Impaired Nurses: Reclaiming Careers. By Emil Vernarec. She may suffer from depression. He may depend on drugs or alcohol just to get by. She may hide a medical condition that's slowing her down. But do they know that more and more nursing boards are intervening to provide help? By ANDREA SLOAN, RN, JD, and EMIL VERNARECANDREA SLOAN is an attorney in private practice in Mc. Lean, Va. She specializes in healthcare and employment law, bioethics, and risk management. EMIL VERNAREC is a senior editor on RN. Jane had been a med/surg nurse for 2. Recently, marital and family problems were pushing her toward a breakdown. One night at work, she took a Xanax from a patient's medication drawer. It helped ease her tension. So from then on, she took more meds, working her way up to narcotic analgesics. Confronted by her manager, Jane indignantly denied any wrongdoing and resigned immediately. Over the years, Jane moved through a series of nursing home jobs, quitting whenever a supervisor became suspicious of her. Impaired Nurse Program MarylandAt her last job, she was caught hiding a syringe containing morphine in her pocket. She lost her job, was arrested for possession of a narcotic, and, followinga conviction, lost her nursing license. Impaired Nurse Program PaKevin, an orthopedic nurse, had begun weekend binge- drinking in college. Eight years later, he still indulged in the habit several times a month. He denied being analcoholic because he could . One Monday, Kevin came to work clearly hungover. He told his manager that he had been up late with some friends. But during that shift, he administered the wrong antibiotics to two patients with similar names. His manager made no mention of the drinking, just the medication errors, fearing a lawsuit for defamation of character. Even though some impaired nurses may appear to function well, the potential for harm exists, noted Smith, as an impaired nurse can impact their own health. One is define and one is describe, and I think if I were to define what an impaired nurse was. Impaired nurses and certificate holders may be referred to the program through self-reports, formal complaints and/or the Board of Nursing identification. Millie suffered from clinical depression. A few days a month, she simply could not manage to make it out the door. At first her co- workers were sympathetic; lately, though, her unreliability, her glumness, and her increasing isolation had become an annoyance. After showing up late for work three times in one month, Millie was fired. She made a weak suicide attempt, taking a small overdose of sleeping pills and then calling her daughter. The ED physician who treated her felt obligated to report the suicide attempt to the Board of Nursing. After a hearing, her license was suspended for two years. Linda had a . Her doctor advised surgery, but Linda, a single parent with college- age children, felt she couldn't afford the time off. With increasing frequency, she took shortcuts just to make it through her 1. On one particularly busy day, when the ICU was short- staffed and Linda was in extreme pain, her patient coded. Linda could not get up out of her chair to assist. Linda was fired and her inaction was reported to the state board, which suspended her license for two years. You may know a nurse just like one of these—no longer able to practice with reasonable skill and safety because of impairment from drugs, alcohol, a mental health disorder, or physical illness. Their impairments put their patients at risk, cost them their jobs, and jeopardized their nursing licenses. There is no question that action was necessary, given the risk to patient safety. What's troubling is that, in each case, a treatable medical condition had to be handled through a disciplinary process. In 1. 99. 2, when RN last reported on nurses impaired by substance abuse, only 1. Boards of Nursing provided an alternative to a disciplinary approach. Legislation to establish such programs was pending in 1. Today, according to the last survey by the National Council of State Boards of Nursing, 3. In addition to rehabilitating nurses with chemical dependence, most of these programs also serve nurses impaired by certain mental illnesses, such as anxiety, depression, bipolar disorder, and schizophrenia. Some cover nurses with physical disabilities as well. Compassion has practical advantages. Impaired Nurses Articles. 2001, Impaired Nurse. PROGRAMS FOR CERTAIN IMPAIRED PROFESSIONALS. The advisory committee would establish criteria for nurse participation in the program. Chemical Dependency and Impaired Nursing Practice Provided by the Wisconsin Nurses Association Peer Assistance Advisory Council 6117 Monona Drive, Suite 1, Madison, WI. The Profession's Response to the Problem of Addictions and Psychiatric Disorders in. PeerAssistance Program forNurses Impaired by Illnessor. Several factors have led state boards to adopt such programs. First, a punitive system creates barriers to reporting and keeps impaired nurses from getting help. Nurse colleagues or practitioners who are treating an impaired nurse may well hesitate to report something that could cost a nurse her job and license. From an employer's standpoint, the fear of litigation often makes it easier to dismiss a nurse without charges of misconduct. But this practice leaves the nurse, who is at risk of harming patients and herself, free to seek work elsewhere. Even if a nurse is reported to the state board, a purely disciplinary approach to impairment not only shows an utterly . A board investigation can take months, during which time the nurse in question can continue working without restraint. If she is licensed in another state, she can simply move away to avoid disciplinary action altogether. A perfect example is the story that appeared last fall in the Chicago Tribune's series on nurses and medical errors. Placed on probation in June 1. May 1. 