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Nurses and Substance Abuse

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Jasmine Harris

on 14 June 2013

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Transcript of Nurses and Substance Abuse

What is Substance Abuse ?
Risk Factors for Substance Abuse in Nursing
There are Four Major Risk Factors associated with Substance Abuse in Nurses: Access, Attitude, Stress, and Lack of Eduction

Access: the availability of prescription medications, training in administration, as well as familiarity with prescription medications increases the risk of Substance Abuse.

Attitude: Nurses are at higher risk of developing a diminished view of harm from prescription medication.

Stress: Several studies indicate that longer hours and shift rotation lead to several issues that precipitate increased use including: sleep disturbances, fatigue, and psycho-physiological consequences, (Geiger-Brown & Trinkoff, 2010).

Lack of Education: Lack of knowledge about substance abuse leads to missing the signs and symptoms, overlooking risk factors, and negative sterotypes and stigmas about people with substance use disorders.
Why are SUDs Important?
•Substance Abuse among nurses puts the health and safety of the general public at risk.

• Substance Abuse increases absenteeism, employee turnover, and financial liability.

•The American Nurses Association (ANA) estimated that 6%–8% of nurses use alcohol or drugs to the extent that professional judgment is impaired (Daprix, 2007).
• Substance Use Disorders (DSM-IV-TR) is an umbrella diagnosis for both abuse and dependence.

Criteria for Substance Abuse:
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
Recurrent substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance
North Carolina Board of Nursing Intervention Program

The Program is a voluntary alternative to disciplinary action for a nurse who:

•Tests positive for an illicit substance on a random or pre-employment screen. An illicit substance is defined as any drug contained in Schedule I or Schedule VI of the Controlled Substances Act of North Carolina, or any drug for which the nurse cannot provide a legitimate prescription OR
•Has a Driving While Impaired (DWI) conviction involving one or more grossly aggravating factors.
Objectives of the Intervention Program include the following:

•Early recognition and intervention for nurses who may abuse drugs/alcohol or be chemically dependent.
•To ensure the health and safety of the public through a program that monitors nurses testing positive for illicit substances.
Ultimate Consequence !
Before it gets this far get help
What is Relapse ?
According to the National Council of State Board of Nursing [NCSBN] (2011), “defines relapse as the occurrence of alcohol or drug dependent behavior in an individual who has previously achieved and maintained abstinence for a period of time after detoxification” (p. 120).
Risk of Relapse
The risk for relapse is the highest in the first two years of recovery, with the highest risk occurring during the first year of recovery.
Behaviors that increase the risk for relapse.
- Dishonesty to self and denial of a problem.
- Lack of or a decreased participation in an ongoing - recovery program.
- Poor response to stress.
- Being over confident.
Signs of an impending relapse.

Failing to comply with treatment recommendations
Employment difficulties
Relationship problems
Unstable emotional status
Lack of a sober support system and a return to socializing with prior substance abuse associates.
Failing to comply with alternative to discipline contract requirements.
Late or missing monitoring reports Missed drug screens.
Dilute specimens
Altered or substituted specimens.
Positive drug screens
In any relapse situation the nurse would be referred to treatment professionals with an expertise in substance abuse for further evaluation and treatment determination. Until it is determined that it is safe for them to return to the nursing practice.
( NCSBN, 2011) Two relapses are considered grounds for terminating the participant nurse from the alternative program, and referring the nurse to the board for determination of appropriate licensure action, (p.141).
( NCSBN, 2011) Studies have revealed that nurses who are subject to a monitoring agreement with significant consequences for non-compliance have a lower relapse rate than the general population, (p. 140).
In Conclusion...
The Nightingale Pledge

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.
Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter's or sculptor's work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts. - Florence Nightingale
Informal Settlement Processes
Shah, A. (2012, June 28). Professional Nurses With Substance Abuse Issues. In Prezi.com. Retrieved November 30, 2012, from http://prezi.com/ckdodjwk6zzc/professional-nurses-with-substance-abuse-issues/?kw=view-ckdodjwk6zzc&rc=ref-15312728

Epstein, P. M., Burns, C., & Helen, A. C. (2010). Substance abuse among registered nurses. AAOHN Journal, 58(12), 513-516. doi: http://dx.doi.org/10.3928/08910162-20101116-03

Geiger-Brown, J., & Trinkoff, A. M. (2010). Is it time to pull the plug on 12 hour shifts for nurses? Journal of Nursing Administration, 40(9), 357-359.

Trinkoff, A.M., & Storr, C.L. (2008). Substance use among nurses: Differences between specialties. American Journal of Public Health, 88(4), 581–585.
*Approximately 12.9 million employed Americans use illicit drugs.
*RNs have approx. 50% higher risk for substance abuse.

*And 1 in 7 nurses are at risk for developing an addiction.
(Epstein, Burns, & Helen, 2010)
Signs and Symptoms
Signs and symptoms of alcohol use can include:
• slurred speech
• lack of coordination
• impaired memory or attention
• leaving the workplace (to consume alcohol)
• the smell of alcohol on the breath
• frequent tardiness or poorly explained absences
(Griffith, 1999; Sloan & Vernarec, 2001).
NC Board of Nursing
Alternative Program
How it works
The AP is a voluntary alternative to traditional discipline action for a nurse whose competency may be impaired because of chemical dependency. Participation in the Program is not published unless disclosure is necessary to protect the health, safety, and welfare of the public or as ordered by a court of competent jurisdiction.
The objectives of the AP include:
Ensure the health and safety of the public by closely monitoring nurses impaired by drugs and/or alcohol.
Achieve earlier intervention with intent to decrease the time between the nurse’s acknowledgment of chemical dependency and entry into the recovery process.
Return the nurse to safe and effective practice in a more efficient manner while minimizing financial impact.
Provide an opportunity for nurses to recovery from impairment in a therapeutic, non-punitive and non-published process.
The nursing license is held in abeyance (a state of temporary inactivity). Licensee is eligible to petition to re-enter practice a minimum of three (3) months from the date treatment is initiated.
Within two (2) weeks of the date the statement is received at the NCBON, Licensee must submit the following evidence from a participating treatment facility:

Initial assessment
Confirmation of treatment start date
Treatment plan

Licensee is required to follow all recommendations of the treatment facility. Once Licensee has completed the initial phase of treatment, he/she is required to participate in Aftercare for one (1) year, which is a minimum of one (1) treatment meeting per week.
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