1. Working with the Impaired Nurse Sharon S. Parker sparker@capital.edu ONA convention, 2015

2.  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

3.  “impaired” is a questionable term since most nurses are high functioning and high achieving

4.  Primary  Chronic  Dysfunction of the brain  Treatable

5.  Rise of prescription misuse has caused most concern recently

6.  Abuse  Dependency  Addiction  Negative aspects of SA affect the nurse, patients, families  ANA estimates that 6-8% of nurses misuse drugs  Recent studies say 10-15% Substance Use Disorder

7.  Medical disorder where a person has a compulsion to take a drug/alcohol in order to experience the effects. Chemical Dependency

8.  Medical disorder marked by compulsive use of drugs/alcohol  Inability to stop using no matter what the consequences  Neurological changes Addiction

9.  The phenomena of needing more and more of a substance of abuse in order to get the same effect Tolerance

10.  Depression  Low self-esteem  Low tolerance for stress  Feelings of resentment  Access or availability of drugs  Genetic predisposition Predisposing factors

11.  Family trauma  Physical, mental abuse or dysfunction of family  PTSD

12.  Alcohol  Opioids  Stimulants  Marijuana  Rise of prescription misuse has caused most concern recently Drugs of Abuse

13.  Substance use is seen as acceptable  Faith in drugs to promote healing  Sense of entitlement  “special” status of health care providers makes them invulnerable to illness that patients get Problematic attitudes

14.  Self-diagnosis  Need to continue working  Not taking care of self

15.  Access  Attitude  Stress  Lack of education Top 4 Risk Factors

16.  Differentiate between impairment and stress-related behavior  Escalating behavior Identification of a Substance Use Disorder

17.  Impaired cognitive functioning and memory  Altered motor skills  Difficulty making decisions  Inability to copy with stressful situations Escalating Impairment Behavior

18.  Slurred speech  Lack of coordination  Frequent tardiness or poorly explained absences  Smell of alcohol on breath  Impaired memory—”blackouts” Signs and symptoms

19.  Sloppy charting  Attire  Geographic cure sought  Diversion of patient drugs for own use Job performance

20.  Excessive use of sick time  Calling in sick on Mondays  Unexplained absences from the unit  Consistently volunteering to be the medication nurse Job Related Behavior

21.  Patients need more narcotics  Discrepancies  Opioid count  Ordering for patients that have been discharged or died  More “spills” than others

22.  Emergency room nurses  ICU, ER, OR  Psychiatric nurses  Nurse anesthetists  Night nurses Rates of Abuse among Specialties

23.  Women more likely to abuse prescription drugs  Males more likely to abuse illegal drugs and alcohol  Oncology nurses more inclined to drink alcohol Gender

24.  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?

25.  A cluster of behaviors that allow the person with a substance abuse problem to keep using  Family members  Colleagues Co-dependence

26.  Being proactive  Screening  Regular monitoring  Guidelines  Referral to treatment What to do?

27.  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

28.  Recognize personal values  Know in-house resources  Document  Feel capable of coordinating nurses re-entry at work  Recognize signs of relapse

29.  Planned meeting with nurse and family, colleagues to break through the pattern of denial intervention

30.  Alternative Program  Monitoring  Return to work guidelines Board of Nursing

31.  Legally?  Morally?  Ethically? Obligations to colleagues

32.  Substance Use Disorder Nursing: a Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs National Council of State Boards of Nursing Reference