1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17 Impaired Nursing Practice: What Are We Doing About It?

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevalence of the Problem Estimates vary Efforts to quantify problematic NCSBN: 16% of nurses suffering from addiction to alcohol and/or drugs Estimate of between 10% to 20% of nurses will have a substance abuse problem some time in their lives. Previous belief: issue of prevalence not as important as patterns of abuse Current belief: can nurse practice safely?

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview of Literature Research about impaired nursing practice lacking Review of recent literature with limited new material –Mostly discussion or anecdotal accounts; few research based Burman and Dunphy (2011): barriers with confronting a colleague Pinto and Schub (2010); evidence-based care sheet –What we know; what we can do No consistent theme

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Early Risk Factors for Substance Abuse Age: younger practitioners at higher risk General moderate usage of alcohol as predictor for any drug use Social contact—not a risk factor Implications –Education of new grads, younger nurses (starting in nursing education community) –Not dismissing alcohol as legal drug of less significance –Need for reporting impaired colleagues

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Positions of National Nursing Organizations ANA –Ethical duty of nurse to patient—advocacy; nurse must report impaired colleague –Support for treatment (not discipline), process for facilitating reentry

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Positions of National Nursing Organizations (cont.) AACN –Policy development in nursing education; prevention, management of substance abuse for students, faculty, staff; attention to confidentiality, legal perspectives –Agreement with ANA of importance of treatment, reentry

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Positions of National Nursing Organizations (cont.) NCSBN –Publication of Substance Use Disorder in Nursing (2011); available on website Practical and evidence-based guidelines for evaluating, treating, and managing nurses with substance use disorder –Support for early detection and treatment with goal of return to practice

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The literature is filled with all types of recent research related to impaired nursing practice.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Recent literature and research about impaired nursing practice is very limited.

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse Reporting—Issues and Ethics No uniform agreement among states for reporting requirements –Reporting requirements from each state board of nursing Recognition of impairment necessary; common signs or behavior changes (see Box 17.2) Ideal: nurse’s job to protect patient from harm, including reporting impaired colleague Historically, possible “code of silence” Currently, other reasons

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse Reporting—Issues and Ethics (cont.) Barriers to reporting: –Lack of general knowledge –Lack of clear protocols or process for reporting –Lack of compassion in workplace for peers –Confrontation terminology

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Impaired Practice Policies in the Workplace Essential for every facility, educational institution to have Impaired Practice Policy –Commitment to drug- and alcohol-free workplace –Procedures for return to workplace (signed contract, restrictions on handling narcotics, random urine testing) –No confrontation unless a plan in place

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Alternative to Discipline/Diversion Programs Through 1980s—disciplinary approach After ANA resolution in 1982, treatment and rehabilitation options as the focus Most states offer treatment; program types vary, some voluntary Intervention Project for Nurses (FL) California diversion program Texas Peer Assistance Program for Nurses Little information about programs for nursing students

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Most states promote the use of treatment options rather than discipline for an impaired nurse.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Most states offer treatment and rehabilitation options instead of discipline for impaired nurses.

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Recovered Nurse: Reentry Into Practice Issues: –Limited or restricted practice –Length of time board can invade nurse’s privacy to ensure recovery is ongoing –End point for organizational responsibility –Cost bearing if nurse does not return to work at full capacity –Confidentiality maintenance (see Box 17.3)

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Recovered Nurse: Reentry Into Practice (cont.) General considerations: –Practice restrictions –Assurance of confidentiality of records, being kept separate from general personnel records –Staff realization of recovering nurse’s commitment

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Recovered Nurse: Reentry Into Practice (cont.) Most Board of Registered Nursing websites with little information on reentry process –Issues of how long to follow the recovered nurse –Random drug testing & invasion of privacy Last-Chance Agreement Other suggestions –Written contract: nurse’s expectations; voluntary agreement –Attendance at support group for chemically dependent nurses

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Research Dissemination—Is It Happening? Question: profession, educational community applying/using findings currently on hand? Need for impaired-practice policies in every health care setting including education –Many nurses unaware of policies –Information about policy as part of orientation, annual renewal of safety procedures –Need for nurses to ask questions

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Stopping the Loss of Nurses to Substance Abuse Increasing focus on preventive health care; still lagging behind what would be ideal –Risk factors difficult to modify –Nursing shortage continuing Education about substance abuse, self-awareness about attitudes and beliefs of those who use substances

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Stopping the Loss of Nurses to Substance Abuse (cont.) Possible approaches –More fully explore experiences of nurses not turning to substances Use of self-care to prevent burnout same as for preventing substance abuse?

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Stopping the Loss of Nurses to Substance Abuse (cont.) Necessary questions to answer: –How is stress channeled for positive or negative coping strategies? –What are hospitals doing to acknowledge, diffuse stress? –Are nurses too stressed to seek counsel from each other? –Are nurses debriefing?

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Impaired-practice policies are inappropriate for an educational institution.

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Impaired-practice policies are essential for every health care institution and educational institution.

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation