Recreational drug use and alcohol abuse is an emerging public health issue in the United States. Due to physical and mental exhaustion, nurses have become more dependent on chemical substances. Per the American Nurses Association at least 10% of the nursing workforce suffer from substance abuse (ANA, 2015). The abuse of prescription drugs in healthcare workers has become an ongoing problem because of the easy access to the drugs. Chemically dependent nurses pose a threat to safety of the patient, employees, and their overall well-being. It is imperative that all cases of abuse be reported so they can be treated and handled in a timely fashion without sacrificing the reputation of the hospital and the nursing profession. Over the last 35 years the treatment of chemically dependent nurses has improved greatly, however there are still challenges in effectively identifying the chemically impaired nurse.
To treat the addiction that exist in the workplace it is very important that all nurses know the signs and symptoms as they relate to substance abuse. Nurses who are chemically impaired rarely admit to the use of drugs/alcohol and take extra precautions to avoid exposing themselves (Dunn, 2005). Many believe that the problem is under control never realizing the actual despair in their professional and personal lives. Signs and Symptoms of Chemically Impaired Nurses As stated previously, to recognize chemical impairment nurses need to be aware of the signs and symptoms. The most common physical signs of substance abuse include slurred speech, fatigue, unusual weight loss, tremors, and dilated or constricted pupils.
The most common behavioral signs of substance abuse include insomnia, lack of concentration, frequent lying, and frequent anger. Other signs could include frequently volunteering to work on days off or coming to work during a scheduled vacation. These behaviors can often be mistaken for being a great employee or dedication to the job which often leaves substance abuse unrecognized. Chemically impaired nurses can also show signs of drug diversion. Drug diversion can cause discrepancies with the narcotics scheduled to be given to patients. Some examples include but are not limited to incorrect medication counts, frequent corrections on the medication records, numerous reports of pain from patients, and big amounts of medication wastage. Audits are done in healthcare facilities to monitor employees who have access to all controlled substances.
Drug diversion not only affects the individual but the entire facility. Per the CDC, if an employee is suspected of using injectable drugs it must be reported immediately to law enforcement. If cases of drug diversion are caught early this can protect the patient as well as the facility. Reporting the Chemically Impaired Nurse When substance abuse is suspected in a colleague the nurse should report this concern to protect the safety of the patient and the employees. However, many nurses are reluctant to reporting substance abuse due to fear of retaliation such as physical attacks by the impaired person (Bettinardi-Angres, 2011). Many nurses also have a feeling of disloyalty about jeopardizing the chemically impaired nurse employment. It is recommended by the American Nursing Association that nurses initially confront the chemically impaired nurse before reporting to a supervisor.
In Florida, all reports must be made to the Intervention Program for Nurses (IPN) or the Florida Department of Health (DOH). There is a need for education in on responding to chemically impaired colleagues because many nurses are unable to identify the signs related to chemical dependence. If nurses are more confident in addressing the problem, it makes it easier for them to act with understanding and confidence. Nurse managers play a very important role in the reporting process. It is imperative for employees to feel they have support and transparency while in the workplace. Nurse managers should encourage employees to express all needs and concerns. When managers are judgmental it limits communication so it’s important for them to keep an open mind and encourage employees to share information which results in a safer environment for patients and employees.
The literature states that having clear and concise protocols for nursing management and staff has advantages, however many nurses have reported a lack of protocols for interventions as barriers. The ANA states that if a nurse is aware of suspicious activity among colleagues it is their ethical obligation to report it. Treatment and Aftercare Screening has proven to be the best tool in identifying substance abuse disorders in nurses. Simple screening can provide early intervention techniques that could prevent the impaired nurse from facing disciplinary actions or having their license revoked. Screenings could include self-administered questionnaires, the drug abuse screening test (DAST), or the self-administered alcohol screening test (SAAST). Many of the tools are made available to the public and readily assessable.
The goal of these screening services is to place the impaired employee in a monitoring program that eventually help to maintain sobriety and return to their career. The non-disciplinary approach protects the patient while also allowing the impaired nurse to receive treatment and rehabilitation. This approach has been found to be successful and cost effective. Nurses can receive treatment at an inpatient or outpatient facility depending on the severity of the problem. Conclusion Healthcare professionals face many workplace stressors that are very uncommon in other specialties. For this reason, they have an increased likelihood of developing a substance abuse disorder.
It is imperative that all nurses are educated on how to identify substance disorders and proceed with reporting the disturbance. All nurses should also be familiar in the characteristics associated with addition. Nurses can provide support to one another and understanding to the chemically impaired colleagues. Signs of impairment are often physical and behavioral. Drug diversion has become a major problem in the healthcare field and affects the entire facility. Colleagues should always watch and monitor for signs of diversion because impaired nurses often resort to this behavior.
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