working with the impaired nurse sharon s. parker ona convention, 2015
DESCRIPTION
“impaired” is a questionable term since most nurses are high functioning and high achievingTRANSCRIPT
Substance abuse is not a disease of choice
Continuous use actually causes changes in the brain
More then half of those with a SA disorder have another co-occurring disease of the brain.
The Disease of Substance Use Disorder
“impaired” is a questionable term since most nurses are high functioning and high achieving
PrimaryChronicDysfunction of the brainTreatable
Rise of prescription misuse has caused most concern recently
AbuseDependencyAddiction Negative aspects of SA affect the
nurse, patients, familiesANA estimates that 6-8% of
nurses misuse drugsRecent studies say 10-15%
Substance Use Disorder
Medical disorder where a person has a compulsion to take a drug/alcohol in order to experience the effects.
Chemical Dependency
Medical disorder marked by compulsive use of drugs/alcohol
Inability to stop using no matter what the consequences
Neurological changes
Addiction
The phenomena of needing more and more of a substance of abuse in order to get the same effect
Tolerance
DepressionLow self-esteemLow tolerance for stressFeelings of resentmentAccess or availability of drugsGenetic predisposition
Predisposing factors
Family traumaPhysical, mental abuse or dysfunction of family
PTSD
AlcoholOpioidsStimulantsMarijuana Rise of prescription misuse has
caused most concern recently
Drugs of Abuse
Substance use is seen as acceptableFaith in drugs to promote healingSense of entitlement “special” status of health care providers makes them invulnerable to illness that patients get
Problematic attitudes
Self-diagnosisNeed to continue workingNot taking care of self
AccessAttitudeStressLack of education
Top 4 Risk Factors
Differentiate between impairment and stress-related behavior
Escalating behavior
Identification of a Substance Use Disorder
Impaired cognitive functioning and memory
Altered motor skillsDifficulty making decisions Inability to copy with stressful situations
Escalating Impairment Behavior
Slurred speech Lack of coordinationFrequent tardiness or poorly
explained absencesSmell of alcohol on breath Impaired memory—”blackouts”
Signs and symptoms
Sloppy chartingAttireGeographic cure soughtDiversion of patient drugs for own use
Job performance
Excessive use of sick timeCalling in sick on MondaysUnexplained absences from the unit
Consistently volunteering to be the medication nurse
Job Related Behavior
Patients need more narcoticsDiscrepancies Opioid countOrdering for patients that have been discharged or died
More “spills” than others
Emergency room nurses ICU, ER, ORPsychiatric nursesNurse anesthetists Night nurses
Rates of Abuse among Specialties
Women more likely to abuse prescription drugs
Males more likely to abuse illegal drugs and alcohol
Oncology nurses more inclined to drink alcohol
Gender
Developing a culture of transparency and support
Nurse managers being aware of own stereotypes and misconceptions about “drug users”
Examining the code of silence among colleagues
What helps?
A cluster of behaviors that allow the person with a substance abuse problem to keep usingFamily membersColleagues
Co-dependence
Being proactiveScreening Regular monitoringGuidelinesReferral to treatment
What to do?
Have basic understanding of SA as a disease
Know common indicators of unsafe practice
Know workplace policies and procedures
Know in-house resources
Accountability of Administration
Recognize personal valuesKnow in-house resourcesDocumentFeel capable of coordinating nurses re-entry at work
Recognize signs of relapse
Planned meeting with nurse and family, colleagues to break through the pattern of denial
intervention
Alternative ProgramMonitoring Return to work guidelines
Board of Nursing
Legally?Morally?Ethically?
Obligations to colleagues
Substance Use Disorder Nursing: a Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs
National Council of State Boards of Nursing
Reference