Addiction is impacting an ever-increasing number of nurses across the country. It is important to understand the ways in which you can spot addiction in a coworker, and how it can be addressed. It is important for nurse managers to talk openly and educate fellow nurses on how to identify a chemically impaired co-worker. The National Council of State Boards of Nursing states. That behavioral changes can include changes or shifts in job performance. Absences from the unit for extended periods, frequent trips to the bathroom, arriving late or leaving early, and making an excessive number of mistakes, including medication errors.(XXXX).Additional indicators of diversion may include irritability, nervousness, and pupil changes.
Unfortunately, many nurses struggling with addiction are often unidentified and continue to practice. The dangers of practicing under the influence of drugs and alcohol are too numerous to count. Those dangers include medication errors, poor patient care, decreased work performance, and an inability to provide safe and appropriate care. Additionally, impairment may result in harm to a nurse’s personal health. This could lead to hypertension, liver disease, cardiovascular disease, mental illness, or overdoses, eventually resulting in death.
The decision to address a nurse demonstrating the symptoms of chemical impairment is one which every nurse manager hopes he or she may never have to make, but one which may save many lives. It is imperative that every leader in the healthcare industry is prepared to confront impairment when necessary, even if – perhaps especially if – the leader has a close relationship to the colleague demonstrating possible impairment. Many nurses are afraid to report impairment for fear of retaliation, whether tangible or intangible, in their personal or professional lives.
There are many good ways to address signs of impairment in a colleague. Most importantly, any signs of impairment should be reported immediately. The most appropriate way to do this is to adhere to the standard chain of command in the hospital. A nurse should report to the charge nurse, and a charge nurse should report upward to the nurse manager. When reporting, each witness to the alleged wrongdoing or impairment must be sure to offer thorough and proper documentation of key observations. The best way to document is through clear, concise, and objective data, always including the “5 W’s” of the situation (Who, What, When, Where, Why).
There should be clearly established expectations in a unit for what the consequences are for nursing while impaired. It is also very important for the consequences for any infractions to be consistently applied to all members of the team. Nurse managers have an obligation to provide education to their nurses on a variety of subjects, including but not limited to: the negative effects of illegal substances, how to ask for and receive help for a self-identified substance abuse problem, and how to report suspected substance abuse.
Nurse managers must strive to be approachable to all members of the nursing team. An effective way to do this is to adopt and advertise an “open door policy.” This allows all members of the team to have access to the leader and seeks to foster open communication between all members of the team.
The rules laid out by the Oklahoma Board of Nursing are clear. The Oklahoma Nurse Practice Act states that, “The Board shall impose a disciplinary action against the person pursuant to the provisions of subsection A of this section upon proof that the person:
Is intemperate in the use of alcohol or drugs, which use the Board determines endangers or could endanger patients; Has been adjudicated as mentally incompetent, mentally ill, chemically dependent or dangerous to the public or has been committed by a court of competent jurisdiction, within or without this state; Is guilty of unprofessional conduct as defined in the rules of the Board; Is guilty of any act that jeopardizes a patient’s life, health or safety as defined in the rules of the Board..”(Oklahoma Nurse Practice Act, ) After a report is filed, then the investigation will begin. If the nurse is in fact, found guilty the state board will address proper corrective action. Health care facilities adopt alternative-to-discipline approaches to treating nurses with substance use disorders, with stated goals of retention, rehabilitation, and re-entry into safe, professional practice.
The goal of treatment is that the nurse will complete the program, recover and enter back into the workplace safely. The Oklahoma Board of Nursing offers a peer assistance program to safeguard the public. This program is voluntary and used as alternative disciple for nurses who abuse drugs and/or alcohol. The program provides structured monitoring of the nurse so that treatment and return to the workplace is the priority.
In addition, OBN states that, “The corrective action may include remedial education, an administrative penalty, or any combination of remedial education and an administrative penalty. The corrective action shall not be considered as disciplinary action. However, the Board may consider a corrective action in an individual’s subsequent violation of the Oklahoma Nursing Practice Act, Board rule or corrective action order.
There is hereby established a peer assistance program to rehabilitate nurses whose competency may be compromised because of the abuse of drugs or alcohol, so that such nurses can be treated and can return to or continue the practice of nursing in a manner which will benefit the public. The program shall be under the supervision and control of the Oklahoma Board of Nursing.” (OBN XXX) If a disciplinary process is initiated, and no settlement occurs between the nurse and the board, a formal hearing may be the next step.
However formal hearings are long and expensive. A final determination on the allegations can take months to reach due to the unavailability of witnesses, burdens of proof (preponderance of the evidence), and difficulty scheduling a hearing. For all these reasons and more, a negotiated consent order or settlement agreement is a better alternative in many instances. What will change in my practice of nursing because of this knowledge.