If a patient who's intoxicated demands to leave the facility, follow facility policy (such as moving the patient to a quiet room, using restraints, or having staff assist) and state law to keep the patient on site. •Use of alcohol over time may cause or exacerbate depression.
Introduction A nurse is likely to experience patients who are intoxicated in various settings, including emergency departments, urgent care centers, outpatient offices, and inpatient units.
The first thing a nurse should do if s/he suspects a colleague has a substance abuse problem is talk to that nurse in private. When talking to that nurse, it is important to be non-confrontational. Make sure the nurse knows you are concerned about patient safety as well as that nurses well being.
Nursing Care Management of Intoxicated Patient 1. Confirm the patient's identity. 2. Assess the patient's airway, breathing, and circulation. 3. Introduce yourself to the patient and explain why he's in the facility.
The Impaired Nurse. The impaired nurse presents a significant challenge in the clinical environment. Impaired nurses risk poor patient outcomes and possible punishment, including license revocations. The number of impaired nurses may be underreported as co-workers often fear reporting colleagues.
The Code's Interpretive Statement 3.6 states, “The nurse's duty is to take action to protect patients and to ensure that the impaired individual receives assistance.
Treatment / Management If someone suspects a colleague has an alcohol or substance use problem, they should refer the impaired health practitioner to the proper authority in your institution or state. In several states, reporting is required by law.
The nurse manager's role in the process of removing the nurse from patient care is essential. Removal from practice will assist the nurse in focusing on care and treatment of the disorder, but more importantly, the earlier SUD is identified and the nurse is removed from patient care, the sooner patients are protected.
Send them home safely – don't allow the employee to drive. If they insist, inform them that you're concerned for their well-being and the well-being of others. Tell them you'll need to contact the police if they drive home. Ask the employee to send someone to pick them up or send them home in a taxi.
Advice / framework for the impaired colleague:Be clear at the opening the reason for the meeting. ... Listen.Listen some more.Explore stressors: family, money, drugs, ETOH, work, health etc.Explicitly check for mental health issues. ... Work out what supports your colleague has, what is their ongoing plan.More items...
Detecting and addressing substance use disorders proactively and systematically are essential for 2 reasons: to protect patient safety and to enable healthcare professionals to recognize problems early and intervene swiftly.
must do no harm intentionallyNon-maleficence This means that nurses must do no harm intentionally. Nurses must provide a standard of care which avoiding risk or minimizing it, as it relates to medical competence. An example of nurses demonstrating this principle includes avoiding negligent care of a patient.
A nurse practicing in Ontario is required to report certain information about themselves to CNO; this is called “self-reporting.” A nurse is required to self-report to CNO if they: have been charged with any offence. have been found guilty of any offence. have a finding of professional negligence and/or malpractice.
It is a duty and obligation to immediately report any good faith suspicion or concern about an impaired physician. Many states have a legal requirement to report any physician that may be practicing while impaired.
Nurses who are aware of their rights and duties in legal matters are better able to protect themselves against liability or loss of professional licensure. Little direct involvement in the area of malpractice.
The nursing interventions for anxiety disorders are: Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa. Assure client of safety.
Substance abuse occurs across all generations, cultures, and occupations, including nursing. About 1 in 10, or 10-15% of all nurses, may be impaired or in recovery from alcohol or drug addiction. Although nurses aren’t at a higher increase risk than the public sector, their overall pattern of dependency is unique because they have greater access to drugs in the work environment.
Do not ignore poor performance. Do not lighten or change the nurses’ patient assignment. Do not accept excuses. Do not allow yourself to be manipulated or fear confronting a nurse if patient safety is in jeopardy.
Myth: Impaired nurse have a long history of drug or alcohol abuse. Truth: Although many substance-abusing nurses have a history of long-term drug or alcohol abuse, a recent stressful life event such as a divorce, accident, or illness can lead to drug abuse as a coping mechanism. Myth: Impaired nurses are easy to recognize.
Common myths and truths. Myth: Impaired nurses use only street drugs. Truth: Many substance-abusing nurses use everyday medications encountered in the workplace as well as common street drugs. The problem may begin by simply taking a patient’s medication for a headache or back pain or to cope during a stressful shift.
Treatment can be effective in reducing substance use and improve health, social, and occupational well-being. Many organizations offer alternative treatment programs instead of drastic action such as termination.
Currently 37 states offer some form of a substance abuse treatment program to direct nurses to treatment, monitor their re-entry to work, and continue their license according to the National Council of State Boards of Nursing. Alternative programs monitor and support the recovering nurse for safe practice.
Myth: Addicts cannot recover and only need treatment for a couple of weeks. Truth: Short-term in-patient programs should be at least 21 days. It is important to have follow-up supervision for physical and emotional support. The length of treatment and the willingness of the nurse are the best predictors for success.
Make sure the nurse knows you are concerned about patient safety as well as that nurses well being. If the nurse admits she has a problem, you need to listen to her and then follow through. A big mistake is keeping quiet because the nurse may promise to get help, but then doesn’t. You must make sure the problem gets addressed and the nurse gets help.
Some of the reasons nurses may fail to report a co-worker may include: friendship. guilt. loyalty. fear of jeopardizing their colleague’s nursing license.
Nurses with addiction problems need help. Most people who went to school to become a nurse did it because they wanted to help others. Nurses are caring, compassionate and they put the needs of others first. But, what happens when the nurse is the one who needs to be cared for.
Nurses must realize they need to report a nurse they suspect has a substance abuse problem because, in the end, the nurse and the patient’s life could depend on it. You must not keep it under the rug.
