The Chemically Impaired Nurse - Article Example

The Chemically Impaired Nurse Introduction: Chemical dependency among health professionals is a great problem that threatens professional standards and the delivery of standards of care and services. A chemically impaired nurse is not an exception. A nurse, otherwise, is the final common pathway for management and care in healthcare disciplines and may commit serious errors in medication administration or other aspects of delivery of care under the influence. If left unchecked and uncontrolled, a chemically impaired nurse may pose grave consequences for the consumers in terms of outcome. The risky behaviour of the chemically impaired nurse needs to be managed accordingly (Robert Wood Johnson Foundation, 2002). Identifying addiction in the working nurses and recognizing the impact of substance misuse and related activity in the nurses would not end there. The nurses have easy access to medications which they administer to the patients. Their knowledge allows them to know the function of the medications. Various factors such as workplace stress, life issues, and their psychological makeup may promote them to take recourse to chemicals, maybe initially just as a trial. Gradually, this becomes an addiction without much of announcement, and the nurse starts to abuse the drugs under their disposal. Since a ready source of the chemical is available, it is extremely difficult to curb this unless the nurse is made to get away from the source. Appropriate mentoring and strict monitoring is essential to make that happen, detection and steps to get rid of chemical dependency. The other side of the picture is to support the chemically impaired nurse to recover from addiction (Impaired Nurse Resource Center). Like any other profession, nurses may present with addiction even under the most routine circumstances. Unless the right person asks the right question, such nurses may go undetected and untreated. The nurse manager who has a role to play the chemically impaired nurse working under her must remember that substance use disorders do not appear in isolation, but often result from embedded patterns of addictive behaviour from early family life. Significant numbers of professionals including nurses experience substance abuse problems that affect their ability to practice. Some do seek recovery, but many continue to practice undetected. The accurate estimate of the problem in terms of statistics is very difficult to obtain, and the American Nurses Association estimates that 6% to 8% of the nurses may have a drug or alcohol problem. For some, the substance use is the primary problem, while for others, the substance use may have begun as treatment for other condition, such as, back pain or depression. Depression is a very frequent accompanied disorder for nurses, women who are highly likely to experience some type of trauma earlier in life, and depression is often present in nurses with substance use disorder (Counseling Points, September 2007). Nurses those who are chemically impaired pose a potential threat to those they care for, and they have neglected above all to care for themselves. According to American Nurses Association, the nurse’s duty to compassion and caring extends to themselves and their colleagues as well as to their patients. A nurse manager is essentially a nurse, and the nurses she mentors or manages are her colleagues, and all the patients served by nurses under her supervision are indirectly her patients. The nurse manager’s responsibility, therefore, encompasses insurance of safety of the patients, caring for all the nurses she manages, and also extending special care to the chemically impaired members of her fraternity, if one is under her management (Nursing World Code of Ethics). The nurse manager is required first to pay adequate attention to the prevalence of chemically impaired nursing practice. A strict following of code of ethics would lead to a stand point of action. In a situation where the manager suspects a nurse’s practice to be impaired, it is her duty to take action designed both to protect patients and assure that the impaired individual receives assistance for recovery and regaining optimal function, implying that the impaired nurse must receive disciplinary action as a professional for not meeting professional standards, and her problem of chemical impairment gets attention as any other patient’s would have received. The stern disciplinarian in the manager would also require seeking ways to assist those nurses with substance addiction or psychiatric disorders to pursue recovery and regain their careers with restored impairment to efficacy (U.S. General Accounting Office, 2001). The nurse manager, therefore, would need to maintain a watchful eye in the clinical area. It is, however, not possible to routinely and periodically screen all nurses for problematic use of substances, defined as any illicit drug use; any risky, hazardous, or harmful alcohol use, and any misuse of prescribed medications. There are recognizable findings detectable upon physical examination that may be revealed in an addiction detection clinical examination session, but some signs are observable to a trained eye. The manager needs to use her trained eye and vigil to suspect an impaired nurse. The best and welcome scenario to the ideal nurse manager is to create an environment where the impaired nurse admits to the use of substances. This does not happen very frequently, and thus, a few of the recognizable findings that can raise the suspicion of addiction even if the suspected nurse denies substance use are better to be learned by the manager (Yocom, C. J. & Haack, M. R., 1996). These signs include changes from previous physical examination. The manager to be able to trace a hint of change in physical examination needs to be in close and cordial contact with the managed nurses. The same thing is applicable to poor nutritional status. Poor nutritional status suggested by weight change is another marker of chemical dependency. The manager should watch out for poor personal hygiene of the nurses. Poor personal hygiene is evidenced by bad breath, body odor, unwashed hair, or dirty clothing. More