The Impaired Nurse

Michelle Klenk

Ferris State University

NURS 450

Background of the impaired nurse

Nursing is a highly esteemed profession

but with that the nature of the job is both demanding and stressful.

Why???• Stress- long hours of caring for critically ill

and dying patients.• Job work area- nurses that work in ICU, ER,

OR, or anesthesia have the highest prevalence of substance abuse, because they are considered high stress settings.

• Workaholic personality leads to addictions• In general nurses take care of themselves

last. Hiding personal needs first to tend to the needs of their patients and others.

Heacock, S. (2013). Nurses And Substance Abuse. Retrieved from http://www.nursetogether.com/nurses-and-substance-abuse

It is estimated that 10-15 percent of all nurses in the United States are addicted to some type of illegal or controlled substance (Heacock, 2013).

Signs and Symptoms of the Impaired Nurse

Thomas, C. (2011). The Impaired Nurse. American Nurse Today. Retrieved from http://www.medscape.com/viewarticle/748598_6

Erik Erikson’s Psychosocial Theory

Harder, A. (2011). The Developmental Stages of Erik Erikson. Support4Change.com. Retrieved from http://www.support4change.com/index.php?option=com_content&view=article&id=47&Itemid=108

Stages of Change Model/Transtheoretical Model (TTM)

Prochaska and Diclemente Model has been the basis of

developing effective interventions to promote health behavior change

• Describes how people modify a problem behavior or acquire a positive behavior

• TTM is a model of intentional change.

• Model focuses on the decision making of an individual

• Model has been widely applied in behavior modification techniques

Stages of Change Model/Transtheoretical Model (TTM) (2012, January 26). In Nursing Theories: a companion to nursing theories and models. Retrieved from http://currentnursing.com/nursing_theory/transtheoretical_model.html

Core Constructs of TTM:

The process of change

Decisional balance

Self efficacy

Temptation

Analysis of the issue:

Leads to nurses caring for patients while using substances. Impairs judgment. Patient safety and health at risk.

Knowledge of medications and willingness to self medicate for relief

Lack of self care putting one’s own needs last.

Role strain at home related to working long hours and high stress

Loss of control of one’s life related to stressors of the job

Job stress*Long Hours*Increase workload*Emotional ties with patients*Easy access to medications

Implications for Impairment

Nurse are at risk for substance abuse for many reasons• Availability of medications• Increased stress and workload• Knowledge of medications

Implications/Consequences• Loss of Nursing License• Loss of Job• Risk for Imprisonment

Outcomes• Early identification of substance abuse• Employer rehabilitation programs and counseling• Legal issues

McCue, C. (2010, November 9). Using the AACN Framework to Alleviate Moral Distress. The Online Journal of Issues in Nursing, 16(1).doi:10.3912/OJIN.Vol16No01PPT02

Assessment of the Health Care Environment The worse thing you can do if you suspect a co-worker is addicted to drugs oralcohol is to do nothing.

Approaching directly will likely meet with resistance and denial

Report suspicions to management, which leads to the nurse receiving help.

Most employers offer drug and alcohol treatment programs but there are severalnationwide programs as well.

Resources for the impaired nurse:

• Alcoholics Anonymous www.aa.org• International Nurses Society on Addictions www.intnsa.org• ANA Impaired Nurse Resource Center

http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Work-Environment/ImpairedNurse.

• Health Professionals Recovery Programs www.hprp.org• Narcotics Anonymous www.na.org

Impaired Nurse Resources Center (2012). In American Nursing Association: Nursing World. Retrieved from http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Work-Environment/ImpairedNurse/Impaired-Nurse-Resources.html.

Quality and Safety Recommendations from QSEN

Patient-Centered Care• "Recognize the patient or designee as the source of control and full

partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.“

Teamwork & Collaboration• "Function effectively within nursing and inter-professional teams,

fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.“

Safety• "Minimizes risk of harm to patients and providers through both

system effectiveness and individual performance.“

Quality and Safety Competencies (2012). Retrieved from http://www.qsen.org/competencies.php.

American Nurses Association Scope and

Standards of Practice The ANA has several standards of practice, the

following apply directly to the impaired Nurse:

Standard 7: Ethics Maintains a therapeutic and professional

healthcare consumer-nurse relationship within appropriate professional role boundaries.

Takes appropriate action regarding instances of legal, unethical, or inappropriate behavior that can endanger or jeopardize the best interests of the healthcare consumer or situation.

Standard 10: Quality of Practice Demonstrates quality by documenting the

application of the nursing process in a responsible, accountable and ethical manner.

ANA Scope and Standards of Practice (2nd ed.). (2010). Silver Spring, MD: American Nursing Association.

National Council of State Boards of

Nursing • Prior to the 1970’s nurses were fired by employers or disciplined by the board of

nursing when evidence of substance use was apparent.

• Non-disciplinary programs offering an alternative to traditional discipline have been used since the 1970’s.

• Treatment is individually tailored to meet needs and supportive monitoring systems are used.

• Recovering nurses can recover and return to practice safely

• Extensive scientific evidence shows that approaching substance use disorders as treatable illness is extremely effective for an individual using substances, as well as for society.

National Council of State Boards of Nursing (2013). Substance Use Disorder in Nursing. Retrieved from https://www.ncsbn.org/2106.htm

Recovering Nurses

One Nurse’s story. An addiction to pain killers lost her job, her family

and her life. In remission. On the road to recovery

https://www.youtube.com/watch?v=chmOrO9fNCc

Conclusion

An impaired nurse is a risk to their self, their patients, and their co-workers.

Goal of intervention is early detection and aiding in getting help for that person

Many fear of intervening because they do not want to get their friend or co

worker in trouble when in reality, this is an illness that needs immediately

medical attention. Nurses often times may overlook their problem of addiction

more so than a typical person because they are used to putting their needs

last. This is a large part of the problem, denial. Having an addiction problem

doesn’t have to mean their career and life is over. With early intervention and

successful therapies and assistance programs the road to recovery is

achievable.

References

ANA Scope and Standards of Practice (2nd ed.). (2010). Silver Spring, MD: American Nursing Association.

Harder, A. (2011). The Developmental Stages of Erik Erikson. Support4Change.com. Retrieved from http://www.support4change.com/index.php?option=com_content&view=article&i

d=47&Itemid=108

Heacock, S. (2013). Nurses And Substance Abuse. Retrieved from http://www.nursetogether.com/nurses-and-substance-abuse

Impaired Nurse Resources Center (2012). In American Nursing Association: Nursing World. Retrieved from http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Work- Environment/ImpairedNurse/Impaired-Nurse-Resources.html.

McCue, C. (2010, November 9). Using the AACN Framework to Alleviate Moral Distress. The Online Journal of Issues in Nursing, 16(1).doi:10.3912/OJIN.Vol16No01PPT02

National Council of State Boards of Nursing (2013). Substance Use Disorder in Nursing. Retrieved from https://www.ncsbn.org/2106.htm

Stages of Change Model/Transtheoretical Model (TTM) (2012, January 26). In Nursing Theories: a companion to nursing theories and models. Retrieved from http://currentnursing.com/nursing_theory/transtheoretical_model.html

Thomas, C. (2011). The Impaired Nurse. American Nurse Today. Retrieved from http://www.medscape.com/viewarticle/748598_6

Quality and Safety Competencies (2012). Retrieved from http://www.qsen.org/competencies.php.