Ethical Dilemma: Substance Abuse Among Nurses NURS 362: Cody Gibo Sylvia Lee Meagan Kubo Janalynn Rollins

Introduction - The Issue - -Substance abuse is high among nurses. -Stealing patients’ medications -Approximately 10% of the nursing population has alcohol or drug abuse problems. -The American Nurse Association (ANA) estimates approximately 6% to 8% of nurses has problems serious enough to interfere with their ability to practice. Substance abuse

Introduction - Why? - Burnout Occupational -Nursing jobs are stressful and can be isolating. -Some nurses turn to substance abuse in an attempt to cope. -The availability and accessibility of medications also has been linked. Burnout Occupational

Introduction - The Issue - -Nurses who divert drugs pose significant threats to patient safety, but also become a liability to healthcare organizations and the nursing departments where the the diversion occurred. -Nurses are morally obliged to report colleagues suspected of stealing drugs at work, but only 37 % of nurses actually report because of “negative stigma.” -Fear of retribution, creating problems in the work environment, or being labeled as a whistle-blower, which can be an obstacle. -Friendships also can be an obstacle.

Signs and Symptoms Patient safety may be compromised Signs and symptoms may often be subtle, but if left unrecognized, Patient safety may be compromised -Increased absenteeism. -Frequent disappearances from the department or unit. -Excessive amounts of time spent in medication rooms or near medication carts. -Work performance that alternates between high and low productivity. -Inattention or poor judgement. PATIENT SAFETY NURSING PRIORITY

The goal is to protect the patient, FYI -Nurses in the past has “Throwaway Nurse Syndrome,” which was to punish their colleagues who violated the rules, including those with and addiction and steal meds from patients. -Addiction was dealt with using harsh discipline. where nurses lost their jobs and their licenses -Harsh discipline is not effective for stopping addiction behavior and is a barrier against seeing management. -Now, addiction is seen as a sickness and treated as such. The goal is to protect the patient, Not to punish the nurse

Legal -Diversion of drugs is defined as the unlawful channeling of regulated pharmaceuticals, including the misuse of prescription medications. -Request for confidentiality applies only to personnel without vested involvement in the situation. -Mandatory reporting and disciplinary actions are required in many states, and penalty and other proceedings are dependent on the investigation.

Legal addiction is a treatable disease Be aware that drug diversion is A symptom of the disease of addiction and that addiction is a treatable disease -If the nurse executive (NE) fails to disclose the information or resolve the problem, further legal quandaries could result the NE being accused of maleficence for failing to protect patients from a potentially unsafe nurse. -Negligent supervision could be charged. -The NE has an obligation to ensure nurses provide safe and prudent patient care and failure to report or resolve the situation would be negligent and potentially subject the nurse and patients to further harm.

Ethical -Nurses have an ethical duty to protect patients, colleagues, the profession, and community. -This ethical responsibility extends to nursing leaders and executives to report an impaired professional and ensure he/she receives the appropriate treatment. -More than 39 states have developed programs to promote treatment and rehabilitation of impaired or addicted nurses. -Nurse diversion programs are critical for the profession and healthcare organizations must ensure nurses are treated, and a safe return to the workplace is facilitated.

Ethical Lower -The ANA supports alternative-to-discipline programs. -The ANA’s Code of Ethics additionally advocates for the promotion of nurses’ well-being and rehabilitation to preserve the nursing workforce and the profession. -Drug diversion in a nursing department affects not only the involved employ and organization, but also the employees within the department. -The NE can facilitate the grief process brought on by the diversion to peers of the impaired employee who could be suffering from betrayal, anger, guilt, and loneliness. Research has shown that relapse rates by nurses from diversion and rehabilitation programs are when compared Lower with the general population

Treatment -Nurses in rehab for addiction may be enrolled in a long term program. -The program will monitor their progress through rehab and identify early signs of relapse. -Nurses can be visited when they return to work to monitor attendance or subject to random drug tests – This can last for 5 years. -The aftercare programs have been recommended by the American Nurses Association, the International Nurses Society on Addiction, and the National Council of State Boards of Nursing.

American nurses association States that “the nurses promotes, advocates For, and strives to protect the Health, safety, and rights Of the patient.”

References American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Retrieved from www.nursingworld.org/about/01action.htm#code Kunyk, D. & Austin, W. (2010). Nursing under the influence: A relational ethics perspective. Nursing Ethics, 19(3), 380-389. doi: 10.1177/096973301140767 Talbert, J. J. (2009). Substance abuse among nurses. Clinical Journal of Oncology Nursing, 13(1), 17-19. doi: 10.1188/09.CJON.17-19 Tanga, H. Y. (2011). Nurse drug diversion and nursing leader’s responsibilities: Legal, regulatory, ethical, humanistic, and practical considerations. JONA’s Healthcare Law, Ethics, and Regulation, 13(1), 13-16.