Download to care enough? - Indiana State Nurses Association

Impaired Nurses: Reclaiming
Careers
Chuck Lindquist, MA, MDiv
Program Director – ISNAP
1-800-638-6623
[email protected]
Continuing Nursing Education
Contact Hours
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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.
Impaired Nurses: Reclaiming
Careers
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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?
Why A Greater Risk?
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Accessibility and Availability
Knowledge/Optimism = Immunity
Care taking philosophy
Burnout – 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)
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Estimated that 13% - 14% of nurses are affected
by a Substance use disorder (SUD)
Stated First Reason for Use
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Chronic Pain
Chronic Overwork/Fatigue
Chronic Stress
Depression/Anxiety…
For Pleasure
IMPAIRMENT
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Generic 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..
Impairment may include but are not
limited to the following:
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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;
Impairment Continued:
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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;
What is Addiction?
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A nurse is defined as being dependent
on alcohol/drugs if he/she reports three
or more of the following symptoms:
(DSM-IV)
Tolerance
Withdrawal
Alcohol/drugs used for longer than
intended
What is Addiction (Con’t)
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Desire &/or unsuccessful effort to cut down
or control use
Considerable more time spent obtaining or
using alcohol/drugs or recovering from its
effects
Important social, work or recreational
activities given up because of use/abuse
Continued use despite knowledge of problems
caused or aggravated by use (e.g. DUI,
relationship or job problems)
Signs and Symptoms of
Impairment
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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)
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Speech affected (slurred, confused, fragmented, slow)
Inability to focus on work – disorientation
Missing in Action (frequent trips to bathroom, pkg. lot, prolonged
lunch breaks, Monday a.m. “flu,” unavailable when “on call,” unauthorized
absences)
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Rapid Mood Swings
drowsy, sudden change in energy level)
(belligerent, moody, ecstatic, nervousness, giddy,
Signs and Symptoms of
Impairment (con’t)
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Unusual/unexplained resistance to authority
Deviation from Standard Procedures/Refusal
to follow reasonable directions
Errors in judgment/practice or in record
keeping
Decrease in efficiency and productivity
Complaints with personal interactions – staff
and patients (secretive, hostile, isolative, contentious, demanding)
Inaccessibility – unexplained departures
from the work area
Signs & Symptoms of Possible
Diversion?
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Consistently signs out more controlled
substances on his/her shift
Frequently breaks/alters vials or spills drugs
Purposely waits until alone to open narcotic
cabinet
Consistently volunteers to be the “narcs”
nurse
Disappears into bathroom directly after
handling controlled substances
Possible Signs of Diversion
(Con’t)
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Incorrect narcotics count at end of shift
Failure to obtain co-signatures
Discrepancies between a patient’s report…
Excessive use of PRN medications
Wastes narcotics without a witness
“Hangs around” or seen in remote areas…
Defensive when questioned about errors
Signs & Symptoms Employment
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Frequent job changes/relocations
Vague letters of reference
Unexplained time lapse(s) from job to
job
Last job not commensurate with
training
Unusual medical history – several trips
to the ER…
ISNAP – MISSION
STATEMENT
To Protect Lives – and
 To Save Careers – by
 Monitoring the Process – and
 Advocating for the Nurse
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WHY PARTICIPATE?
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Administered by ISNA – a non-state
agency – “nurses caring for nurses”
Alternative to disciplinary action
Confidentiality
Support and Encouragement in the
Rehabilitation Process
Referral Sources
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Self
Employer/Human Resources/EAP
Co-Workers – “obligated to report”
Family/friends
Attorney General’s Office
State Board of Nursing
(Applications/Renewals)
Participation Steps
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Intake
Referral for
Evaluation/Treatment/Aftercare
Recovery Monitoring Agreement (RMA)
Elements of the RMA
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Abstinence Based Program
Random Urine Drug Screens (UDS’s)
Approval of Employment/Conditions of
Employment
Treatment Providers
Twelve Step Support Groups – Sponsor
Monthly/Quarterly Reports & AA/NA
Logs
Professional Enabling
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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)
Colleagues “enable” by:
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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”
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Performing the impaired nurses’ duties –
“picking up the pieces”
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Not discussing the work performance issues
or behavioral changes
Professional Organizations
“enable” by:
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Fostering unrealistic goals or expectations
Believing that addiction can not happen
here
Remaining uneducated about the addictions
process
Promoting the keeping of “secrets”
Disciplining rather than Rehabilitating
Acting only when the problem is “too”
obvious
Enabling Results In:
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A Delay in Intervention
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A Delay in Treatment
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A Progression of the Illness
Conclusions
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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!