Prescribed Narcotics

Shara

We have a nurse at our facility who has had several falls within the last year. Each time she falls there is no attributing reason - for instance, the floor is not wet, there is nothing in the hall to trip over, etc. It is our policy to perform a urine drug screen each time an employee sustains an injury. We have done so each time, and each time a controlled substance has appeared on the drug screen, but she has prescriptions for those medications. After this last fall, her supervisor stated that she believes that this employee is impaired due to the type of prescriptions that she is taking. As a patient-care provider, this is an important issue. Our drug and alcohol policy states the following:

"Reporting to or being at work with a measurable quantity of prescribed narcotics in blood or urine or use of prescribed narcotics is also prohibited, where in the opinion of the facility such use prevents the employee from performing the duties of his or her job or poses a risk to the safety of the employee, other persons or property."

Our administration wants to terminate this employee. Of course, I am concerned on many levels...that it will appear to be retaliation for multiple worker's comp claims, this prescription medication showed up in the UDS before and we did not take action then, and there's also the matter of FMLA. Of course, I'm also very concerned that she should not be taking this type of medication and taking care of patients. What suggestions do you guru's have?

stilldazed

I don't think I would move to termination, but I would address the fitness for duty aspect of being a healthcare provider. You didn't mention whether the nurse is LPN or RN, not that it matters much, but licensed nurses have a duty (to their license) to refrain from practicing while impaired. For any nurse who will not refrain, co-nurses in the same work environment who observe what appears to be an impaired nurse have a duty to report also.

I think you have plenty of evidence with the positive drug screens, documentation that the substance is prescribed, and some level of potential impairment (repetitive falls), to take some action. You could probably suspend the nurse until you get a fitness for duty certificate and base the suspension on your evidence, and explain that you will have a duty to report to the nurse licensing board if the nurse does not self report.

best wishes.

Rockie

I also work in healthcare and we drug test as well. If someone tests positive for a controlled substance and they have a proper prescription,that's one thing. However, someone in a patient care capacity cannot perform the essential functions of their position if they are under the influence of a controlled substance. It does not matter if this substance is prescribed or not.

What I have done in the past when I have these issues is to put the employee on leave and start the interactive process via ADA. I send the physician a copy of the position description and our substance abuse policy and ask if the employee can perform the essential functions of the position with or without accomodations. If the physician says they can, (and some do!), we will allow the employee to come back under supervision. If they still appear impaired, we will not allow them to render patient care and will put them back on leave.

I had a nurse working for us that was in charge of drawing blood and adjusting Coumadin dosages. You can kill someone if this is adjusted incorrectly. Observing that she was impaired, she was immediately taken off this duty and put on clerical type work. Her physician (family practice) stated she was perfectly fine, but we did not feel comfortable with her doing this type work. She finally came to the conclusion herself that she could not perform patient care competently and felt she may be putting patients in danger. She resigned voluntarily.