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Transcript of Impaired Nurses
•Substance abuse by healthcare providers is occurring in greater frequency in today’s organizations. Recognizing that substance abuse is a medical illness that requires treatment is the first step in removing the stigma associated with it.
•Although nurses generally use drugs and alcohol at about the same rate as the rest of the population, nurses in certain stressful specialties are more prone to substance abuse.
•According to a study published in the April 1988 issue of the American Journal of Public Health, emergency and critical care nurses are more than three times as likely to use cocaine and marijuana as nurses in other specialties. •Scope of the Problem: (AACN 2009 Statistics)
•Rate for prescription type abuse is 6.9%. Prevalence of chemical dependency is 6-8%o
•Prevalence of use of all substances (including tobacco) is 32%.
•The Impaired Nurse:Alcohol is the most commonly abused substance.
•Prescription drugs are the second most commonly abused substance Recognizing the Warning Signs of Substance Abuse:
• Frequently depressed
• Increased overtime
• Increased isolation from others
• High performance followed by deteriorating performance • Frequent days off for implausible reasons
• Excessive use of mouthwash or mints to cover breath
• Frequent absence from the unit or visits to the restroom
• Patients complaining that pain medicine is not effective or that they never received
• Discrepancies in signing/documentation procedures for controlled substances
• Volunteering to medicate other nurses’ patients • Negative effects on patients, families, and staff • Nurses with substance abuse problems need help! They are in danger of harming patients, the facility’s reputation, the nursing profession, and themselves. The consequences of not reporting concerns can be far worse than those of reporting the issue. Fatigue and Sleepiness-
• Sleepiness refers to a tendency to fall asleep, whereas fatigue refers to an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion associated with impaired physical and/or cognitive functioning.
• 12-hour shifts favored by many nurses and frequent overtime are associated with difficulties staying awake on duty, reduced sleep times, and nearly triple the risk of making an error.
• Fatigue can be exacerbated with increased numbers of shifts worked without a day off, and working more than four consecutive 12-hour shifts is associated with excessive fatigue and longer recovery times. What can be done about; What is being done about it? - Texas Peer Assistance Program for Nurses (TAPAPN)
o Established under Chapter 467 of the Health and Safety Code
o Operated by the Texas Nurses Association
o Offers licensed nurses who are impaired by chemical dependency or mental illness an opportunity to undergo treatment and to safely return back to nursing practice → all under strict confidentiality o Available to both LVNs and RNs who are diagnosed with substance abuse, chemical dependency, anxiety disorders, major depression, bipolar disorder, and schizophrenia
o Program participation is an alternative to being reported to the Texas Board of Nurse Examiners
o A nurse who is suffering from any of the above can self-report or be referred to TAPAPN through their employero Completely voluntary – the nurse can withdraw participation at any time, however failure to fulfill the TAPAPN contract may result in being reported to the Texas Board of Nurse Examiners. o Once enrolled, the nurse is provided a case manager and an advocate. Advocates are volunteer LVNs and RNs who are there to support the nurses going through the program.
o In the first 90 days after treatment, participants must attend daily self-help meetings such as NA or AA. After 90 days, they are required to attend four meetings a week. o Once they are ready to return to work, they must receive authorization from their case manager and are subject to temporary practice restrictions. They must be supervised by another nurse, are barred from accesses to controlled medications during the first six months, no overtime, on-call, or night-shift assignments. They must abstain from alcohol and drugs and are subject to random drug tests. o Advantages: confidential and successful completion is an alternative to being reported to the Board and possible disciplinary action against the nurse’s license. It also provides advocacy and assistance to help impaired nurses gain control over their lives and return to their profession. Some evidence-based practices that have been shown to improve alertness on the job:
- Caffeine should be used therapeutically. Caffeine should not be consumed when alert or on a regular basis. Nurses should not drink caffeine outside working hours.
- Nurses should be allowed to nap during their break periods and these naps should be less than 45 minutes.
- If you work nights, especially if your shift starts at 11 PM or midnights, take a nap prior to starting your shift to help you remain awake during these early morning hours.