Substance Use Disorder
of Nurses: Ethical Dilemma or Disease
Process?
According to DeClerk (2008) “Substance use disorder is a
progressive disease which untreated continues to worsen leading to the addict’s
decline physically, psychologically, emotionally, and eventually their death”
(p. 22). Substance abuse is considered
an occupational hazard of nursing affecting 10% of nursing professionals. 6% of nursing professionals with substance
use disorder experience interference with their ability to practice (Michigan
Nurse, 2008). Impaired nurses are a
danger to not only themselves, but coworkers and patients in their care.
Behaviors indicative of substance use disorder must be
identified in order to confront a nurse believed to be impaired. Fleck (2012) recognized behaviors suggestive
of impairment as follows:
Unkempt appearance,
shakiness, tremors, pinpoint pupils, slurred speech, flushed face, bloodshot
eyes, smell of alcohol on breath, injuries such as bruises/burns/wounds,
increased physical complaints, increased reliance on prescription medications,
impaired motor coordination, personality changes, overreaction to criticism,
professional and social isolation, medication errors, illogical or absent
documentation related to controlled substances, discrepancies in documentation
related to controlled substances, excessive absences or tardiness, difficulty
focusing on task and forgetfulness, absent from unit without explanation, and
patient complaints of ineffective pain relief after being medicated. (p.22).
In addition to the list of behaviors offered by Fleck (2012),
DeClerk (2008) offered the following signs and symptoms of substance use
disorder:
Long trips to the
bathroom after being in medication/narcotic cabinet, volunteering for overtime
or showing up at work when not scheduled, unreliability with appointments and
deadlines, mistakes due to inattention and poor judgment, heavy wastage of
drugs, frequently breaks and spills drugs, usage of maximum PRN dose when other
RNs have used less, wears long sleeves when inappropriate, irritable with
patients, sleepy or dozing off while on duty, and defensive when questioned
about medication errors. (p.12-13).
So I recognize it, now
what?
The American Nurses Association (2013) believes that the
nurse’s duty of compassion and caring extends to self and colleagues as well as
patients. It is an ethical
responsibility to provide care to the impaired nurse. A substance abuse problem displays neglect of
self. The ANA supports peer assistance
programs, such as the Kentucky KARE program.
The Kentucky Board of Nursing has a program to identify, assist, and
monitor nurses whose ability to practice is impaired by substance use disorder (Kentucky
Board of Nursing, 2013).
It is the ethical obligation of a coworker to report an
impaired nurse as much as it is an ethical responsibility to not abuse
substances. Nurses have an obligation to
report impaired colleagues. Friendship,
concern for colleague’s reputation, and stigma associated with reporting can
cause hesitance to report. While many
factors dissuade nurses from reporting questionable behavior of a colleague,
legal and ethical duty require the nurse to uphold state and federal laws
pertaining to nursing practice. “The
nurse has a legal, as well as professional, responsibility to report an
impaired colleague, or any nurse to the Board that is suspected of misusing or
misappropriating drugs placed in the custody of the nurse for administration or
for use of others” (Fleck, 2012, p. 23).
Reporting an impaired nurse should be done following the
facility’s policies and procedure. The
staff must report findings objectively to the immediate supervisor (Fleck,
2012). Key factors to remember while
confronting and reporting an impaired nurse include remaining objective,
non-accusatory, non-threatening, non-confrontational, and maintain confidentiality
(Michigan Nurse, 2008). Substance use
disorder is dangerous and can lead to death if untreated. According to DeClerk, drug addiction is often
discovered in the workplace last and has already affected other aspects of the
individual’s life (2008). Identifying
and reporting an impaired nurse is necessary to protect the health and
well-being of the nurse and patients in their care.
References
American Nurses
Association (2013). Impaired nurse resource center. Retrieved from
http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/ImpairedNurse
DeClerk, P. (2008).
Recognizing the chemically impaired nurse. ASBN
Update, 12(4), 12-13.
Fleck, P. L. (2012).
HELP! I think I know a nurse who may be impaired! KBN Connection, (31), 22-23.
Kentucky Board of Nursing (2013, May
8). KARE for nurses program. Retrieved June 10, 2013, from
http://kbn.ky.gov/kare/
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