Operating in a healthcare setting while under the influence of drugs and other substance is a violation against the nursing practice act and hence considered as a legal/regulatory issue. It poses a risk to both the patient and the nurses. Chemically impaired nurses expose the healthcare facility to possible litigations due to an occurrence of medical errors. A study established that in 2009, the one-year prevalence of the nurses in the United States with identified substance use problem was 17,085 approximately 0.51 of the nursing population (Monroe, Kenaga, Dietrich, & Carter, 2017). During the same time period, the one-year prevalence of the nurses newly enrolled in the substance abuse monitoring programs in the US was 12,060 or 0.36% of the nurse’s population. The factors influencing the nurses’ chemical impairment include easy access to drugs, the work environment in a critical care specialty, job-related stress, depression, understanding of medications, and enabling colleagues (Thomas & Siela, 2011). The paper will present the measure that a nurse leader should take to establish whether a nurse is chemically impaired, discuss a possible recovery program, and establish measures that may be applied by the facility to deal with the issue of chemical impairment among nurses.
Investigating an Allegation of Chemical Impairment
It is essential for a nurse executive to establish the basis of the accusation of chemical impairment among nurses. The first thing that a nurse executive should consider is on the medication errors that the nurse committed in a span of one week. This will help the nurse executive establish the level of negligence that could be associated with the nurse’s action. The next step would be to carry out an audit for all the medical records to establish any discrepancies. The nurse executive should make direct observations and document any signs and symptoms. Some of the signs that are expected to be observed include the quality and accuracy of documentation, attendance and time consciousness, somnolence, mood shifts, and tendencies and isolation. Other issues that the nurse executive may consider include a comparative rate of PRN narcotic administration among all nurse staff and establish any outliers, establish medication errors, as well as incorrect narcotic counts. Where evidence indicates that the nurse is chemically impaired, it is important for the nurse executive to have the affected nurse undergo a screening and assessment to ascertain the intoxication. The screening and assessments are meant to identify and refer individuals at risk for substance abuse as well as establish the extent of symptom-severity (National Council of State Boards of Nursing, 2011). The screening may be carried out through self-administered questionnaires.
A recommended strategy by the State of Arizona for assisting the nurses who are chemically impaired is Chemically Addicted Nurses Diversion Option (CANDO). The Arizona State Board of Nursing indicates that CANDO is an initiative by the Board of Nursing that is non-disciplinary, and confidential monitoring program for chemically impaired nurses who were established to meet the criteria for admission into the program and who would voluntarily join the program (Arizona State Board of Nursing, 2016). This program is voluntary and requires a three-year commitment by the nurse. The program seeks to assist the nurse in avoiding any relapse and create a basis for total recovery from drug and substance addiction. The programs require that the nurses undertake random urine drug screens, attend alcohol and narcotics anonymous meetings, group meetings, work restrictions, and abstinence by the nurse from using any narcotics or alcohol.
Nurses under the program are allowed to continue working but with a restriction on narcotic medication administration. Such a program is beneficial to the healthcare facility. It offers an opportunity for the nurse to continue being engaged in the duties thereby, eliminates the need of hiring nurses to replaces those affected.
Strategies to Improve Costs and Improve the Quality of Healthcare
Among the key strategies that will be used to improve quality of care would be to use nurse’s education on the addiction process, means of identifying nurses with chemical impairment issues, and implementation of effective interventions. Provision of nurses’ education will be essential in this case. The nurse executive has a role to play in enhancing the nurse’s knowledge and attitude on substance abuse. Coggins (2017) indicated that the education is an essential component of any drug prevention program and it helps the healthcare practitioners understand their duties in preventing diversion of medication.
The next strategy will entail the development of a hospital policy on how to deal with issues of chemically impaired nurse practitioners. This is an effective strategy seeking to promote safety and offer guidance to the nurse practitioners within the facility. The policy will contain guidance to promote safety for the nurses and the patients and outline the steps to be followed to provide assistance to the nurses who suffered substance use impairment. The policy should declare that facility as a drug-free workplace and seek to maintain this status. Among the recommendations to be provided on the policy will be the measures meant to minimize the risk of impaired nurses on the healthcare facility. These will include pre-employment drug testing, for cause testing after logical suspicion, and fitness to practice evaluations.
Arizona State Board of Nursing. CANDO Program. (2016). Retrieved from https://www.azbn.gov/discipline-complaints/cando/
Coggins, M. D. (2016). Drug diversion by health care professionals. Today’s Geriatric Medicine, 9(6), 6.
Monroe, T. B., Kenaga, H., Dietrich, M. S., Carter, M. A., & Cowan, R. L. (2013). The prevalence of employed nurses identified or enrolled in substance use monitoring programs. Nursing Research, 62(1), 10.
National Council of State Boards of Nursing, & National Council of State Boards of Nursing. (2011). Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs. Author, Chicago, IL.Thomas, C. M., & Siela, D. (2011). The impaired nurse: Would you know what to do if you suspected substance abuse. Am Nurse Today, 6(8), 1-9.
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