8.2 The Chemically Impaired Nurse

Question 1

Red Flags for SUD

Answer 1

• Report drugs as wasted or broken without witness
• Documents administration of PRN or maximum dose medications when other nurses are not
• Families report variance in pain relief for their patients
• Nurses who request night shift, transfer to units with minimal supervision and heavy narcotic use, or routinely administer controlled substances to confused patients

Question 2

Reporting SUD

Answer 2

• Failure to report SUD can result in disciplinary action
• Relay concern to a supervisor
• Focus on observed behaviors that violate policies or put patients at risk
• Avoid making judgments or statements that can be considered defamatory
• Information must remain confidential
• Do not confront workers alone
• Involve nurse manager and HR
• Never allow impaired nurse to care for a patient

Question 3

Preventing Impaired Practice

Answer 3

• Develop culture of transparency/support
• Provide access to workplace employee assistant programs (EAP)
• Educate nurses at workplace
• Develop pro-active policies/procedures
• Prevent diversion of drugs
• Manage nurse with SUD
• Identify/investigate all reports of impaired practice

Question 4

Re-Entry into Practice

Answer 4

• Returning nurses practice may be limited
• Leadership considers if it is appropriate to let this nurse back into stressful practice environments or other areas that could potentiate a relapse.
• Leadership determines when working hours should be.

Questions
- Should they be allowed to work full-time?
- Should their work hours be limited
- Is the nurse in question allowed to work un-supervised
- Is the nurse allowed to work night shift