99. 9. 3. By contrast, in the same time period, a nurse referred to an impaired practitioner program could be well on her way to recovery and back to work under close monitoring. A review of Florida's Intervention Project for Nurses—the first of its kind, established in 1. Finally, an alternative program is cheaper to administer than an investigation. In the Diversion Program set up by the California Board of Registered Nursing, the cost of participation in a four- year program for chemical dependence is about a third the cost of pursuing traditional discipline for a single violation. Recovery calls for commitment. Impaired practitioner programs go by various names. Florida calls its program the Intervention Project for Nurses; other states, including Texas, use the term . Still others, like California, call it a . They are not a cake walk: Nurses must make an average commitment of two to five years of active participation in treatment and monitoring. But in return, depending on the nature and severity of the impairment, most states will let a nurse maintain his or her license in good standing during and after participation. Some states, such as Massachusetts, however, require that a nurse surrender all other current licenses until she has successfully completed the program. What it takes to undergo rehab. While no two programs are exactly alike, here's the general pattern they follow: Often, a nurse does not learn about a program until she is under investigation or facing the loss of her license. Some state boards contact the nurse after receiving a complaint (including anonymous ones) from an employer or a concerned co- worker and offer her the chance to participate. But ideally, a nurse volunteers on her own. Some programs are open only to practitioners currently licensed by that state's board. In some states, though, nursing students and RNs licensed in another state, but who are applying for a license in that state, can participate. Strictly speaking, all the programs are voluntary—although in many instances, the only alternative is suspension or revocation of a nurse's license. A nurse entering a program undergoes an extensive interview and evaluation and signs an agreement that contains specific terms and conditions tailored to her impairment. It is legally binding. Nurses must also agree not to use nonprescribed mood- altering substances including drugs and alcohol. Failure to comply can mean expulsion from the program and immediate disciplinary action. The type of treatment required depends on the nature and level of a nurse's disability. Chemical dependence and severe psychological or physical impairments may require immediate inpatient treatment. All programs require counseling and ongoing participation in support groups, with periodic progress reports. For substance abusers, attendance at a 1. Alcoholics Anonymous or Narcotics Anonymous is mandatory, as are random urine drug screens and blood alcohol tests, sometimes under a highly restrictive policy—one positive test and you're out. Although participation in the monitoring program itself is usually free, or at minimal cost to the nurse, the costs of treatment and drug screens are the nurse's responsibility. Her health or disability insurance may cover all or most ofthese costs, but co- pays and treatment costs beyond the usual fee an insurer covers may still present a serious financial barrier, especially to a nurse who has to quit working to participate. The return to work. The ability to work during treatment is an important incentive to keep participants compliant. Initially, a nurse may be required to stop working immediately so she can be assessed and then focus on recovery. However, once she meets specific criteria—often in as little as two weeks—and is deemed fit to work, she can return to nursing. In most programs, she will need to notify her employer that she is taking part in an impaired practitioner program. She will also be assigned a workplace supervisor, who will communicate regularly with the program director about the nurse's work performance and progress in recovery. Some job modification—such as a change to a less stressful job or shift—may be necessary to make the work environment conducive to recovery and to ensure adequate monitoring. Chemically dependent nurses are not permitted to work in settings where they have access to controlled medications. Generally, the intensity of participation and monitoring is reduced after a period of proven compliance with prescribed treatment plans. Measures to ensure patient safety. Because of the need for close supervision, an impaired practitioner is usually not allowed to work for multiple employers, to be self- employed, to do agency nursing, to take on private- duty assignments for a nursing registry, to work inhome health, or to be floated to other units. Any job change must also be approved by the program director. Some programs don't allow a nurse to continue to participate if she moves out of state. Eligibility requirements also serve as a public safety net.
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