Impaired Nurses: Reclaiming Careers

1. Impaired Nurses: Reclaiming Careers Chuck Lindquist, MA, MDiv Program Director – ISNAP 1-800-638-6623 clindquist@indiananurses.org

2. Continuing 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.

3. Impaired 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?

4. Why A Greater Risk? • 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) • Estimated that 13% - 14% of nurses are affected by a Substance use disorder (SUD)

5. Stated First Reason for Use • Chronic Pain • Chronic Overwork/Fatigue • Chronic Stress • Depression/Anxiety… • For Pleasure

6. IMPAIRMENT • 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..

7. Impairment 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;

8. Impairment 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;

9. What 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) • Tolerance • Withdrawal • Alcohol/drugs used for longer than intended

10. What is Addiction (Con’t) • 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)

11. Signs 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 – disorientation • Missing 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)

12. Signs and Symptoms of Impairment (con’t) • 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

13. Signs & Symptoms of Possible Diversion? • 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

14. Possible Signs of Diversion (Con’t) • 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

15. Signs & Symptoms - Employment • 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…

16. ISNAP – MISSION STATEMENT • To Protect Lives – and • To Save Careers – by • Monitoring the Process – and • Advocating for the Nurse

17. WHY PARTICIPATE? • Administered by ISNA – a non-state agency – “nurses caring for nurses” • Alternative to disciplinary action • Confidentiality • Support and Encouragement in the Rehabilitation Process

18. Referral Sources • Self • Employer/Human Resources/EAP • Co-Workers – “obligated to report” • Family/friends • Attorney General’s Office • State Board of Nursing (Applications/Renewals)

19. Participation Steps • Intake • Referral for Evaluation/Treatment/Aftercare • Recovery Monitoring Agreement (RMA)

20. Elements of the RMA • 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

21. Professional Enabling • Is an action by which a person intentionally or unintentionally supports an individual’s continued use of drugs/alcohol by protectingthem 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)

22. Colleagues “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

23. Professional Organizations “enable” by: • 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

24. Enabling Results In: • A Delay in Intervention • A Delay in Treatment • A Progression of the Illness

25. Conclusions • 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!