2Continuing 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.
3Impaired 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?
4Why A Greater Risk? Accessibility and Availability Knowledge/Optimism = ImmunityCare taking philosophyBurnout – 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)
5Stated First Reason for Use Chronic PainChronic Overwork/FatigueChronic StressDepression/Anxiety…For Pleasure
6IMPAIRMENTGeneric 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..
7Impairment 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;
8Impairment 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;
9What 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)ToleranceWithdrawalAlcohol/drugs used for longer than intended
10What is Addiction (Con’t) Desire &/or unsuccessful effort to cut down or control useConsiderable more time spent obtaining or using alcohol/drugs or recovering from its effectsImportant social, work or recreational activities given up because of use/abuseContinued use despite knowledge of problems caused or aggravated by use (e.g. DUI, relationship or job problems)
11Signs 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 – disorientationMissing 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)
12Signs and Symptoms of Impairment (con’t) Unusual/unexplained resistance to authorityDeviation from Standard Procedures/Refusal to follow reasonable directionsErrors in judgment/practice or in record keepingDecrease in efficiency and productivityComplaints with personal interactions – staff and patients (secretive, hostile, isolative, contentious, demanding)Inaccessibility – unexplained departures from the work area
13Signs & Symptoms of Possible Diversion? Consistently signs out more controlled substances on his/her shiftFrequently breaks/alters vials or spills drugsPurposely waits until alone to open narcotic cabinetConsistently volunteers to be the “narcs” nurseDisappears into bathroom directly after handling controlled substances
14Possible Signs of Diversion (Con’t) Incorrect narcotics count at end of shiftFailure to obtain co-signaturesDiscrepancies between a patient’s report…Excessive use of PRN medicationsWastes narcotics without a witness“Hangs around” or seen in remote areas…Defensive when questioned about errors
15Signs & Symptoms - Employment Frequent job changes/relocationsVague letters of referenceUnexplained time lapse(s) from job to jobLast job not commensurate with trainingUnusual medical history – several trips to the ER…
16ISNAP – MISSION STATEMENT To Protect Lives – andTo Save Careers – byMonitoring the Process – andAdvocating for the Nurse
17WHY PARTICIPATE?Administered by ISNA – a non-state agency – “nurses caring for nurses”Alternative to disciplinary actionConfidentialitySupport and Encouragement in the Rehabilitation Process
18Referral Sources Self Employer/Human Resources/EAP Co-Workers – “obligated to report”Family/friendsAttorney General’s OfficeState Board of Nursing (Applications/Renewals)
19Participation Steps Intake Referral for Evaluation/Treatment/Aftercare Recovery Monitoring Agreement (RMA)
20Elements of the RMA Abstinence Based Program Random Urine Drug Screens (UDS’s)Approval of Employment/Conditions of EmploymentTreatment ProvidersTwelve Step Support Groups – SponsorMonthly/Quarterly Reports & AA/NA Logs
21Professional 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)
22Colleagues “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
23Professional Organizations “enable” by: Fostering unrealistic goals or expectationsBelieving that addiction can not happen hereRemaining uneducated about the addictions processPromoting the keeping of “secrets”Disciplining rather than RehabilitatingActing only when the problem is “too” obvious
24Enabling Results In: A Delay in Intervention A Delay in Treatment A Progression of the Illness
25Conclusions 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!