.

deehaverrn

Specializes in ob high risk, labor and delivery, postp.

i have continued to work despite severe pain, but it is getting harder and harder for me to do so. being in pain also becomes its own distraction. it is difficult to attend to sometimes trivial patient and family's needs when one is in pain. i try to maintain my professionalism and pleasant attitude at least when i am in the public view (crying and 'losing it' only in the locker room and lavatrory). as far as driving goes...i have definitely driven in severe pain the harder thing is that sometimes after working my feet are numb or have "pins and needles" kind of pain which is not conducive to driving. i have told my doctors about these problems but since i am cleared to work, there's not much else i can do. i'm not sure if woody meant to be critical of my decision to finally try to alleviate my pain...its interesting that we all care about helping our patients with pain though. i feel like woody is saying that i should, once again, just endure the pain..? is that it? i just can't take it anymore.

as far as checking with my bon i thought i addressed that in my initial post but i will show you exactly how little my state board was willing to address this problem. i'm sure others in my state have the same difficulty as me. i know that my pain doc has other working nurses on narcotics. the shame is that no one is protecting nurses, certainly not the state board. if they took a definite position saying that working in patient care (at least) was prohibited while on narcotics, then my employer would have to provide me with a suitable replacement employment or allow me to continue on permanent disability. as it is, i don't really have a choice, other than remaining in pain or quitting my job which is not an option. anyway here's what the board said in response to my previous query:

in response to your question, the professional nursing law section 14 (a) states "the board may refuse, suspend or revoke any license in any case where the board shall find that - ... (2) the licensee is unable to practice professional nursing with reasonable skill and safety to patients by reason of mental or physical illness or condition or physiological or psychological dependence upon alcohol, hallucinogenic or narcotic drugs or other drugs which tend to impair judgment or coordination, so long as such dependence shall continue..." this information can be found on the board of nursing website at [color=#003399]www.dos.state.pa.us/nurse.

the board cannot, by law, pre-approve a specific practice. regulations and published policy statements of the board may provide guidance. it is the responsibility of the nurse to practice in accordance with the nurse practice acts and regulations and ascertain whether a practice is acceptable to the professional nurse community and to exercise professional judgment in the treatment of patients. the board's authority to decide whether a nurse has adhered to accepted ethical and quality standards arises only in the context of a disciplinary action.

i guess this means that they won't help me, but if i mess up ...they'll be right there to punish me.

Hoozdo, ADN

Specializes in ICU, Research, Corrections.

I feel your pain.........

Do whatever your doc says to do. Who really cares what others think - they are not the ones in pain. Just because you are a nurse doesn't mean you are immune to pain and should be forced to work with excruciating pain.

I think if it is OK for an airline pilot to command a plane on opiates, then why should a lowly nurse be denied the same courtesy.

The bottom line is - do what you need to do. Examine yourself and your performance critically and make the best decision you can.

Have you ever tried a TENS unit? If you haven't, you owe yourself the experience.

ohmeowzer RN, RN

Specializes in ob/gyn med /surg.

in my state you can't work while on narcotics. i understand the pain you are feeling. i don't think woody was offensive , he was just stating what his BON says and that he has been in severe pain in the past, but he suffered through it. not that you should. it's just what he did.

i understand chronic pain , i have had it for years, i have osteo in my hands and feet, somedays i can barely move my fingers somedays. i am young at 40 , and have kids , and i am a RN . i don't take anything for pain ( except motrin when i have to work) and on my days off i do take a lortab PRN before bed , just because my night pain is bad. you are in my prayers and i hope you can get back to work. maybe you could get a job at a dr office or something not as physical. i work 3 -12 hour shifts i week on a med/surg floor. please keep me updated.

woody62, RN

Specializes in icu, er, transplant, case management, ps.

I am not taking issue with anyone. For an airline pilot to work under the influence of pain medication violates all FAA guidelines. And I wouldn't want to be on his plane. I understand that he may not have any problems but there is no guarantee.

Woody:balloons:

woody62, RN

Specializes in icu, er, transplant, case management, ps.

in my state you can't work while on narcotics. i understand the pain you are feeling. i don't think woody was offensive , he was just stating what his BON says and that he has been in severe pain in the past, but he suffered through it. not that you should. it's just what he did.

i understand chronic pain , i have had it for years, i have osteo in my hands and feet, somedays i can barely move my fingers somedays. i am young at 40 , and have kids , and i am a RN . i don't take anything for pain ( except motrin when i have to work) and on my days off i do take a lortab PRN before bed , just because my night pain is bad. you are in my prayers and i hope you can get back to work. maybe you could get a job at a dr office or something not as physical. i work 3 -12 hour shifts i week on a med/surg floor. please keep me updated.

