Transcript The Impaired Nurse

The Impaired Nurse
Michelle Klenk
Ferris State University
NURS 450
Background of the impaired nurse
It is estimated that 10-15 percent of all nurses in the United States are addicted to
some type of illegal or controlled substance (Heacock, 2013).
Nursing is a highly esteemed profession
but with that the nature of the job is both
demanding and stressful.
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Why???
Stress- long hours of caring for critically ill
and dying patients.
Job work area- nurses that work in ICU, ER,
OR, or anesthesia have the highest
prevalence of substance abuse, because they
are considered high stress settings.
Workaholic personality leads to addictions
In general nurses take care of themselves
last. Hiding personal needs first to tend to
the needs of their patients and others.
Heacock, S. (2013). Nurses And Substance Abuse. Retrieved from
http://www.nursetogether.com/nurses-and-substance-abuse
Signs and Symptoms of the Impaired Nurse
Thomas, C. (2011). The Impaired Nurse. American Nurse Today. Retrieved from http://www.medscape.com/viewarticle/748598_6
Erik Erikson’s Psychosocial Theory
Harder, A. (2011). The Developmental Stages of Erik Erikson. Support4Change.com. Retrieved from
http://www.support4change.com/index.php?option=com_content&view=article&id=47&Itemid=108
Stages of Change Model/Transtheoretical Model
(TTM)
Prochaska and Diclemente
Model has been the basis of
developing effective
interventions to promote
health behavior change
• Describes how people
modify a problem behavior
or acquire a positive
behavior
• TTM is a model of
intentional change.
• Model focuses on the
decision making of an
individual
• Model has been widely
applied in behavior
modification techniques
Core Constructs of TTM:
The process of change
Decisional balance
Self efficacy
Temptation
Stages of Change Model/Transtheoretical Model (TTM) (2012, January 26). In Nursing Theories: a companion to nursing theories
and models. Retrieved from http://currentnursing.com/nursing_theory/transtheoretical_model.html
Analysis of the issue:
Knowledge of medications and willingness to
self medicate for relief
Lack of self care putting one’s own needs last.
Role strain at home related to working long
hours and high stress
Loss of control of one’s life related to stressors
of the job
Job stress*Long Hours*Increase workload*Emotional ties with
patients*Easy access to medications
Leads to nurses caring for patients while
using substances. Impairs judgment.
Patient safety and health at risk.
Implications for Impairment
Nurse are at risk for substance abuse for many reasons
• Availability of medications
• Increased stress and workload
• Knowledge of medications
Implications/Consequences
• Loss of Nursing License
• Loss of Job
• Risk for Imprisonment
Outcomes
• Early identification of substance abuse
• Employer rehabilitation programs and counseling
• Legal issues
McCue, C. (2010, November 9). Using the AACN Framework to Alleviate Moral Distress. The Online Journal of Issues in Nursing, 16(1).
doi:10.3912/OJIN.Vol16No01PPT02
Assessment of the Health Care Environment
The worse thing you can do if you suspect a co-worker is addicted to drugs or
alcohol is to do nothing.
Approaching directly will likely meet with resistance and denial
Report suspicions to management, which leads to the nurse receiving help.
Most employers offer drug and alcohol treatment programs but there are several
nationwide programs as well.
Resources for the impaired nurse:
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Alcoholics Anonymous www.aa.org
International Nurses Society on Addictions www.intnsa.org
ANA Impaired Nurse Resource Center
http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/WorkEnvironment/ImpairedNurse.
Health Professionals Recovery Programs www.hprp.org
Narcotics Anonymous www.na.org
Impaired Nurse Resources Center (2012). In American Nursing Association: Nursing World. Retrieved from
http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Work-Environment/ImpairedNurse/Impaired-Nurse-Resources.html.
