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A Growing Problem: Impaired Nurses in Practice

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Angela Vitek

on 11 December 2014

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Transcript of A Growing Problem: Impaired Nurses in Practice

Proposed Study
Explore hospital policies
Recognize strategies to implement evidence-based practice on recovery for impaired nurses
Assess nurses' current knowledge of signs of impairment

Questions &
Policies and Procedures
The ANA's Role
Random Drug Testing Policy 1994
Disciplinary Policies vs. Alternative-to-Discipline Policies
Track 1: Non-Board Referral:
A Growing Problem:
Impaired Nurses in Practice

Idaho's Policy
"One essential element of safe nursing practice is a nurse's functional ability: the competence and reliability with which a nurse is able to practice at any given time" (Position on Safety to Practice, 2005).
Nurse Re-Entry
Signed contracts which
specify the evaluation and treatment requirements, drug screening requirements, work-site
limitations, notification and practice monitoring and compliance reporting
Research Questions
Identifying an Impaired Nurse
What are the best evidence based practice policies and procedures to manage impaired nurses and maintain patient safety?
What resources are currently in place at hospitals to counsel impaired nurses?
How can nursing and healthcare leaders best protect patients from impaired practitioners?
Texas' Policy
A Presentation By:
Jesse Acheson, Amy Carlin, Angela Hobdey, Mandi Kendig & Lawrence Petersen
American Nurses Association (1994). Drug testing for healthcare workers. Retrieved April 19, 2014, from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Drug-Testing-for-Health-Care-Workers.html
American Nurse Today, retrieved April 20, 2013chttp://www.medscape.com/viewarticle/748598_6'3e
Idaho State Board of Nursing (2005). Position on safety to practice. Print, Page 1.
Idaho State Boards of Nursing Impaired Nurses: Reclaiming Careers. n. p., n. d. retrieved April 20, 2014. http://www.cartercenter.org/news/documents/doc591.html.

Statistics &
Types of Impairment
Legal and ethical responsibility
Reporting the Nurse in Question
Barriers to reporting and confronting the nurse
The board did not create a set of rules to be applied in all situations.
It is the individual nurse's responsibility to evaluate one's ability to safely, effectively and competently take care of their patients.
This policy is specific to nurses who are dependent on substances.
To get a license reinstated a nurse must complete an approved treatment program
have one year of documented sobriety.
They will be placed on three years probationary period after their license is reinstated.
References Cont.
"Impairment" Impairment Definition and More from the Free Merriam-Webster Dictionary n. p., n. d. retrieved April 20, 2014. http:/www.merriam-webster.com/dictionary/impairment.
Monroe, T., Pearson, F., & Kenaga, H. (2008). Procedures for handling cases of substance abuse among nurses: a comparison of disciplinary and alternative programs.
Journal of Addictions Nursing (Taylor & Francis Ltd). 19(3)
, 156-161.
National Council of State Boards of Nursing. (2011). Substance use disorder in nursing. Retrieved from https://www.ncsbn.org/SUDN_11.pdf
Texas Board of Nursing (2008). Eligibility and disciplinary sanctions for nurses with substance abuse, misuse, substance dependency, or other substance use disorder. Pages 1-6. Retrieved on April 20, 2014 from http://www.bne.state.tx.us/pdfs/chemical.pdf
Thomas, C. and Siela, D. (2011) The Impaired Nurse Symptoms of a Substance-abusing Nurse. American Nurse Today, retrieved April 20, 2014 from http://www.medscape.com/viewarticle/748598_6'3e
Conduct further research
Update current policies
Continue examining current policies/procedures for handling impaired nurses
Promote nurse education
Consider recovery programs
Your Thoughts
What does it mean to be an

Can you provide examples of different types of impairment?
The Definition of Impairment
According to Webster's Dictionary impairment means "to make something weaker or worse".

ANA Position Statement:
Substance Abuse
"We oppose fraudulent or incompetent prescribing activities and the misuse of prescribed drugs by nurses themselves"
American Nurses Association
The Elephant in the Room
Signs & Symptoms
Nurses coming to work hung over
Disappearing from the unit for long periods of time
Offering to take patients who are on high levels of narcotics
Drug diversion
Repeatedly calling in sick

A formal complaint has been filed with the Board of Nursing or
the nurse has voluntarily surrendered his/her license to the Board and has admitted to a disability relating to alcohol or drug use or to emotional or mental conditions.
The nurse waives the right to a hearing.
Nursing practice must be discontinued for a time period.
The nurse is referred to the Program for Recovering Nurses and signs a Contract for Monitoring through the program.
The nurse agrees to enter treatment.
Nursing Practice may be resumed only after a conditional limited license is issued by the Board with requirements for continued monitoring through the program for up to five (5) years.
The nurse is compliant with all conditions of the monitoring contract.
The nurse is released from the Program following satisfactory completion.
There is no record of formal disciplinary action by the Board of Nursing.

Models Of Discipline
Unfit nurses will face disciplinary action from the Board of Nursing, which may include license suspension or revocation.
Program for Recovering Nurses in Idaho
"To Protect the Public Safety, Health and Welfare while Assisting Nurses in their Recovery
and Return to Safe Practice"

The nurse has not come to the attention of the Board for violations of the Nursing Practice Act or Rules.
The nurse or an agent of the nurse (employer, colleague, family member, etc.) contacts the Program for Recovering Nurses requesting assistance.
The nurse agrees to enter treatment for chemical addiction or mental conditions and signs a contract for monitoring by the program.
The nurse is compliant with all conditions of the monitoring contract.
Nursing practice may be resumed following approval by the Program Coordinator.
The nurse is released from the Program following satisfactory completion.
The Board of Nursing receives no information about the nurse.
What are some barriers to reporting a suspected impaired nurse?
Name some signs and symptoms of an impaired nurse?
What is the top priority/concern for nurses everywhere?
Track 2: Referral by Board of Nursing:
National Council of State
Boards of Nursing
We will be surveying nurses in Idaho hospitals to understand their current knowledge on impaired nursing.
The topics that will be covered in our survey include the following; signs and symptoms of an impaired nurse, hospital policies regarding impairment, where these policies would be located, and how nurses will maintain patient safety if they suspect a nurse is impaired.
These surveys will be anonymous and contain five short answer questions.
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