Running head: IMPAIRED NURSES

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Impaired Nurses Nurses who use Drugs Illegally

Paula Hasty Chamberlain University

Transitions to Professional Nursing NUR 351 Professor Faye Silverman

IMPAIRED NURSES

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Impaired Nurses Nurses who use Drugs Illegally

A Licensed Practical Nurse (LPN,) who works for the local hospital for about 10 year, she is conscientious and is respected by her peers and management. A Registered Nurse (RN), who the LPN does not know well, was covering her; the RN was responsible to do all the intravenous (IV) medication pushes for her. She asked the RN to give a patient some pain medications IV push. The patient complains one hour later that he did not receive pain relief. After speaking to some colleagues, the LPN hears from other colleagues that when this RN works the patients are unable to receive pain relief. The LPN informs management of her concerns. After extensive investigation, management and a few of the RN's close colleagues, who were concerned for her health, conducted an intervention with the RN. It seemed that she had fallen into the drug addiction trap. After injuring her back two years ago, the RN was taking prescribed Oxycontin. The RN started needing the medication to believe she was normal. When she could not get any more medication from her doctor, she started diverting medication from the Pyxis system at the hospital. She and her spouse divorced and her addiction started to escalate. She worked several shifts of overtime so that she would have access to the medications that she craved. She was in fear of being caught and started taking the medication that was ordered for the patients. She was ashamed and did not know where to turn when the intervention occurred. Definitions Nurses have a reputation as the most trusted profession in America. Nurses have taken an oath to maintain "good moral character." In Florida, signing a "Good Moral Character" affidavit

IMPAIRED NURSES that explains exactly what a violation to that oath may be, is required. Nurses are entrusted with the care of America's weakest citizen. These people are sick and debilitated. Ill people are dependent on the care of a nurse for everything. Because of this responsibility, nurses must have access to all types of medications. No matter how responsible a nurse is, some nurses still succumb to temptations of drug abuse. This is a huge problem for hospitals; with the nursing

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shortage the board of nursing cannot afford to lose these valuable resources. That is one reason the Board of Nursing is turning away from punishment to treatment for this problem. Drug addiction has become recognized as an illness in this country. Punishing people for their illnesses is not an accepted way of dealing with the problem. Treatment is an accepted way to deal with the issue of impaired nurses. Nursing education does not include information on how to recognize a colleague battling an addiction. In Nursing Forum (2009), "«specific characteristics of chemically dependent nurses include high achievement and success orientation. These nurses often have earned advance degrees, are in positions of responsibility, are polysubtance abusers and tend to lack support in recovery. They often have co morbid mental health disorders, as depression, that is common in chemically dependent nurses and should be addressed in treatment". Signs and symptoms as frequent job changes, working frequent off shifts, history of chronic pain from an injury or recent surgery, and patients complaining of inadequate pain relief are often indicators of an impaired nurse. According to Jack Stem, who is the founder of the Peer Advocacy for Impaired nurses LLC in Ohio, "The stigma that addiction is a moral failure or lack of willpower rather than a disease is embedded in U.S. society." According to RN (2009), nurses rarely self report because they are fearful of losing their livelihood. Drug addicts also think they are in control and will not admit they are having a problem until they hit rock bottom. Intervention may create an "artificial

IMPAIRED NURSES rock bottom" that will make the drug addicted nurse seek treatment if they may avoid losing their license. Drug Diversion

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According to Dictionary.com, diversion is defined as the act or an instance of diverting: as an unauthorized rerouting or appropriation <diversion of funds>. Drug diversion is on the rise in nursing, as drug use is in America. Diversion by nurses is not just theft from their employer, but it is also theft from the people they are in charge of caring for. According to AORN Journal (2008), "Most researchers believe that rates of addiction in nursing mirror the national addiction levels 10% to 12%." Drug diversion is illegal and is punishable by anti-theft laws in which the diversion is taking place. According to Pharmacy Times, (2008) "«opioid abusers had health care costs that were roughly 8 times higher than those of nonabusers." Per patient cost of opioid abuser were about $16,000 per year, compared to just $1830 for non opioid abusers. These cost are high because of the enormous cost of the physician visits, procedures, x rays, and emergency department visits , which makes the pharmaceuticals a minuscule cost in comparison. Diversion happens in a variety of ways. One way is to get medications is to withhold the medication from the patient it was intended for. Another way to divert drugs is to go under someone else's identification in the Pyxis system and take the medications out. Yet another way to divert drugs from the hospital is to get a patient's medication and get out extra medication. Unfortunately, drug addicts are creative in their methods to obtain their medication. According to Pharmacy Time (2008) drug diversion cost health insurers about 72 billion dollars every year. The money is almost never recovered and is passed on to the consumer, contributing to higher insurance costs. Another reason for drug diversion is selling medication on the black market for large amount of money.

