Update on prescribed narcotics....
Shara
14 Posts
Thanks so much for the response on my previous thread regarding the possibly impaired nurse. We received her drug screen, and it came back negative - apparently she has a prescription for everything she is taking. Her supervisor states that she still believes that she is impaired, but more importantly....surprise, surprise, she is a terrible employee. She says that she has received numerous complaints from her peers about her documentation, poor attitude, she has had attendance issues in the past, (attendance is documented). She and our administrative team are insisting that this individual is to be terminated immediately because she is putting patients at risk. The only prior counselings i have on this employee is attendance (addressed in 2007) and a patient complaint issue in 2005.
It was my recommendation that since the UDS came back clean that we send her for a fitness for duty exam to determine if she is taking too much of this prescription to be working, or to determine if she has other issues that may prevent her from taking care of patients - she told me that she will be seeing a neurologist, because she thinks she's falling because of a neurological problem that she has. She insisted to me that she does not take the narcotic at work.
I explained to the director and administration If she has other issues, such as poor charting and poor job performance, we've got to document those issues before we move toward termination. I asked why we hadn't documented all this before, if we've had these issues, but administration states it does not matter, that this is a patient safety issue and by no means are they going to allow this individual to come back to work, and that we should not keep this employee and waste time documenting these problems when a patient could be harmed by her.
Basically....I'm hoping for some input. I feel as though I have said everything that I can at this point, and made recommendations that I thought were appropriate. I'm not trying to be overly conservative, and I certainly don't wish to put our patients at risk - the lack of documentation concerns me right now, as does the fact that we have basically ended the process that we began when we thought this was due to an impairment.
Thank you!!
Original Thread:
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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?
It was my recommendation that since the UDS came back clean that we send her for a fitness for duty exam to determine if she is taking too much of this prescription to be working, or to determine if she has other issues that may prevent her from taking care of patients - she told me that she will be seeing a neurologist, because she thinks she's falling because of a neurological problem that she has. She insisted to me that she does not take the narcotic at work.
I explained to the director and administration If she has other issues, such as poor charting and poor job performance, we've got to document those issues before we move toward termination. I asked why we hadn't documented all this before, if we've had these issues, but administration states it does not matter, that this is a patient safety issue and by no means are they going to allow this individual to come back to work, and that we should not keep this employee and waste time documenting these problems when a patient could be harmed by her.
Basically....I'm hoping for some input. I feel as though I have said everything that I can at this point, and made recommendations that I thought were appropriate. I'm not trying to be overly conservative, and I certainly don't wish to put our patients at risk - the lack of documentation concerns me right now, as does the fact that we have basically ended the process that we began when we thought this was due to an impairment.
Thank you!!
Original Thread:
_____________________________________________
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?
Comments
I, for one, can say that I've "been there & done that" myself. It is not a pleasant situation. My suggestion in situations like this is that you still have a role to play for your organization and that is to help minimize whatever risk is not introduced. Assess quickly how your company may be targeted--unemployment, workers' comp, wrongful termination--and work to get some documents in place. If you are faced with an unemployment claim, you will probably pay (at least we would in Florida). If there is a history of workers' comp claims, diligently work to get something in place (recorded notes of meetings & dialog with supervisory staff) to point a discharge away from the workers' comp history. Likewise for the wrongful termination. Sometimes in HR the best you can do is work really hard to help cover the mistakes of others whether you like doing so or not. Keep yourself focused on your organization and your responsibility to "minimize" risk. You can't eliminate risk completely, and you can't always get others in your organization to buy into your suggestions.
From their point of view, a patient safety issue is very serious also and has the potential to effect licensing. My experience with folks who oversee licensed healthcare facilities is that they are prone to serious tunnel vision. They have a tendency to see only what affects their facility license, which often include regulations that explicitly detail the do's and dont's. Labor law issues have a tendency to be a little more vague, thus harder to see, and rarely subject to annual inspections/surveys that are conducted by healthcare licensing agencies.
My sympathy is with you!
best wishes.
Although this may be an FMLA or ADA-qualifying condition, you do not have to continue the employment of someone who poses a health or safety risk to herself or others. Of course, how that plays out will depend on the specifics of what you discover in the fitness for duty exam.