Impaired Nurse Essay

The American Nurses Association (ANA) defines an impaired nurse as one who “has cognitive, interpersonal or psychomotor skills affected by psychiatric illness and/or drug or alcohol abuse or addiction.” They go on to state that an impaired nurse “is unable to meet the requirements of the code of ethics and standards of practice of the profession.” Impaired nurses may be under the influence of alcohol, amphetamines, opioids, inhalants, sedatives, hypnotics, or tranquilizers. Some of these drugs may be obtained illegally, whether on the street or by diverting them from patients to whom they are prescribed, or through legal prescriptions used improperly before or during work. (tlcprojects.org) Warning signs of impairment include multiple errors in documentation or judgement, elaborate excuses, declining work ethic, and increased tardiness or sick days. Warning signs specific to alcohol impairment/abuse include alcohol breath, hand tremors, unusual drowsiness at work, mood swings, irritability, avoidance of coworkers, slurred speech, and excessive use of breath
mints or mouthwash. Warning signs specific to drug impairment/abuse include refusing narcotics tests, regularly administering maximum PRN doses when most nurses administer a lower dose, preference of evening or night shift, pinpoint pupils, rhinitis, lacrimation, diaphoresis, offering to give additional medications to patients, wearing long sleeves even in hot weather, and increased patient complaints of uncontrolled pain. (aana.com) According to the PA State Board of Nursing, a nurse who is found to be impaired may have their license suspended or revoked. (SBON Board Laws and Regulations) However, in Pennsylvania the Nurse Board is able to decline disciplinary action if an impaired nurse agrees to enter into an approved treatment program, signs an agreement with the Nurse Board, and makes progress that is deemed satisfactory by the board. The Pennsylvania Nurse Peer Assistance Program (PNAP) has been created to provide support to impaired nurses. The focus isn’t on removing an impaired nurse’s license, but rather treating and rehabilitating the nurse so he or she can safely provide care to their patients. (Pennsylvania SBON Newsletter, 2009) Becoming an RN is a lot of work.
With many facilities being understaffed, RN’s can pick up a lot of overtime. Combine a hectic work schedule with all of the other demands in a nurse’s life and it is easy to understand how he or she could become overstressed. Some may choose to turn to drugs or alcohol to help them cope with their stress. It may help calm them or, in the case of amphetamines, might give them the energy they need to get through their next shift. Studies have also shown a correlation between the occupational environment and the use of drugs and alcohol. The more dissatisfied a nurse is with her work environment, the higher chance he or she may turn to drugs or alcohol. (Occupational Environment article) Whatever the cause of the nurse’s drug or alcohol use, it is crucial that there be a way that an impaired nurse can get treatment to overcome drug or alcohol addiction without fear of
judgement. Obviously, a nurse’s number one obligation is to the patients. If a nurse is suspected of being unable to safely perform his or her job because of drug or alcohol use, it is important that he or she is reported to the charge nurse or nursing supervisor on duty. It is not something that can wait to be reported until after the shift. It needs to be reported immediately for the safety of the impaired nurse’s patients. According to American Nurse Today, many substance-abusing nurses will not seek treatment until they are confronted by coworkers, family, or nursing management, or they are in danger of losing their job. Nurses who abuse drugs or alcohol can continue to be very successful in the nursing field if they enter and complete a structured treatment program. (americannursetoday.com) There is no doubt that nurses are overworked. With such a nursing shortage, it is next to impossible to avoid overtime. It can be quite easy for an exhausted or burnt out nurse to turn to drugs or alcohol to cope, but this makes them unsafe in the workplace. It is vital that he or she receives the help needed to enter into and complete a treatment program. He or she should be encouraged to report the substance abuse personally. However, if he or she chooses not to, it is the responsibility of anyone who witnessed the impairment to report the event to their charge nurse or nursing supervisor. The safety of the patients must come first.