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Any nurse may find themselves asked by their employer to provide a drug test. Urine drug tests may be requested for suspicions of drug diversion, substance abuse, or simply because the pyxis drug count is not correct. The question arises for many nurses: “Should I provide the sample.” The answer is yes, though providing a sample does not necessarily protect the nurse from being reported to the Board of Nursing, even if the results are negative. It is a double-edged sword.

If the nurse refuses a drug test, it is assumed to be positive, though this is never documented by the Board. The nurse is considered to have been hiding something. The negative urine drug test becomes mute if the employer reports to the Board of Nursing. The Board of Nursing will rationalize that the Nurse may have been diverting to provide drugs for someone else or may have been selling diverted drugs. I once had a Board of Nursing attorney proudly tell me that she did not need a positive drug test to prosecute a diversion charge successfully. She stated all she needed was eyewitness testimony that the nurse was not: “acting right" and that she was "staggering or slurring her words.” I told her that after 14 hours in a trauma resuscitation room, clothed in heavy radiation protection lead, with the thermostat set at 95 degrees, caring for multi-trauma adult and pediatric patients, one after another, and having no time to eat, I have no doubt I often staggered and slurred my words. I further told her that I have no doubt that on more than one occasion, I gave a jumbled report after a night from hell and was acting strange. Hypoglycemia, gross dehydration, and profound fatigue will do that to you. She did not answer me. I have no doubt she understood my point.

If the nurse knows they will produce a sample positive for substances they do not have a prescription for, then it might be best to refuse to produce the sample and self-report to the Board. The nurse will be assumed to be positive and should tell the Board what substances they are abusing. It is always better to fall on the sword and take responsibility. It is better to ask for help than to deny needing help. There is no way to get out of having illicit drugs or controlled substances in one's system at work that are not prescribed. The Board will charge the nurse with at least substance abuse, if not a diversion. They are likely to order a three to five-year program where the nurse will have imposed very strict stipulations that essentially control their lives.

The nurse will be required to submit to a psychological assessment that includes the Minnesota Multiphasic Personality Inventory, which looks for personality disorders, addiction, depression, and anxiety and has a veracity scale. They, of course, will not be permitted to consume alcohol or any controlled substance, no illicit drugs; and must produce regular and random drugs of abuse samples, attend regular addiction counseling meetings, attend therapy, attend group therapy, and in most programs a whole host of other expectations that are costly to the nurse. Some states expect nurses to pay for initial inpatient rehabilitation at a considerable cost to the nurse. Nurses who are unable to attend or comply with all requirements because of the costs will have their licenses suspended until they can comply. It is a money-making industry that started with Physicians and has now spread to nursing. Nurses find themselves referred to these programs for such mental health diagnoses as stable anxiety or depression that were self-reported because when they went to renew their license and the question was asked.

In summary, it is always best to comply with a request to produce a drug toxicology test unless the nurse knows they are positive for substances that they do not have a current prescription for. If they do refuse, the Board of Nursing can still assume that they were positive. If the nurse is sent to a screening for substance abuse and a neuropsychiatric assessment, they will again be asked to provide a drug test sample. If you refuse again, their active license will, more likely than not, be immediately suspended. Any refusal or non-compliance with the substance abuse program or Board Orders will also result in immediate suspension.

If you are struggling with substance abuse, you must understand that you are not safe contributing to patient care in any manner. You are unsafe and cannot practice according to the standard of care because you are altered when under the influence, even if you do not feel so. You must self-report and get the help you need. The bottom line is that the only way to protect yourself from this mess is never to consume illicit or controlled substances that you are not prescribed. Please don't do it. You never know when the count may be wrong, and you were the last person in the Pyxis to take a pill from that particular drawer. Or you noticed there was a discrepancy, and you never reported it immediately to the charge nurse and Director and Pharmacy. The dance between Nursing Boards is laden with pitfalls that can jeopardize the nurse's career and cause more heartache than one can imagine. In our rapidly evolving healthcare landscape, where nurses are on the front lines, constantly working, understaffed, and not treated as of value, it is imperative to provide unimpeachable care that maintains the standard of care. No matter how tempting, diverting from this path puts your license at risk and your entire livelihood and, therefore, your family at risk. With the stakes so high, the line of action is clear: Maintain an unwavering commitment to professional ethics and standards. By doing so, you arm yourself with the best protection and defense against a claim of substance abuse or diversion by your employer or Board of Nursing, though, as explained, the Board of Nursing still finds a way to label the nurse with such a label not supported by the evidence.


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