Professional Substance Abuse

(1)

Professional Substance

Abuse

(2)

Addiction

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z A complex lifelong _{A complex lifelong}biopsychosocialbiopsychosocial

disease with serious physical, emotional, disease with serious physical, emotional,

financial and legal consequences. financial and legal consequences.

(3)

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z The American Nurses Association _{The American Nurses Association} estimates that between 6

estimates that between 6--8% of nurses 8% of nurses are affected by substance

are affected by substance

abuse/dependence to the extent that job abuse/dependence to the extent that job

performance is impaired. performance is impaired.

(4)

Risk Factors for Nurses

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z Job related stress_{Job related stress}

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z Knowledge of drugs_{Knowledge of drugs}

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z Access to narcotics_{Access to narcotics}

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z Experience with effects of drugs_{Experience with effects of drugs}

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z Tendency to self_{Tendency to self}--medicatemedicate

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(5)

Warning Signs

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z Medication discrepancies_{Medication discrepancies}

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z Volunteering to give medications for other _{Volunteering to give medications for other} nurses

nurses’’ patientspatients

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z Unusual interest in pain control _{Unusual interest in pain control} medications

medications

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z Frequent bathroom trips_{Frequent bathroom trips}

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z Unexplained absences_{Unexplained absences}

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z Requests to work _{Requests to work}

evenings/nights/weekends evenings/nights/weekends

(6)

Job Performance Changes

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z Illogical or sloppy chart entries_{Illogical or sloppy chart entries}

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z Change in handwriting_{Change in handwriting}

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z Late entries of narcotics/drugs on records_{Late entries of narcotics/drugs on records} z

z Frequent errors_{Frequent errors}

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z Too many controlled drugs spilled or _{Too many controlled drugs spilled or} broken

broken

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z Wastage of controlled drugs not observed_{Wastage of controlled drugs not observed}

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(7)

Job Performance Changes

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z Difficulty meeting deadlines_{Difficulty meeting deadlines}

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z Controlled drugs and tranquilizers only being _{Controlled drugs and tranquilizers only being}

given when suspect nurse works

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z IM meds given when other nurses consistently _{IM meds given when other nurses consistently}

use oral meds

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z Use of smaller size drug than _{Use of smaller size drug than}necesssarynecesssary (i.e., (i.e., two 30mg codeine instead of one 60mg)

two 30mg codeine instead of one 60mg)

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z Excessive amounts of narcotics signed out to _{Excessive amounts of narcotics signed out to}

patients by suspect nurse

(8)

Changes in Behavior

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z Increased absenteeism_{Increased absenteeism}

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z Mood swings_{Mood swings}--irritability/forgetfulnessirritability/forgetfulness

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z Long lunch hours_{Long lunch hours} z

z Preference to work alone_{Preference to work alone}

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z Disheveled appearance/changes in _{Disheveled appearance/changes in} manner of dress

manner of dress

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z Stays late_{Stays late}

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(9)

Changes in Behavior

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z Absent from floor without explanation_{Absent from floor without explanation}

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z Drinks sodas excessively_{Drinks sodas excessively}

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z Excessive use of breath mints_{Excessive use of breath mints}

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z Red or bleary eyes_{Red or bleary eyes}

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z Frequent surgery or pain_{Frequent surgery or pain}

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z Depression/excessive happiness_{Depression/excessive happiness}

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(10)

Identification Criteria

-

-Preemployment

Preemployment

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z Numerous job changes in last 3_{Numerous job changes in last 3}--5 years5 years

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z Frequent moves_{Frequent moves}

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z Inability to remember employment record_{Inability to remember employment record}

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z _{Frequent hospitalizations}_{Frequent hospitalizations} z

z Unexplained lapses in life_{Unexplained lapses in life}

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z Inappropriate references_{Inappropriate references}

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z Overeducated/prepared for the job_{Overeducated/prepared for the job}

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z Reluctant for immediate physical exam_{Reluctant for immediate physical exam}

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(11)

Physical Signs

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z Shakiness_Shakiness

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z Hand tremors_{Hand tremors}

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z Slurred speech_{Slurred speech}

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z Constricted pupils_{Constricted pupils}

