Working with the Impaired Nurse

Sharon S. Parkersparker@capital.eduONA convention, 2015

Substance abuse is not a disease of choice

Continuous use actually causes changes in the brain

More then half of those with a SA disorder have another co-occurring disease of the brain.

The Disease of Substance Use Disorder

“impaired” is a questionable term since most nurses are high functioning and high achieving

PrimaryChronicDysfunction of the brainTreatable

Rise of prescription misuse has caused most concern recently

AbuseDependencyAddiction Negative aspects of SA affect the

nurse, patients, familiesANA estimates that 6-8% of

nurses misuse drugsRecent studies say 10-15%

Substance Use Disorder

Medical disorder where a person has a compulsion to take a drug/alcohol in order to experience the effects.

Chemical Dependency

Medical disorder marked by compulsive use of drugs/alcohol

Inability to stop using no matter what the consequences

Neurological changes

Addiction

The phenomena of needing more and more of a substance of abuse in order to get the same effect

Tolerance

DepressionLow self-esteemLow tolerance for stressFeelings of resentmentAccess or availability of drugsGenetic predisposition

Predisposing factors

Family traumaPhysical, mental abuse or dysfunction of family

PTSD

AlcoholOpioidsStimulantsMarijuana Rise of prescription misuse has

caused most concern recently

Drugs of Abuse

Substance use is seen as acceptableFaith in drugs to promote healingSense of entitlement “special” status of health care providers makes them invulnerable to illness that patients get

Problematic attitudes

Self-diagnosisNeed to continue workingNot taking care of self

AccessAttitudeStressLack of education

Top 4 Risk Factors

Differentiate between impairment and stress-related behavior

Escalating behavior

Identification of a Substance Use Disorder

Impaired cognitive functioning and memory

Altered motor skillsDifficulty making decisions Inability to copy with stressful situations

Escalating Impairment Behavior

Slurred speech Lack of coordinationFrequent tardiness or poorly

explained absencesSmell of alcohol on breath Impaired memory—”blackouts”

Signs and symptoms

Sloppy chartingAttireGeographic cure soughtDiversion of patient drugs for own use

Job performance

Excessive use of sick timeCalling in sick on MondaysUnexplained absences from the unit

Consistently volunteering to be the medication nurse

Job Related Behavior

Patients need more narcoticsDiscrepancies Opioid countOrdering for patients that have been discharged or died

More “spills” than others

Emergency room nurses ICU, ER, ORPsychiatric nursesNurse anesthetists Night nurses

Rates of Abuse among Specialties

Women more likely to abuse prescription drugs

Males more likely to abuse illegal drugs and alcohol

Oncology nurses more inclined to drink alcohol

Gender

Developing a culture of transparency and support

Nurse managers being aware of own stereotypes and misconceptions about “drug users”

Examining the code of silence among colleagues

What helps?

A cluster of behaviors that allow the person with a substance abuse problem to keep usingFamily membersColleagues

Co-dependence

Being proactiveScreening Regular monitoringGuidelinesReferral to treatment

What to do?

Have basic understanding of SA as a disease

Know common indicators of unsafe practice

Know workplace policies and procedures

Know in-house resources

Accountability of Administration

Recognize personal valuesKnow in-house resourcesDocumentFeel capable of coordinating nurses re-entry at work

Recognize signs of relapse

Planned meeting with nurse and family, colleagues to break through the pattern of denial

intervention

Alternative ProgramMonitoring Return to work guidelines

Board of Nursing

Legally?Morally?Ethically?

Obligations to colleagues

Substance Use Disorder Nursing: a Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs

National Council of State Boards of Nursing

Reference