Sorry but Woody is a she, not a he. But that is OK. I related my experience because I had to work between having a failure of a percutaneous disectomy and waiting for a laminectomy. And since I had to drive up to 1500 miles a week, I didn't dare take any narcotics. I was too afraid of having an accident and being cited with driving under the influence.

BON will not tell you that you can or cannot work while taking narcotics. And some doctors will advise you that it is legal, which they do not know for certain. If you work while taking a narcotic and you have any problems, you can be in a great deal of legal trouble. And the doctor who told you you could work, will no longer be around to support you. Sorry but that is just the way it is. And if you have an accident, a pill bottle is found in your car, you will have to undergo blood test. And you can be charged with driving under the influence. I take narcotics but I never take them and drive. I never take them and drink. And I would never take them and work. No matter how long you have taken them, they still influence you. One wrong choice and it is your license, at best. And a prison sentence or losing a lawsuit at worse.

Woody:balloons:

sharona97, BSN, RN

Specializes in IM/Critical Care/Cardiology.

i injured my back at work two years ago, so have the usual (it seems) hassles with worker's compensation delaying my treatments and trying not to pay me. I've all ready been to court twice to fight for my benefits and won both times (thank goodness). I will probably be there again soon because they are sending me for another IME (independent medical exam) this week. That is actually an exam where a doctor employed by the insurance company does a cursory exam then says whatever it is the insurance company wants him to say. My lawyer says that they generally keep tormenting people until they give up or settle the case. Unfortunately all this is costing me part of my decreased income, plus adding to the stress.

Anyway..that's not my point.

I'd like to hear from nurses who have chronic pain. I've pretty much done everything I can to get better and its just not going to happen. The next step is starting on a long acting morphine to at least control my pain. I will still need to be "light duty" at work although for me this means I usually have a normal assignment and just have to get people to help with anything I can't handle. Its hard because sometimes I feel like I'm put in unsafe situations when a delay (like waiting for help to come) can result in a worse outcome for the patient. I'm trying to deal with this, too. My pain management doc is keeping me off work at present while he tries to adjust my medication to keep me comfortable but lucid. I checked all ready with my state board of nursing and they don't have any rules prohibiting my working. Neither does my hospital.

They are both vague though..kind of putting everything back on me..while the board "does not take a position BEFORE any given situation..each nurse needs to take responsibility for their own practice and make the decision to not work if impaired". This was pretty much the answer I got. In other words, CATCH 22! Once they clear me to work, I really won't have a choice, since I need the money. I just wonder, other than obviously being mentally vague, will I know? That's kind of like intoxicated people feeling like they're fine to drive because their judgement is impaired isn't it? Certainly I will do everything I can to make sure I am not impaired and work..for my safety as well as my patients well being. I question, though, what if I make a mistake, will it be automatically blamed on my being on medication and used against me? I don't want to lose my license certainly.

I'd just like to hear from anyone who has been in this situation, how you handled it, or anyone who know anything about this. Please include what state you're from, since that might make a difference. Thanks!

I'm not sure if I missed this or not, bt is your pain muscular in nature or spine related, bone? I have chronic muscular pain and what I have been successful with is trigger injections. This may not work for the type of injury you have, but thought I'd let you know, as you asked in your post. Best of luck

deehaverrn

Specializes in ob high risk, labor and delivery, postp.

my pain is spinal in nature...degenerative changes, several annular tears, 3 bulging discs, etc...

right now i haven't been back to work since a. i'm still in too much pain following a procedure and b. i feel wiped out from the kadian..both tired ALL the time and nauseated..its kind of like when i was pregant (except that would be impossible considering my back problems)

have an appt with my doc again this week and i'm praying i don't get released for work yet..because i am definitely not ready or competant, but i was sent to work before when i was in way too much pain to do so and just had to do the best i can. as i said i wish i could just be assigned to non patient care activities but that isn't up to me...and once i am cleared to work, i'll have to do so. my workman's comp insurance company is constantly trying to make me go back even when my doctor doesn't want me to..they make me see one of theirs. as it is my boss calls me practically every day to ask if i'm cleared yet...like i'm not out of it and sleeping all day!!! and this is after i all ready have said that i'll (obviously) call when i am released to work.. ARRGh.

sorry. ..long answer for short question

rehab nurse

Specializes in rehab; med/surg; l&d; peds/home care.

