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Transcript of Impaired Nursing
Jennifer Miller What is an impaired nurse? ANA Code of Ethics
Provision #3 The Statistics What is the impact for nursing? According to the ANA, an impaired nurse is someone who is unable to meet the requirements of the code of ethics and standards of practice of the profession and who has cognitive, interpersonal or psychomotor skills affected by psychiatric illness, and/or drug or alcohol abuse or addiction. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. Approximately 6% of nurses practice while impaired The present treatment... Impaired Nursing “In a situation where a nurse suspects another’s practice may be impaired, the nurse’s duty is to take action designed both to protect patients and to assure that the impaired individual receives assistance in regaining optimal function.” “Nurses in all roles should advocate for colleagues whose job performance may be impaired to assure that they receive appropriate assistance, treatment and access to fair institutional and legal processes. This includes supporting the return to practice of the individual who has sought assistance and is ready to resume professional duties.” (American Nurses Association, 2011) Approximately 10% of nurses suffer from substance abuse No higher than in the general population
(10%) Emergency and critical care nurses 3.5x more likely to use cocaine or marijuana than other specialties Oncology nurses are 42% more likely to engage in binge drinking than other specialties Psychiatry nurses are more likely to smoke cigarettes than other professions Pediatrics, general medicine and women’s health have the lowest substance use rates (American Nurses Association, 2011) 2.5 million nurses employed in US. Why do nurses abuse? Role strain
Problems of daily living
Enabling by peers and managers
Attitudes towards drugs and drug use
Lack of education regarding a substance use disorder
Lack of controls
Physician prescribing practices Access
Lack of education Four biggest factors: - National Council of State Boards of Nursing (2011) - National Council of State Boards of Nursing (2011) -M.J. Willis, 2007 - Trinkoff & Storr, 1998 10% of CRNAs reported abuse of the controlled drugs used in their practice What to look for... • Volunteering to administer medications for other nurses
• Pt reports no pain relief, but records show documentation of getting their prn medications
• Frequent reports of lost or wasted medication
• Requesting to work in an area of high pain med administration
• Tampered medications such as torn packets, missing vial tops, puncture holes, and uneven fluid levels
• Blood spots on clothing if injecting at work Physical signs... Diarrhea Nausea Irritability or Restlessness Can also be signs of psychological problems so need to assess the situation and context Hand tremors •Headache Diaphoresis Abdominal/muscle cramps •Patient mistreatment, including incorrect basic care, medication errors, and abuse. •Nurses can lose their job and even their entire career depending on the damage drug abuse has created in their life. •Ultimately, the biggest issue is patient safety! •Patient death. •Higher hospital or clinic costs associated with legalities of patient mistreatment, stolen drugs, lost wages, training, and re-hiring. •Nurses may lose time due to treatment, thus receive lower wages. •Short and long-term emotional costs cannot be easily estimated, but are likely high for nurses, patients, peers of nurses abusing, and everyone else that a care provider’s substance abuse touches. Past treatment of impaired nurses based on the theory of deterrence that is based on the idea that fear of the consequences will deter a person to act
Loss of employment
Loss of license
State Board posts name and reason license is lost
Name added to national data bank and insurance companies have access to this national data bank
Loss of professional liability insurance
Loss of health insurance
Public media - name mentioned on the news, in the newspapers, and other forms of public media (Monroe, Pearson, & Kenaga, 2009; Monroe & Kenaga, 2011) "Cindy Loo Whoo, license no. RN123456, of Whoville, was indefinitely suspended for no less than three years, with such suspension stayed immediately in favor of no less than three years probation, subject to the Board's terms and conditions, because she is unable to practice the profession with reasonable skill and safety to patients by reason of mental or physical illness or condition or physiological or psychological dependence upon alcohol, hallucinogenic or narcotic drugs or other drugs which tend to impair judgment or coordination." Santa Claus, license no. RN678912 of the North Pole, was immediately temporarily actively suspended for no more than 180 days because he is unable to practice nursing with reasonable skill and safety to patients by reason of dependence on drugs and presents a clear and immediate danger to the public health and safety. In the late 80s, the American Medical Association declared all forms of substance abuse to be considered a disease, yet as of 2009 50% of hospitals still fire impaired nurses
We are still being treated as if addiction is a moral or ethical choice In their review of past treatment of impaired nurses, Monroe and Kenaga found a study reporting the odds of a nurse not reporting a co-worker for suspected substance abuse while at work were 5 to 1 Alternative-to-discipline (ATD) programs i) 1990s all 50 states had an ATD program for physicians, but as of 2009 only 43 states have ATD programs for nurses
ii) Entails treatment, recovery, reentry or transition out to another profession, confidentiality, aftercare, and monitoring
iii) Those nurses who cannot or will not be rehabilitated can still be disciplined by their respective State Board of Nursing
Punishment system can take up to years to work leaving impaired nurses opportunities to harm or even end patients’ lives
ATD programs can take as little as a few days to get nurses into treatment and off hospital floors The bottom line... (Monroe, Pearson, & Kenaga, 2009; Monroe & Kenaga, 2011) Another option... Why don't nurse's report? Worst you can do is nothing!!! friendship
fear of jeopardizing their colleague’s nursing license Questions? American Nurses Association, 2011 Hrobak, M. L., (n.d.) Hrobak, M. L., (n.d.) Drug Abuse Among Nurses. (n.d.). Heacock, S. (n.d.) (Monroe, Pearson, & Kenaga, 2009; Monroe & Kenaga, 2011)