Addiction as taboo among nurses. Unfortunately, a nurse with an addiction is considered “taboo” among their colleagues. Fellow nurses do not know what to do or how to handle it when they suspect a colleague has an addiction. Many nurses choose to remain silent about a nurse they feel may have a substance abuse problem.
Nursing Code of Ethics: Should nurses report co-worker drug use? Reporting a fellow nurse you think has a substance abuse problem should be done in a caring, compassionate way. Ultimately, the nurse needs to be reported to protect her/his life and patients’ lives who are in their care.
Both Lachman and Murray recommend nurses spend time gaining an understanding of the ANA’s Code of Ethics. They agree most nurses don’t know what the code says. In developing moral courage, Murray encourages open dialogue about ethical principles, the use of case studies and discussion with ethics consultants.
Murray said a nurse also may need to summon moral courage outside of the clinical setting. If they witness misconduct, which goes against the very strict guidelines governing research, such as funding issues or findings published early for personal reasons. In academia it can occur when faculty members are asked to pass a failing student ...
Because exerting moral courage to speak up when an unethical situation arises is risky and creates anxiety, Lachman advises nurses learn self-calming techniques . “Know a relaxation strategy to calm yourself. Tell yourself, ‘I can manage this.’”. Nurses also must assess the risk. She said a nurse must believe that the outcome ...
Nurses must summon moral courage to confront unethical behavior. There are times nurses must draw on moral courage, and to draw on it, they need a working definition. “Moral courage is the ability to overcome your fear and stand up for your core values and your ethical obligations as a nurse,” said Vicki Lachman, PhD, APRN, MBE, FAAN, ...
Nurses also must assess the risk. She said a nurse must believe that the outcome of speaking up is worth the risk. “If you [saw] someone break sterile technique and you don’t speak up, the risk is the patient having an infection,” Lachman said. The risk is worth [speaking up].”.
While Doe was waiting for his treatment, the nurse texted her sister-in-law and told her Doe was being treated for the STD. The manner in which she texted this information led the sister-in-law to believe the staff was making fun of his diagnosis and treatment. The sister-in-law immediately forwarded the messages to Doe.
A letter was sent to Doe from the president and CEO of the facility informing Doe that an unauthorized disclosure of his confidential health information did occur, appropriate disciplinary action had been taken and steps put into place to prevent such a breach from happening in the future.
The court opined that a medical facility’s duty of safekeeping a patient’s confidential medical information is “limited to those risks that are reasonably foreseeable and to actions within the scope of employment.”. Because the nurse’s misconduct did not meet these requirements, the facility cannot be held liable in this case or any other case in ...
Apparently Doe did not name the nurse in his lawsuit but elected to sue only the facilities that either owned or provided staff and other support to the facility. Perhaps Doe thought this was how he could obtain the largest amount of a monetary award. If so, the decision was unwise at best.
Substance abuse has the potential to lead to mental illness, cardiovascular disease, hypertension, liver disease, hepatitis, human immunodeficiency virus, traumatic injuries and possibly death due to over dose.
Determines fitness to practice. The IPN determines fitness to practice by assessing the nurse’s judgment, problem-solving abilities, stability in recovery, support systems, decision making capacity, coping ability and cognitive function (Smith, 2013). The IPN also determines when the nurse can return to practice.
Nurses need to be aware of the impact impairment has on the patients and the health care system in general because the impaired nurse may not be able to provide safe and appropriate care. It is critical that nurses are aware of signs of impairment and how to report a fellow nurse suspected of substance abuse.
Planning an intervention is the first step in getting an impaired nurse help. First, the behaviors that are suggestive of impairment should be well documented. The staff should document concise, objective, clear and factual data along with the place, time and date.
Impairment occurs when a nurse is unable to provide safe patient care due to using a mood or mind altering substance, having a physical condition or a distorted thought process from a psychological condition (Intervention Project for Nurses, 2015).
Many nurses fear reporting a colleague because they worry about retaliation.
Employers should implement strategies to promote safety and provide assistance. Guidelines should be developed to promote safety for nurses and their patients and offer assistance to nurses who suffer with substance abuse or other conditions that lead to impairment.
The nursing leadership team and human resource leaders are required to, in most states, report the abuse to the Board of Nursing (BON) and the local police authority. Each BON has a process for investigation and varying levels of programs to assist nurses through recovery.
The Nurse Practice Act for each state will define the process for programs in the state to assist the nurse with returning to work once they are safe to practice. Many states offer a graduated program of returning to work where there is oversight of the nurse with strict restrictions on the work environment.
Nurses are entrusted to protect the patients in their care from harm at all times. This protection includes the ability to perform at a high level of critical thinking. Caring for patients while under the duress of substance abuse puts the entire nursing process in harm's way.
A unique challenge to the nursing profession and substance abuse is the access to narcotic medications. Diversion of these drugs for self-use is not only harmful to the nurse, but is also unethical in the failure to protect the patient from harm by diverting the drugs from the patient. Furthermore, the impairment of the nurse may endanger ...
Prior to the 1980s, before substance abuse was recognized as a disease, nurses were relieved of duty and/or had their nursing license revoked with little recourse or treatment options when found to have a substance abuse disorder. Since that time, many states have enacted non-disciplinary rehabilitation programs to assist nurses with recovery.
The National Council of State Boards of Nursing, who oversees each BON, has many resources for nurses and nurse leaders on addressing the disease of substance abuse disorder.