Deehaven, we have talked privately, but I have been in your position.

I had many mental tests to prove I was not "impaired" and that reflex time, etc were actually BETTER with my pain controlled, than not. If all I can do is think of my 10/10 pain, how can I care for my patients??? If I am medicated, and not going through a dose change or dose increase, I think you are okay, as long as you have doctor's approval. But, I know in some states, BON's need to come up with the times.

Chronic pain is increasing in this country, as the detrimental effects of pain on a person's body and mind is being discovered. As our country ages, we will see more and more people on long-term opiates for pain control. I know this scares the begeezus out of a lot of people, but those people probably have never felt our pain. My pain is not a simple "I did too much moving furniture this weekend". No, my pain at a 7 level makes me diaphoretic, shaky, unable to think about anything but my back feeling like a dagger is on fire, twisting along my spine and down my legs. It has gotten so bad in the past few months that I can't go to a store without a scooter. I am only 30. It is humiliating. I am scared to think about what will happen to me if I ever end up in a nursing home. I am on a lot of narcotics now, and in 30 years, it will be more. Will I get a nurse or doctor who thinks "Oh, she's on WAY TOO MUCH of this morphine!!! OMG!!! Take her off ALL OF IT and give her Vicodin!!!" or "She's an addict, take her off everything"!!! I would rather die than have that happen.

BON's around this country need to understand CHRONIC pain is different than ACUTE pain. Yes, during an acute injury, when a opiate-naive patient is given morphine, most likely they will be "out of it". If a person has been on morphine for a while, at a stable dose, they are not "out of it". But, many many health care workers and laymen alike don't understand. I wish, more than anything, that all the nay-sayers I am confronted by could feel my pain just by my touching them. Maybe that would change some minds.

I don't know what the answer is. My nurse practice act does not state that you can't work on narcotics. I have seen NPA's that DO state that, however. I know my opinion will be an unpopular one, but I think that nurses who are seen on a monthly basis by a pain management specialist, and who follow their contract with said physician, and are not just starting opiate therapy, or trying a dose change or increase, or a med change, should be able to work with physician clearance. Do the tests or whatever they need to do to see you are not impaired by having your pain controlled, you are impaired by having your pain OUT OF CONTROL. And that's all I have to say about that.

Myxel67

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

I agree totally with rehab nurse. It is much more difficult to drive and/or work while in severe pain than it is to do so with pain control achieved with narcotic analgesics.

Several years ago I had a horrible time with kidney stones. The problem was compounded by a urologist who just would not consider that he did not get all the stones with the lithotripsy. The hospital I worked at would not let me work while taking Percocet. I was out of work almost nine months--I finally went to another urologist who did another lithotripsy and I was back to work in 2 weeks.

Before I became a nurse, If I had pain that was bad enough to require narcotics, I would just take the pill and go to work. If I take OxyContin, Percocet, or hydrocodone, it relieves the pain. I don't get a buzz, or feel out of it. I don't lose the ability to think clearly or do drive. If the dose is appropriate, and you don't drink alcohol with it, a narcotic pain medication should not cause intoxication.

if one is opiate-tolerant, i see no reason why they shouldn't be able to work.

it doesn't cause a "high", but does make them productive and functional.

it's ridiculous to compare one that is opiate-naive to one who is accustomed to taking narcotics.

not even close to comparing apples to apples.

leslie

happybunny1970

Specializes in Acute Hemodialysis, Cardiac, ICU, OR.

i guess this means that they won't help me, but if i mess up ...they'll be right there to punish me.

unfortunately, here i think you are right -- it almost becomes a "don't ask/don't tell" situation (though with it being a wc case, probably everyone around you already knows).

yes, people who are opiate tolerant feel and act like sober people -- not 'high.' but heaven forbid something fishy goes on with your unit narc count and hey decide to drug test everyone... or you make an honest mistake in charting a narc. or even your unit hires a new employee or manager who is just completely against narcotic use for any reason.

you might want to start looking into case management or some other sort of position, which would also help with your light duty requirements. there are plenty of nursing jobs out there where your physical limitations or medication requirements are probably not an issue (school nurse, insurance companies, telephone triage, blood bank, etc., etc.), but where your knowledge and expertise can be of great use.

all it takes is for one person to make an accusation (founded or not) to land you in front of the board. and if that happens, you will not be permitted to work while taking pain medication. due to the drug laws in this country (and the abuses of some), the bon is never going to admit that it's ok for a person to maintain pain control with narcotics and work as a licensed medical practitioner.

i wish there was an easy answer -- clearly you are conscientious and are concerned about this or you would not have posted the question. but you're going to have to determine, from your own experience in your job/coworkers/state bon whether or not you need to change your position.

good luck in your pain control and your career!

