The Impaired Professional: Chemical Dependency in Health Care Professionals Rose Bianchi, RN, DNSc. Copyright 2009

Substance Abuse ___________________________ According to Lillibridge, Cox, and Cross (2002) substance abuse is defined as: maladaptive patterns of psychoactive substance abuse indicated by continued use even when faced with recurrent: 1.Occupational 2.Social 3.Psychological or 4.Physical Problems as well as /or use in dangerous situations.

Substance Abuse Statistics ___________________________ 6% – 14%of all RNs A higher rate than the general population

How do Health Care Professionals Obtain Drugs? _____________________________________ 1.Legitimate Prescriptions for themselves 2.Diversionary Measures on the job (Workplace Theft)

The Majority of BRN Disciplinary Actions related to Misconduct resulting from Chemical Impairment Include: 1.Misappropriation of drugs personal use. 2. Sale of drugs & drug paraphernalia to support the RNs addiction.

Chemicals Of Choice ___________________________ FirstAlcohol SecondMeperidine (Demerol) ThirdOxycodone (Oxycontin) FourthClonazepam (Klonopin)

Other Drugs Abused ___________________________ Diazepam (Valium) Morphine Pentazocine (Talwin)

Common Personality/Behavior Changes of the Chemically Impaired Employee _______________________ * Increased irritability often followed by extreme calm * Social Isolation * Extreme & rapid mood changes, Euphoric recall of events * Elaborate excuses for behaviors * Strong interest in narcotics or the narcotics cabinet _______________________ * Sudden dramatic change in grooming, etc. * Forgetfulness * Physical changes: weight loss, flushed face, red or bleary eyes, unsteady gait,tremors, restlessness, bruises, cigarette burns, & ascites * Extreme defensiveness regarding medication errors (Marquis & Huston, 2006)

Common Job Performance Changes of the Chemically Impaired Employee ____________________ Difficulty meeting schedules & deadlines Illogical or sloppy charting High incidence of medication errors, etc. Volunteers to be the medication nurse High number of the nurse’s patients complain of no pain relief ____________________ Minimal job performance Judgment errors Sleeping or dozing at work Complains from staff about work quality or quantity (Marquis & Huston, 2006, p. 663)

Common Time & Attendance Changes of the Chemically Impaired Employee ____________________ * Increased work absences without adequate notification or explanation (Absent Mondays or Fridays) * Long lunches or breaks * Excessive sick leaves * Frequent requests for compensatory time off ____________________ Arriving early or staying late at work for no apparent reason Consistent lateness Frequently disappears from the unit with no explanation

Stages of Chemical Dependency ___________________________ First Stage- Uses chemical for pleasure primarily recreational & social use Second Stage – Develops drug tolerance, must use the substance in greater quantities & more frequently to achieve the same effect

Stages of Chemical Dependency (Con’t) _____________________________________ Third Stage – Final Stage Continual substance use, No longer gains pleasure or gratification

Confronting the Chemically Impaired Employee ___________________________ Step #1 a. Gather data to document your suspicions b. Check your organization’s policy re: urine toxicology or serum drug/alcohol screens

Confronting the Chemically Impaired Employee ___________________________ Step #2 a. Direct confrontation between the manager & the employee 1. Expect denial & anger 2. Share evidence 3. Focus on performance 4. Dismissal may be necessary

Confronting the Chemically Impaired Employee ___________________________ Step #3 Discuss organization’s plan for the employee to overcome chemical impairment (Contract)

The Manager’s Top Priority ___________________________ First PROTECT PATIENTS! SecondIdentify performance expectations confront the employee when they are not met Third Refer employee for help

Recovery Process ___________________________ Phase #1 - Denies the significance or severity of the chemical impairment Phase #2 – Denial ends (Break Through Phase) a. Realizes negative impact b. Hopeful

Recovery Process ___________________________ Phase #3 – Examines values & coping skills a. Develops more effective coping skills b. Joins a Support Group c. Feels humiliation

Recovery Process ___________________________ Phase #4 – Last Phase a. Understands why (s)he became addicted b. Develops coping skills to deal with stressors c. Increased self-esteem & self-respect

State Boards of Nursing Diversion Program Goals ___________________________ 1.Protect the public by early identification of the impaired RN 2.Provide access to intervention programs & treatment services

Reentry Guidelines for the Recovering Nurse ___________________________ 1.No psychoactive chemical use 2.Day shift assignment for one year 3.Pair with a successful recovering nurse if possible 4.Random urine toxicology or alcohol screens 5.Attend AA or NA meetings several times per week 6.Attend a Structured Aftercare Program 7.Seek individual counseling or therapy prn

Case Study – Mr. Porter, RN __________________________ 1.First Licensed – June License Suspended – June Conviction of Misdemeanor Battery 4.Factors that incident – Anger Issues 5. Wants to Return to Army Reserve

Case Study – Mr. Porter, RN (Con’t) ______________________________ 6. Rehabilitation Measures a. 52 Week Batter’s Treatment Program b. 160 Hours of Community Service c. Completed a Mental Health Exam d. Support Network Family e.Goes to AA every 2-4 Weeks f. No Drug Screens g. No 12 Step Program h.Sobriety Date – Date of Incident