important is the intoxicated or abnormal behavior, especially slurred speech and staggering gait. Signs of physical abuse may also indicate addiction. These include bruises, lacerations, scratches, burns, needle marks, sores, or abscesses. Skin rashes, skin discoloration, hair loss, excessive sweating, and irritation of the head, eyes, nose, and throat all point to chemical dependence. Cognitive skills that are so important in nursing may get impaired, and this may extend to sensory, motor, or memory impairment. This last point has gross and massive significance in patient care and is highly likely to result into impairment of care of the patients. The impaired nurses may also demonstrate drug seeking behavior. These are vague physical complaints and requests for medications to improve sleep, energy, anxiety, concentration, and indigestion. The impaired nurses would either steal medications from the patient boxes leading to mismatch of indent and use. They would often request for samples of medications; even they would refill prescriptions earlier than schedule (American Nurses Association, 1984). The nurse manager’s goal would be thus to identify at-risk and impaired nurses who demonstrate the outlined substance abuse behavior and to manage them. The managers are keys to this effort since they have access to the nurses both on the supervisory level and professional level where there are frequent and long points of contact. The manager can ask verbal questions or have the nurse fill a self-report form. Since her role is dual, the manager should focus on the screening as a part of an overall health improvement plan and would be able to discuss the benefits of stopping, decreasing, or remaining free of substance use. Thus, the manager would be able to uncover the full picture of the individual’s use pattern. Laboratory tests and urine toxicology screens can identify physiologic dependency, although this would fail to detect at-risk nurses and will have potential to breach the manager-nurse cordiality (International Nurses Society on Addictions, 1997). Summary: When established, the impaired nurse is to be managed again by bimodal actions. The ethical responsibility of the nurse manager would dictate that impairment of practice would call for disciplinary action. Since nurse’s primary role is to be vigilant to protect the patient, public, and profession from potential harm from a colleague’s practice that is impaired, the manager would take action designed both to protect the patient from potential harm. Disciplinary action would call for relief from duty of the impaired nurse until she is declared free and recovered and ready to be rehabilitated to the work. The other part of the manager, again, is bound by ethics to extend compassion and caring to the colleagues when their illnesses interfere with job performance. This can be extended to the phase of the recovery of the impaired nurses. Recovery by professional treatment is not enough unless the manager extends assistance to regain optimal function. Such action may include consultation with professionals who can handle addiction and may also include confronting the impaired nurse in a supportive manner with assistance at a personal level and from others. This also includes helping the individual nurse to access appropriate resources. The manager would need to create an environment among her subordinates so that they not only follow the guideline of the employer in this regard. This would not only involve taking action to report the impaired nurse to persons authorized to address the problem, the reason being the impaired practice poses a threat or danger to self and others, mainly patients. This would have negative consequences to the career of the impaired nurse. The ethical responsibility now calls for assist a colleague whose job performances are adversely affected by mental or physical illness or by personal circumstances. The manager should be an advocate for colleagues who are in trouble, so that appropriate and legitimate assistance, treatment, and access to fair institutional and legal processes are ensured for them. The most important of these is supporting the return to practice after recovery for the impaired nurse who sought assistance, has become clean, and is ready to resume professional duties. During this period, the suffering nurse would need many resources since her license would be suspended, and she would be in severe financial problems. There are many state-based resources which can be utilized, and the manager would serve as the liaison between these resources and the affected impaired nurse. Workplace policies may be inappropriate in that they deny the impaired nurse to access due legal process and may demand resignation. In such situation advocacy by the manager may become very difficult, and she is bound by law to follow workplace regulations. She can always help the impaired nurse on a personal level to access appropriate resources (State Based Resources), guidance from professional nurses’ associations, state peer assistance programs, employee assistance programs, or similar resources. Reference American Nurses Association (1984). Addictions and psychological dysfunctions in nursing: The profession’s response to the problem. Kansas City, MO: ANA, 1984:2 Counseling Points September 2007; accessed from http://www.nxtbook.com/nxtbooks/dmg/cp0907/. Accessed on November 9, 2007. Impaired Nurse Resource Center. Accessed from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workplace/ImpairedNurse.aspx#below Accessed on November 9, 2007. International Nurses Society on Addictions (1997). Peer assistance. Position paper. Nursing World Code of Ethics. Accessed from http://nursingworld.org/ethics/code/protected_nwcoe813.htm.Accessed on November 9, 2007. U.S. General Accounting Office, (2001). Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944). Washington, DC: Author. Yocom, C. J. & Haack, M. R., (1996). An Interim Report: A Comparison of Two Regulatory Approaches to the Management of Chemically Impaired Nurses. (Available from the ational Council of State Boards of Nursing, 676 North St. Clair Street, Ste. 550, Chicago, IL, 10 60611-2921). Read More