Transplant Nurse, BSN, RN

Specializes in ICU, Tissue & Organ Recovery, Surgery.

This is not legal advice, just my personal opinion (If I were in your shoes what I would think about). I wanted to reply to rehab nurse and happybunny1970. Agreed completely with rehab nurse; and as long as the BON does not forbid working while on opiates and you are chronic and tolerant a physician letter from pain mgnt should cover you as they are legally vouching for your ability to perform. Keep in mind any increases in dose or change in dosing would probably warrant a new letter detailing your meds etc. If you were found in error this would hopefully be solid enough to show your competence (could have a lawyer read it to be sure it's good enough).

happybunny1970 I think the worst part of being on narcs while working is feeling like you cant tell anyone. But I felt like I might be suspect #1 if any problems arose. So, I was very forward about it (taking it) and had all wastes witnessed. Also if I was working in a patient room with another nurse (I was not primary nurse for them) for bathing etc, and they needed narcs, I asking the primary nurse to get it from pxyis. I did not want a red flag to be up that I was using more narcs for my pts. Also if you have a MD Rx for opiate and test positive at work, it is covered with the rx. They would probably interview pt about if they got the doses and that would be the biggest reason to suspect you.

Just my opinion. :twocents:

can you give more details of how you injured yourself and exactly what is still wrong with you or what the PM doctor and neuro surgeon have diagnosed you with post op?

Dee, my concern is not the opioids - I think that we as a nation are far too puritanical as regards these useful drugs, and that one can be productive and medicated at the same time - but your back. You WILL worsen your injuries. Can you possibly find a case management or similar gig that doesn't put you back on the floor? For you, and your back, not out of being judgmental.

deehaverrn

Specializes in ob high risk, labor and delivery, postp.

Thanks for all the concern and well wishes. I haven't gone back to work, as my pain is not controlled even with medications. Last time I wrote I was taking Kadian (a kind of long-acting morphine), and experiencing many unpleasant side effects. These ranged from constant nausea and incapacitating constipation, to drowsiness which sometimes meant inability to stay awake. And I still could not do much of anything without being in pain. My Pain management doc finally switched me to the Fentanyl patch..which has been much better. I am still in pain when I do anything other than lie around, but can actually do some light reading and watch television (thank goodness for Tivo because I still fall asleep readily so have to rewind often). About the only other thing I do is family obligations such as occasional dinners at the parents, or one of my kid's activities. Even then I need to supplement with narcotics to get through it.. of course, there are the doctor appointments and worse..the legal proceedings. I think that most of us assume that Worker's Compensation will take care of us if we are injured...what a great fallacy that is. If this is how government regulation works..forget about the health care issues now in Congress! I get 2/3 of my 2004 salary (since that was the year before I was injured), but my lawyer receives 20 % of that ..which is standard in my state. And I needed that lawyer because the insurance company filed to stop my compensation, despite that even their initial doctor agreed with me! I have been to court about six times and so far have always won..but it only takes once for the worker to lose benefits. On the other hand, the insurance company can just keep refiling every six months with a new issue. They generally have paid what they owe as far as medical costs, although if the doctor's office or pharmacy doesn't fill out their forms just right they will not. Also, they have sometimes been behind thousands of dollars in compensation at a time. And keep in mind that the worker never gets any increase in payments regardless of inflation. The strategy for the insurance company is to keep harassing people until they feel it isn't worth continuing, and also offering a pittance as a settlement just to get them to leave you alone. And once they have decided that you have reached "maximum medical improvement", if you arent judged to be over 50% impaired they only have to pay you for a maximum of 500 weeks. (and with a back injury it is pretty much impossible to go over 25%) It doesn't matter that you can't work..they don't really consider that in their formula. In fact, they don't consider many things..like inability to sleep, or focus, or medication side effects... Anyway, more workers should be aware of this stuff. I know that I would have refused to do a lot of things.