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z Diaphoresis_Diaphoresis

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z Unsteady gait_{Unsteady gait}

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(12)

Narcotics Discrepancies

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z Incorrect narcotics count_{Incorrect narcotics count}

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z Apparent alterations of narcotics vials_{Apparent alterations of narcotics vials}

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z Large amounts of narcotics wasted_{Large amounts of narcotics wasted}

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z Numerous corrections on narcotics records_{Numerous corrections on narcotics records}

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z Patient reports of ineffective pain medication_{Patient reports of ineffective pain medication}

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z Variations in patterns of narcotics discrepancies _{Variations in patterns of narcotics discrepancies}

among shifts or days of the week

(13)

When you suspect a

Collegue

_Collegue

is

_is

using

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z Identify specific examples/patterns of _{Identify specific examples/patterns of} warning signs

warning signs

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z Discuss examples with a trusted colleague _{Discuss examples with a trusted colleague} or friend

or friend

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z Present your observations and concerns _{Present your observations and concerns} to your nurse manager

to your nurse manager

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z Take a long term outlook_{Take a long term outlook}

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z Remember your responsibility to protect _{Remember your responsibility to protect} your patients

(14)

Confrontation

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z Establish agency policy and procedure _{Establish agency policy and procedure} prior to confronting nurses

prior to confronting nurses

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z Identify concerns in writing with backup_{Identify concerns in writing with backup}

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z Evaluate the evidence to see if it has a _{Evaluate the evidence to see if it has a} pattern, is clear, and is accurate

pattern, is clear, and is accurate

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z Do not confront until all information is _{Do not confront until all information is} obtained

obtained

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z Never confront anyone alone, gain _{Never confront anyone alone, gain} assistance from appropriate agencies assistance from appropriate agencies

(15)

Confrontation

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z Consult with agency legal personnel if _{Consult with agency legal personnel if} necessary prior to the confrontation

necessary prior to the confrontation

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z Start by stating the purpose of the meeting_{Start by stating the purpose of the meeting}

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z Show the nurse the evidence you have put _{Show the nurse the evidence you have put} together

together

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z Have sources of help prearranged_{Have sources of help prearranged}

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z Advise the nurse the law requires that you _{Advise the nurse the law requires that you} report any alleged violation of the Nurse report any alleged violation of the Nurse

Practice Act to the State Board of Nursing Practice Act to the State Board of Nursing

(16)

Confrontation

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z Be systematic_{Be systematic}-

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z Identify the perceived problem_{Identify the perceived problem}

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z Show the supporting evidence_{Show the supporting evidence}

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z Allow for the nurse to respond_{Allow for the nurse to respond}

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z _{Stick to the relevant facts}_{Stick to the relevant facts}

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z Ask direct questions, including hard ones (i.e., _{Ask direct questions, including hard ones (i.e.,}

Did you take the

(17)

Confrontation

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z Tell the nurse the consequences of her _{Tell the nurse the consequences of her}

choices

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z Repeat questions as many times as needed_{Repeat questions as many times as needed}

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z Do not rush_{Do not rush}

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(18)

Dealing with the Addicted Nurse

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z Things that you should definitely not do_{Things that you should definitely not do}

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z Don_Don’’t lecture, scold, blame, threaten or argue t lecture, scold, blame, threaten or argue with the person about the problem

with the person about the problem

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z Don_Don’’t lose your tempert lose your temper

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z Don_Don’’t enable the problem to continue by t enable the problem to continue by

covering up, trying to protect, making excuses

or doing his/her job

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z _Don_Don_’_’_{t give the nurse an easier work schedule}_{t give the nurse an easier work schedule}

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z Don_Don’’t be overly sympathetict be overly sympathetic

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(19)

Dealing with the Addicted Nurse

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z Things that you should definitely not do_{Things that you should definitely not do}

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z Don_Don’’t accept more promises to t accept more promises to ““do betterdo better””

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z Don_Don’’t accept the responsibility of letting t accept the responsibility of letting someone work on your unit or team if

someone work on your unit or team if

impaired

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z Don_Don’’t put off facing the problem hoping it will t put off facing the problem hoping it will get better