Working with the Impaired Nurse Sharon S. Parker ONA convention, 2015

 Substance abuse is not a disease of choice  Continuous use actually causes changes in the brain  More then half of those with a SA disorder have another co-occurring disease of the brain. The Disease of Substance Use Disorder

 “impaired” is a questionable term since most nurses are high functioning and high achieving

 Primary  Chronic  Dysfunction of the brain  Treatable

 Rise of prescription misuse has caused most concern recently

 Abuse  Dependency  Addiction  Negative aspects of SA affect the nurse, patients, families  ANA estimates that 6-8% of nurses misuse drugs  Recent studies say 10-15% Substance Use Disorder

 Medical disorder where a person has a compulsion to take a drug/alcohol in order to experience the effects. Chemical Dependency

 Medical disorder marked by compulsive use of drugs/alcohol  Inability to stop using no matter what the consequences  Neurological changes Addiction

 The phenomena of needing more and more of a substance of abuse in order to get the same effect Tolerance

 Depression  Low self-esteem  Low tolerance for stress  Feelings of resentment  Access or availability of drugs  Genetic predisposition Predisposing factors

 Family trauma  Physical, mental abuse or dysfunction of family  PTSD

 Alcohol  Opioids  Stimulants  Marijuana  Rise of prescription misuse has caused most concern recently Drugs of Abuse

 Substance use is seen as acceptable  Faith in drugs to promote healing  Sense of entitlement  “special” status of health care providers makes them invulnerable to illness that patients get Problematic attitudes

 Self-diagnosis  Need to continue working  Not taking care of self

 Access  Attitude  Stress  Lack of education Top 4 Risk Factors

 Differentiate between impairment and stress-related behavior  Escalating behavior Identification of a Substance Use Disorder

 Impaired cognitive functioning and memory  Altered motor skills  Difficulty making decisions  Inability to copy with stressful situations Escalating Impairment Behavior

 Slurred speech  Lack of coordination  Frequent tardiness or poorly explained absences  Smell of alcohol on breath  Impaired memory—”blackouts” Signs and symptoms

 Sloppy charting  Attire  Geographic cure sought  Diversion of patient drugs for own use Job performance

 Excessive use of sick time  Calling in sick on Mondays  Unexplained absences from the unit  Consistently volunteering to be the medication nurse Job Related Behavior

 Patients need more narcotics  Discrepancies  Opioid count  Ordering for patients that have been discharged or died  More “spills” than others

 Emergency room nurses  ICU, ER, OR  Psychiatric nurses  Nurse anesthetists  Night nurses Rates of Abuse among Specialties

 Women more likely to abuse prescription drugs  Males more likely to abuse illegal drugs and alcohol  Oncology nurses more inclined to drink alcohol Gender

 Developing a culture of transparency and support  Nurse managers being aware of own stereotypes and misconceptions about “drug users”  Examining the code of silence among colleagues What helps?

 A cluster of behaviors that allow the person with a substance abuse problem to keep using  Family members  Colleagues Co-dependence

 Being proactive  Screening  Regular monitoring  Guidelines  Referral to treatment What to do?

 Have basic understanding of SA as a disease  Know common indicators of unsafe practice  Know workplace policies and procedures  Know in-house resources Accountability of Administration

 Recognize personal values  Know in-house resources  Document  Feel capable of coordinating nurses re-entry at work  Recognize signs of relapse

 Planned meeting with nurse and family, colleagues to break through the pattern of denial intervention

 Alternative Program  Monitoring  Return to work guidelines Board of Nursing

 Legally?  Morally?  Ethically? Obligations to colleagues

 Substance Use Disorder Nursing: a Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs National Council of State Boards of Nursing Reference