As far as my injury ..I just was pushed backwards when a stretcher bumped my leg...with immediate sharp severe pain in my back. My MRIs show many things wrong with my back...multiple bulging discs, degeneration, annular tears, pretty much a result of the daily stress which was put on my back in my nursing career. ..and make no mistake..I was told by a physical therapist years earlier..when I had strained my back..that I had great body mechanics! This is a complete fallacy that they tell you..that being strong and fit and using good body mechanics will prevent back injury..it won't! 120 lb women are just not meant to be lifting and turning 200 plus lbs! Since I worked in a delivery room, I often lifted and pulled women of all sizes, not to mention all the bending ..and since my hospital had antiquated beds and stretchers it was even worse. :angryfire

Since I can't even tolerate sitting at the computer for an hour, it is impossible to even consider getting employment..although of course the insurance company doesn't agree. They are now claiming that I can return to work..although at a light or sedentary job. I guess that I should be happy that they are finally conceding something..but it is still too much. And guess what...to reduce my payments, they only have to convince the govt. that their doctor is correct in my being able to work a sedentary job, and that there are jobs that I can do. They don't even have to show a job being offered to me. Its hard to believe in this economy. Like any employer would chose to me rather than someone without issues! Anyway...I'm in way too much pain to come back to this again tonight!

Thanks for caring!:heartbeat

pooh54

Specializes in Level 2 and 3 NICU, outpt peds.

Deehaven, we have talked privately, but I have been in your position.

I had many mental tests to prove I was not "impaired" and that reflex time, etc were actually BETTER with my pain controlled, than not. If all I can do is think of my 10/10 pain, how can I care for my patients??? If I am medicated, and not going through a dose change or dose increase, I think you are okay, as long as you have doctor's approval. But, I know in some states, BON's need to come up with the times.

Chronic pain is increasing in this country, as the detrimental effects of pain on a person's body and mind is being discovered. As our country ages, we will see more and more people on long-term opiates for pain control. I know this scares the begeezus out of a lot of people, but those people probably have never felt our pain. My pain is not a simple "I did too much moving furniture this weekend". No, my pain at a 7 level makes me diaphoretic, shaky, unable to think about anything but my back feeling like a dagger is on fire, twisting along my spine and down my legs. It has gotten so bad in the past few months that I can't go to a store without a scooter. I am only 30. It is humiliating. I am scared to think about what will happen to me if I ever end up in a nursing home. I am on a lot of narcotics now, and in 30 years, it will be more. Will I get a nurse or doctor who thinks "Oh, she's on WAY TOO MUCH of this morphine!!! OMG!!! Take her off ALL OF IT and give her Vicodin!!!" or "She's an addict, take her off everything"!!! I would rather die than have that happen.

BON's around this country need to understand CHRONIC pain is different than ACUTE pain. Yes, during an acute injury, when a opiate-naive patient is given morphine, most likely they will be "out of it". If a person has been on morphine for a while, at a stable dose, they are not "out of it". But, many many health care workers and laymen alike don't understand. I wish, more than anything, that all the nay-sayers I am confronted by could feel my pain just by my touching them. Maybe that would change some minds.

I don't know what the answer is. My nurse practice act does not state that you can't work on narcotics. I have seen NPA's that DO state that, however. I know my opinion will be an unpopular one, but I think that nurses who are seen on a monthly basis by a pain management specialist, and who follow their contract with said physician, and are not just starting opiate therapy, or trying a dose change or increase, or a med change, should be able to work with physician clearance. Do the tests or whatever they need to do to see you are not impaired by having your pain controlled, you are impaired by having your pain OUT OF CONTROL. And that's all I have to say about that.

Sorry for the long quote> Here in Virginia, it is not against the law or nurse practice act to work while on opiates for chronic pain, that this is an issue between the nurse and her employer. While I find this gratifying (in some weird sense), it doesn't address reality in that no one will employ you on the meds and/or disability, I am frightened that while working in an acute care area, I will make a mistake that will harm a patient. I decided to take myself out of the field when the pain became impossible to control. I wouldn't take any meds for at least 8 hrs before beginning a shift or during the shift. I spoke to my nurse manager about my concerns and got ZERO support:o Not very surprising since I have found that we are the least supportive of all the medical professions for disabilities, both mental and physical. Again sorry, I have no answers (still trying to find something I can do) other than make sure you are NOT disabled or malfunctioning in any sense while on the meds, you will be left to hang on your own!:o:o:o:o:o:o

Guest
This topic is now closed to further replies.
×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK