Impaired Nurses: Reclaiming Careers

Chuck Lindquist, MA, MDivProgram Director – ISNAP

1-800-638-6623clindquist@indiananurses.org

Continuing Nursing Education Contact Hours

This program has no commercial sponsorship.

The speaker has no conflict of interest.

Attendance for the entire program and completion of the evaluation is required to receive continuing nursing education contact hours.

Impaired Nurses: Reclaiming Careers

Why are nurses at a greater risk? Stated first reason for use? What is Impairment? Addiction? What are signs and symptoms of

impairment? Diversion? Why participate in ISNAP? What is Professional Enabling?

Why A Greater Risk? Accessibility and Availability Knowledge/Optimism = Immunity Care taking philosophy Burnout – Chronic stress – It’s a cumulative

process “One of the most serious consequences of

burnout is a tendency towards substance abuse” (Annals of Int. Medicine, 7/01)

Estimated that 13% - 14% of nurses are affected by a Substance use disorder (SUD)

Stated First Reason for Use

Chronic Pain Chronic Overwork/Fatigue Chronic Stress Depression/Anxiety… For Pleasure

IMPAIRMENT

Generic definition: Nursing behaviors/conduct failing to meet the minimal standards of acceptable and prevailing nursing practice, which could jeopardize the health, safety and welfare of the public.

Impairment can be caused by an RN or LPN who has been affected by the use or abuse of alcohol or other drugs..

Impairment may include but are not limited to the following:

Using unsafe judgment, technical skills or inappropriate interpersonal behaviors in providing nursing care;

Falsifying, omitting or destroying documentation of nursing actions on the patient record/medication log;

Abusing a patient verbally, physically, emotionally or sexually;

Abandoning or knowingly neglecting patients requiring nursing care;

Delegating nursing care, functions, tasks or responsibilities to others when the nurse knows or should know that such delegation is to the detriment of the patient;

Impairment Continued: Diverting prescription drugs for one’s own or

another person’s use; Misappropriating money or property from a

patient, colleague or the facility. Performing any nursing technique or

procedure for which the nurse is unprepared by education or experience;

Disregarding a patient’s dignity, right to privacy and confidentiality;

Failing to provide nursing care because of diagnosis, age, sex, race, color or creed;

What is Addiction?

A nurse is defined as being dependent on alcohol/drugs if he/she reports three or more of the following symptoms: (DSM-IV)

Tolerance Withdrawal Alcohol/drugs used for longer than

intended

What is Addiction (Con’t) Desire &/or unsuccessful effort to cut

down or control use Considerable more time spent obtaining

or using alcohol/drugs or recovering from its effects

Important social, work or recreational activities given up because of use/abuse

Continued use despite knowledge of problems caused or aggravated by use (e.g. DUI, relationship or job problems)

Signs and Symptoms of Impairment Change in personal appearance or work

station (eyes, nose, skin color, perspiration, long sleeves, always fatigued)

Smell of alcohol/MJ on the person (or attempts to cover it up)

Speech affected (slurred, confused, fragmented, slow)

Inability to focus on work – disorientation Missing in Action (frequent trips to bathroom, pkg. lot,

prolonged lunch breaks, Monday a.m. “flu,” unavailable when “on call,” unauthorized absences)

Rapid Mood Swings (belligerent, moody, ecstatic, nervousness, giddy, drowsy, sudden change in energy level)

Signs and Symptoms of Impairment (con’t)

Unusual/unexplained resistance to authority Deviation from Standard Procedures/Refusal

to follow reasonable directions Errors in judgment/practice or in record

keeping Decrease in efficiency and productivity Complaints with personal interactions –

staff and patients (secretive, hostile, isolative, contentious, demanding)

Inaccessibility – unexplained departures from the work area

Signs & Symptoms of Possible Diversion? Consistently signs out more controlled

substances on his/her shift Frequently breaks/alters vials or spills drugs Purposely waits until alone to open narcotic

cabinet Consistently volunteers to be the “narcs”

nurse Disappears into bathroom directly after

handling controlled substances

Possible Signs of Diversion (Con’t)

Incorrect narcotics count at end of shift Failure to obtain co-signatures Discrepancies between a patient’s report… Excessive use of PRN medications Wastes narcotics without a witness “Hangs around” or seen in remote areas… Defensive when questioned about errors

Signs & Symptoms - Employment

Frequent job changes/relocations Vague letters of reference Unexplained time lapse(s) from job

to job Last job not commensurate with

training Unusual medical history – several

trips to the ER…

ISNAP – MISSION STATEMENT

To Protect Lives – and

To Save Careers – by

Monitoring the Process – and Advocating for the Nurse

WHY PARTICIPATE?

Administered by ISNA – a non-state agency – “nurses caring for nurses”

Alternative to disciplinary action Confidentiality Support and Encouragement in

the Rehabilitation Process

Referral Sources

Self Employer/Human Resources/EAP Co-Workers – “obligated to report” Family/friends Attorney General’s Office State Board of Nursing

(Applications/Renewals)

Participation Steps

Intake

Referral for Evaluation/Treatment/Aftercare

Recovery Monitoring Agreement (RMA)

Elements of the RMA

Abstinence Based Program Random Urine Drug Screens (UDS’s) Approval of Employment/Conditions of

Employment Treatment Providers Twelve Step Support Groups – Sponsor Monthly/Quarterly Reports & AA/NA

Logs

Professional Enabling Is an action by which a person intentionally or

unintentionally supports an individual’s continued use of drugs/alcohol by protecting them from the negative consequences of their actions resulting from their use of drugs/alcohol

“The reluctance of fellow professionals to infringe on a colleague’s freedom, as well as their willingness to allow unusual behaviors to flourish because of respect for someone’s professional standing…” (Professionals in Distress, Hospital & Community Psychiatry, 7/98)

Colleagues “enable” by: Minimize the obvious effects of their

behavior by accepting their excuses or believing their “lies”

Make rationalizations for their behaviors – “having a bad day, problems at home”

Performing the impaired nurses’ duties – “picking up the pieces”

Not discussing the work performance issues or behavioral changes

Professional Organizations “enable” by: Fostering unrealistic goals or expectations Believing that addiction can not happen

here Remaining uneducated about the

addictions process Promoting the keeping of “secrets” Disciplining rather than Rehabilitating Acting only when the problem is “too”

obvious

Enabling Results In:

A Delay in Intervention

A Delay in Treatment

A Progression of the Illness

Conclusions Every Organization will see

impairment Often, the last thing to be affected is

the job! Treatment is EFFECTIVE! It’s cost effective to “treat” rather

than “re-train” Do you “CARE ENOUGH to reclaim a

career!