Impairment Issues Related to Nursing

1. Impairment Issues Related to Nursing/Nursing Assistant Practice An afternoon of Discussion with the New Hampshire Board of Nursing

2. Clint Jones Award Foundation for Healthy Communities This award is given in memory of a man who remained dedicated to the nursing profession and served as an inspiration for excellence in nursing care.

3. Road to Recovery Margaret Walker and William Kohut of the NH Board of Nursing discuss the board discipline-alternative program: Provides an option for a licensee in need of assistance with drug/alcohol impairment, physical, and mental health issues that interfered with practice. Remains non-public provided no harm has occurred and the individual has self-reported.

4. Diversion Program Help nurses that are at a low risk who meet the following criteria: Never been before the Board; Are not being prosecuted; Are not on medication; Have no criminal record; Have no alcohol or drug violations; Are recommended by the completed treatment program; They have been recommended by an Independent Evaluation; Have Board Approval.

5. Benefits of Road to Recovery Licensees avoid official board action; Motivates licensees to attend self-help and ongoing treatment; Helps licensees to stay focused and develop constructive priorities; Keeps them employed; No interruption of skill development.

6. Requirements of R2R Duration of the program is 5 years or more; We know that the longer a person remains in treatment the less likely for relapse Nurses are required to call-in daily to a designated drug testing program (24 tests are required yearly); Nurses are required to provide monthly self-reports; Nurses are required to provide quarterly reports from work and therapists Nurses are required to document 3 self-help meetings and a Professional meeting per week; Nurses are required to document obtaining a sponsor in the 1st month of the program

7. R2R Program Administration A transparent data base between Board Staff and Coordinator is developed; Each case is Board approved; Detailed forms and files are maintained.

8. R2R Program Completion Independent evaluation; Recommendation from treatment provider to include accomplishments by the nurse; Documentation of meetings and reports are up to date; Abstinence for 5 years Board approval

9. Sandy General overview: Nature of the profession Chemical dependence General Introduction into Talk We have long been aware that nurses are at risk for musculoskeletal injuries, infections from needle sticks and patient contact and job burnout. Educational programs, policies, competencies and standards of care have been developed to prevent such occurrences. We believe that there is another risk that is both subtle and unexpected. That risk is chemical dependence by taking prescribed or non-prescribed controlled medication. Yet only recently have we seen this topic begin to appear in the programs of nursing conferences and discussions. It is up to us as nurses to lower the risk of chemical dependence in nurses by attending educational programs such as this and helping to develop and implement protocols that are focused on early recognition, effective evaluation ,adequate aftercare and the eventual opportunity to reenter the the workplace if they have remained compliant with their contracts. We believe that we as nurses own this risk and need to feel as comfortable addressing a co-worker with alcohol on her breath as we would a nurse who neglected to wear gloves when advised.General Introduction into Talk We have long been aware that nurses are at risk for musculoskeletal injuries, infections from needle sticks and patient contact and job burnout. Educational programs, policies, competencies and standards of care have been developed to prevent such occurrences. We believe that there is another risk that is both subtle and unexpected. That risk is chemical dependence by taking prescribed or non-prescribed controlled medication. Yet only recently have we seen this topic begin to appear in the programs of nursing conferences and discussions. It is up to us as nurses to lower the risk of chemical dependence in nurses by attending educational programs such as this and helping to develop and implement protocols that are focused on early recognition, effective evaluation ,adequate aftercare and the eventual opportunity to reenter the the workplace if they have remained compliant with their contracts. We believe that we as nurses own this risk and need to feel as comfortable addressing a co-worker with alcohol on her breath as we would a nurse who neglected to wear gloves when advised.

10. Situations that place licensees at risk _Knowledge deficit by nurses _Attitude of professional immunity to addiction _too smart to become addicted _different from others due to managing health care of others _Predisposition for addiction _genetic _early trauma -scattered psychiatric conditions -Stress from professional demands vs. lack of self care

11. Situations continued�. Work injuries requiring pain management _Sandwich generation _ History of social alcohol and drug use _Concept that pills/medication works _ knowledge of drug actions, dosages and interactions _ observation of drug effectiveness in their patients, both physical and psychological

12. Situations continued� Nursing culture that accepts self-prescribing of medications _ Need to appear competent , leading to the numbing of feelings of inadequacy _Availability of controlled medications _License allows addiction to become far advanced _ secret of addiction enhanced by having license _ provides income, identity, easy drug access, and cover-up

13. Kelly: Behaviors Prior to Discovery Alcoholic Late for work � Frequent absences Mondays & Fridays Last minute sick calls Smell of alcohol or mouth wash Tremors, Glassy red eyes Decreasing attention to personal hygiene Unplanned trips to car Extended lunch hours & breaks Difficulty following instructions Very Unreliable

14. Kelly: Behaviors Prior to Discovery Addict Volunteers for extra hours/days Volunteers for 3rd shift & weekends Volunteers for sickest patients Frequent trips to bathroom Volatile behavior Very high achiever Best employee Narcotic counts are frequently off Frequent wastage & broken vials Unobserved wastage Patients experiencing increased pain levels

15. Kelly: Points of Interest Dual diagnosis � commonly bipolar Sample snatching Master manipulators Doctorate in Lying

16. Sandy Barriers to intervention Enabling

17. Intervention Do�s Treat with dignity and respect Take action Focus on job performance Do not use labels Prepare a plan Review documentation Request help from others Ask nurse to listen to all before responding to interveners Have evaluator options ready Expect denial Report as necessary to the R2R Debrief with interviewers

18. Intervention Do Not Just React Intervene alone Try to diagnose the problem Expect a confession Give up Use Labels

19. Laura and Rebecca: Treatment Options Inpatient Treatment Outpatient Treatment ((IOP) Individual counseling with a LADAC 12 Step Program Attendance (AA, NA) Professional Support Groups

20. Goals of Treatment Establish Physical Sobriety Create Ongoing Recovery Plan Evaluation by an Addiction Specialist

21. Early Recovery Fear of Judgment Shame & Remorse Financial insecurity Relationship challenges Anger

22. Re-entering the workforce Interviewing and Self Disclosure Typical Contracted Requirements to Return to Practice Risk of Relapse

23. Roles and Responsibilities It is the responsibility of the Board of Nursing to ensure safe practice for public safety. It is NOT the responsibility of the Board of Nursing, The Employer, or any other group or individual to ensure that an addicted nurse recovers. The only person who can ensure recovery is the individual themselves.

24. Group Panel Discussion and examination of the issues related to impairment. Support group information. Goals and purpose of the Road to Recovery program. Future direction.