Quality and Safety Recommendations
from QSEN
Patient-Centered Care
• "Recognize the patient or designee as the source of control and full
partner in providing compassionate and coordinated care based on
respect for patient's preferences, values, and needs.“
Teamwork & Collaboration
• "Function effectively within nursing and inter-professional teams,
fostering open communication, mutual respect, and shared decisionmaking to achieve quality patient care.“
Safety
• "Minimizes risk of harm to patients and providers through both
system effectiveness and individual performance.“
Quality and Safety Competencies (2012). Retrieved from http://www.qsen.org/competencies.php.
American Nurses Association Scope and
Standards of Practice
The ANA has several standards of practice, the
following apply directly to the impaired
Nurse:
Standard 7: Ethics
Maintains a therapeutic and professional
healthcare consumer-nurse relationship
within appropriate professional role
boundaries.
Takes appropriate action regarding instances of
legal, unethical, or inappropriate behavior
that can endanger or jeopardize the best
interests of the healthcare consumer or
situation.
Standard 10: Quality of Practice
Demonstrates quality by documenting the
application of the nursing process in a
responsible, accountable and ethical manner.
ANA Scope and Standards of Practice (2nd ed.). (2010). Silver Spring, MD: American Nursing Association.
National Council of State Boards of
Nursing
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Prior to the 1970’s nurses were fired by employers or disciplined by the board of
nursing when evidence of substance use was apparent.
Non-disciplinary programs offering an alternative to traditional discipline have
been used since the 1970’s.
Treatment is individually tailored to meet needs and supportive monitoring
systems are used.
Recovering nurses can recover and return to practice safely
Extensive scientific evidence shows that approaching substance use disorders as
treatable illness is extremely effective for an individual using substances, as well
as for society.
National Council of State Boards of Nursing (2013). Substance Use Disorder in Nursing. Retrieved from https://www.ncsbn.org/2106.htm
Recovering Nurses
One Nurse’s story. An addiction to pain killers lost her job, her family
and her life. In remission. On the road to recovery
https://www.youtube.com/watch?v=chmOrO9fNCc
Conclusion
An impaired nurse is a risk to their self, their patients, and their co-workers.
Goal of intervention is early detection and aiding in getting help for that person
Many fear of intervening because they do not want to get their friend or co
worker in trouble when in reality, this is an illness that needs immediately
medical attention. Nurses often times may overlook their problem of addiction
more so than a typical person because they are used to putting their needs
last. This is a large part of the problem, denial. Having an addiction problem
doesn’t have to mean their career and life is over. With early intervention and
successful therapies and assistance programs the road to recovery is
achievable.
References
ANA Scope and Standards of Practice (2nd ed.). (2010). Silver Spring, MD: American Nursing Association.
Harder, A. (2011). The Developmental Stages of Erik Erikson. Support4Change.com. Retrieved from
http://www.support4change.com/index.php?option=com_content&view=article&i
d=47&Itemid=108
Heacock, S. (2013). Nurses And Substance Abuse. Retrieved from http://www.nursetogether.com/nurses-andsubstance-abuse
Impaired Nurse Resources Center (2012). In American Nursing Association: Nursing World. Retrieved from
http://nursingworld.org/MainMenuCategories/WorkplaceSafety/WorkEnvironment/ImpairedNurse/Impaired-Nurse-Resources.html.
McCue, C. (2010, November 9). Using the AACN Framework to Alleviate Moral Distress. The Online Journal of Issues
in Nursing, 16(1).doi:10.3912/OJIN.Vol16No01PPT02
National Council of State Boards of Nursing (2013). Substance Use Disorder in Nursing. Retrieved from
https://www.ncsbn.org/2106.htm
Stages of Change Model/Transtheoretical Model (TTM) (2012, January 26). In Nursing Theories: a companion to
nursing theories and models. Retrieved from
http://currentnursing.com/nursing_theory/transtheoretical_model.html
Thomas, C. (2011). The Impaired Nurse. American Nurse Today. Retrieved from
http://www.medscape.com/viewarticle/748598_6
Quality and Safety Competencies (2012). Retrieved from http://www.qsen.org/competencies.php.