Expert: Jeanne Rust, PhD - 12/2/2011

Question
I am a nursing student, in the 3rd year of my BScN degree.  A member of my cohort just found out today that she has failed her practicum placement because she was taking ativan while working.

While in our practice settings, we are occasionally watched and evaluated (on a pass/fail basis) while performing a psychomotor skill.  Due to an experience in a previous practicum placement (I don't know the details) this evaluation process has become a significant trigger for my friend's anxiety.  She has spoken with her doctor who has set her up with counselling, but has also prescribed ativan PRN as a temporary measure while she is working through the issue with her counselor.

On three separate occasions she was informed she would be going through an evaluation process, took *0.25mg* of ativan (half her prescribed dose of 0.5mg), and received a "pass".  However, when our instructor found out she'd been taking ativan, she informed her she would not be allowed to take it for the next skills evaluation.  Due to this requirement, she was even more anxious performing the next skill and received a fail.  This is the basis on which she has been told she's failed her placement and will not be allowed to move forward in the program.

Personally, I suffer from migraines and have on several occasions taken codeine (tylenol #3s) in order to be able to function in my practice setting.  Our instructor is aware of this but has absolutely no problem with it (she is, in fact, very sympathetic with me).  Am I wrong to be drawing fairly direct parallels here?  It seems quite unfair that I am allowed to take medication to get control of my medical condition (which would otherwise certainly prevent me from functioning well) while she is failed for taking hers.

I am acting as her student advocate and as such have been sitting in on her meetings with administration.  When I asked if they were allowed to fail her for taking a legally prescribed medication, the associated chair went stone-faced and responded (to me) "I don't think you understand the seriousness of this; I certainly wouldn't want *my* nurse to be caring for me while taking sedatives".  Honestly, I wouldn't consider my friend to be impaired after taking 0.25mg of ativan.

Would you say that someone with an anxiety disorder is fit to practice in a hospital setting under the influence of 0.25mg of ativan (particularly when she has been deemed competent by the instructor while under its influence)?

Further, is our college's school of nursing allowed to fail her for not being able to pass an evaluation without taking a medication that's been legally prescribed for the purpose?

Thanks in advance for your time and consideration.

Answer
Dear Ev,

I think this differentiation is because of the type of drug Ativan is.  It is a barbituate.  It not only relaxes people but also can take the edge off of decision making ability and judgement.

Your friend can just as easily take another type of medication such as bus par or Paxil, etc.  these medications are in a different category and should not be objected to by the associated chair.  I agree with her in that I wouldn't want anyone to work on me ho had taken Ativan.  Different dosages have different effects.

Please let me know how this all comes out!

Jeanne Rust, PhD
Mirasol
www.mirasol.net