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Substance Use Disorder in Nursing: Awareness & Prevention - Part 2

Learn about the risk factors, signs, and interventions for nurses with substance use disorder. Understand the role of reporting, recovery, and alternative-to-discipline programs in addressing SUD among nursing professionals.

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Substance Use Disorder in Nursing: Awareness & Prevention - Part 2

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  1. Substance Use Disorder (SUD) in Nursing: Awareness and Prevention: Part 2 These educational materials were developed through a collaboration with the Minnesota State Board of Nursing, the University of Minnesota School of Nursing, the Nurse Peer Support Network, and MHealth. Dina Stewart, DNP, APRN, PMHNP-BC created the learning materials and has given permission for the University of Minnesota School of Nursing to disseminate the materials to schools of nursing in Minnesota.

  2. Objectives • Describe the risk factors and protective factors of substance use disorder for nurses • Clarify personal values related to substance use disorder in order to address the stigmatization of nurses with substance use disorder • Outline the professional, personal and legal consequences for nurses with substance use disorder • Describe the signs of an impaired nurse in the workplace • Identify evidence of diversion in order to have awareness in a clinical setting • Identify approaches to engaging peers and managers regarding substance use disorder related concerns

  3. Signs of an Impaired Nurse – Behavioral Signs • Attendance issues • Frequent breaks • Slurred speech • Errors in judgement • Self Isolation • Irritability (NCBSN, p.60, 2011)

  4. Signs of an Impaired Nurse – Physical Signs • Changes in appearance • Reddened eyes • Odor of alcohol • Drowsiness • Hyperactivity • Wearing long sleeves in a warm environment • Excessive sweating • Clumsiness (NCBSN, p.60, 2011)

  5. Signs of Diversion • Volunteer to administer medications • Volunteer to work overtime or extra shifts • Patients complaint of ineffective pain relief • Discrepancies in medication counts • High amounts of opioid waste

  6. Reporting a Nurse Colleague must be Based on the Code of Ethics for Nurses When Suspicions Occur… ANA Code of Ethics (2015: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” (Provision 3) “Nurses must understand that if nurses with a substance use disorder are not helped they are in danger of harming patients, the facility’s reputation, the nursing profession and themselves” (NCSBN, 2011, p. 54). State nurse practice acts may have rules and regulations mandating that nurses with knowledge of another nurse practicing while impaired is required to report it.

  7. Only about 1 in 3 nurses who suspect a peer is impaired report it to a supervisor (Kunyk & Austin, 2011)

  8. When Suspicions Occur… SAY SOMETHING DO NOT DO NOTHING

  9. Intervening for a Nurse Colleague When Suspicions Occur… WHAT to inform the Nurse Manager: • Deviation of job performance from normal baseline • Personality changes / emotional lability • Alterations of mental status • Possible / probable diversion of drugs from the workplace (miscounts, poor patient pain control, etc.)

  10. Approaches for engaging peers and managers

  11. Hey, are you feeling okay? (concerned tone) You actually look a little tired. Before your break you were seemed so jittery. It was like you were bouncing out of your chair. And now you are super mellow. It is a big change from how you were before break to how you are now. If I’m noticing it, then others are too. Over the past few weeks, it seems you are not yourself. You usually look put together and it seems like something is off. I’m feeling great, why? What’s up? Well I feel fine. You don’t need to make a big deal out of it. So what are you saying? I don’t know what to say…

  12. Alternative-to-Discipline Programs • Alternative programs were developed to offer rehabilitation (especially monitoring) prior to or in lieu of discipline from state Boards of Nursing (BON) • Alternative programs offer some nurses the option to bypass BON investigation and disciplinary hearings • Nearly every state in U.S. has an alternative program (In Minnesota – Health Professionals Services Program [HPSP])

  13. Health Professionals Services Program (HPSP) Minnesota’s Alternative-to-Discipline Program: • Mission: Minnesota's Health Professionals Services Program protects the public by providing monitoring services to regulated health care professionals whose illnesses may impact their ability to practice safely. https://mn.gov/boards/hpsp/

  14. Disciplinary Consequences for Nurses with SUD • The board can dismiss the complaint without taking action • The board can refer a nurse to HPSP • The board can take disciplinary action(s): • Deny license • Revoke license • Suspend license • Impose limitations on practice • Impose civil penalty • Order unremunerated services • Censure or reprimand • Other action, as justified

  15. Recovery Definition: An active, ongoing process for a person with a substance use disorder to: • Admit having a substance use disorder • Abstain from drugs/alcohol • Acceptance of SUD • Improve health through the integration of body, mind, and spirit -- (Betty Ford Institute Consensus Panel, 2007).

  16. Nurses Peer Support Network: Mission: • Meaningful peer support for nurses with substance use disorder in a safe environment with the purpose of giving hope and healing the individual nurse • Education and outreach about substance use disorder in nursing to promote safety to the public Vision: All nurses in Minnesota will have access to a community-based peer support for substance use disorder http://npsnetwork-mn.org/

  17. References American Nurses Association. (2015). Code of ethics for nurses: With Interpretive statements. Silver Springs, MD: NurseBooks.org: Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33, 221-228. doi:10.1016/j.jsat.2007.06.001 DesRoches, C. M., Rao, S. R., Fromson, J. A., Birnbaum, R. J., Iezzoni, L., Vogeli, C., & Campbell, E. G. (2010). Physicians' perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA, 304(2), 187-193. Dunn, D. (2005). Substance abuse among nurses: Defining the issue. AORN Journal, 82, 573-596. Health Professionals Services Program. (2016). State of Minnesota: Health Professionals Services Program (HPSP). Retrieved from http://mn.gov/health-licensing-boards/hpsp/ NCSBN. (2011). Substance use disorder in nursing: A resource and guidelines for alternative and disciplinary monitoring programs. Chicago: NCSBN. Monroe, T., & Kenaga, H. (2010). Don't ask don't tell: Substance abuse and addiction among nurses. Journal of Clinical Nursing, 504-509.

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