IMPAIRED NURSES Consequences

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According to Journal of Addictions Nursing, "Although the need to address the problem of nurses was recognized as early as the turn of the century, it was not until 1980 that the National Nurses Society on Addictions (NNSA) created a task force to examine the need for professional assistance programs." Because drug diversion is in fact, employee theft, it is punishable by law. Nurses are sometimes arrested and prosecuted for larceny. When the nurse, is charged with a felony, she will not be able to renew her license or practice nursing. The disciplinary approach is designed to protect the public from harm, that an impaired nurse can do to the people she is caring for. Unfortunately, with the discipline approach nurses receive little in the way of rehabilitation. On top of that, according to the Journal of Addictions Nursing any hospital that hires a nurse who has be charged with a felony may not receive payment from the federal government for the services rendered. The punishment approach almost always includes suspension of the nursing license, they are ineligible to work as a nurse for a period of one to five years. Nurses are then placed on a probationary period where they are allowed to practice under contract to the board of nurses. According to Nursing Forum (1999),"«in Florida 80-90% of disciplinary actions by the Florida Board of Nursing were related to alcohol and substance abuse." According to the Billings Gazette, about 50-60% of the action taken by the Board of Nursing in Montana is related to drug diversion. Law enforcement rarely gets called when drug diversion is discovered. Facilities think that refraining from calling law enforcement is the best way to encourage someone to go into recovery. Some law enforcement agencies think that nurses get special treatment when theft of narcotics and drug diversion is concerned. According to the Glacier County Attorney Larry Epstein, "I know of no other profession exempt from criminal prosecution when they steal drugs."

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According to RN (2009), "If nurses have been involved in diverting drugs, their employers have an obligation to report this to drug control authorities and the state Board of Nursing. "In 1982 the American Nurses Association addressed the problem of impaired nursing practice, promoting the use of peer assistance programs and dissemination of information regarding impaired nursing practice within the profession" according to Nursing Forum (1999). Since that time, disciplinary diversion programs have become popular. There are many models of alternative programs. Forty-four states have adopted some kind of discipline diversion program; although the standards for each program vary greatly. The oldest is the Florida Intervention Project for Nurses (IPN), established in 1983. IPN is a diversion program that included intensive case management, individual counseling, and strict monitoring. In the Journal of Addiction Nursing, it defines alternative to discipline as programs that are non-compulsory and confidential. The philosophy underlying the programs is the nurse will voluntarily seek assistance if they are allowed to retain their livelihood and keep their treatment confidential. Once an impaired nurse chooses this path they usually sign a contract that can be more stringent than the sanctions imposed by a disciplinary program. A nurse will be required to refrain from practice until she may complete a drug treatment program. When a nurse finishes either and inpatient treatment program or an intensive outpatient program, she is allowed to return to work under the close supervision of the administration of the hospital and her case manager. She will have a restriction on her access to narcotics and she will be randomly frequently drug tested. She will also be required to attend a recovery group as Alcoholics Anonymous or Narcotics Anonymous where she must have a sponsor. She will be required to attend a nurse support group meeting weekly for the length of the contract. She will also be required to attend regularly scheduled follow up appointments by a therapist and psychiatrist for medication management in the treatment of any psychiatric co

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morbidities. Her supervisor at work, the nurse support group, and her case manager quarterly will evaluate her for the length of her contract. Contracts in Florida are usually 5 years. Nevertheless, the discipline diversion program supports nurses in recovery and does not take action against the nurse's license. When rehabilitation fails through treatment and recovery options, or when they fail to be compliant to the contract they signed they may be referred for disciplinary action. Recovery According to Cinahl Information Sheets, relapse is common between 27-92% with family history of substance abuse, use of major opioid, and co morbid psychiatric disorders increasing the chances. Journals of Addiction Nurses(2008) states that one study 90% of those nurses completing monitored treatment achieved abstinence, and research has also indicated when a nurse is monitored for an extended length her chances of long term success is improved. Some programs offer a statistic of 85-95% successful recovery rate. Some states as Idaho, Mississippi and Arkansas offer statistics of 47-61% successful recovery rates, according to the Journal of Addiction Nursing (2008). Retention In the time of nursing shortages, retention of nurses is a big concern. With the costs of orientation of a nurse to a specific facility retaining a nurse affected by drug addiction is important. Journal of Addictions Nursing (2008) reports that retention rates for nurses who are taking part in a discipline diversion program are double from those that were disciplined. Some studies attribute that to the shame and lack of support when nurses have been disciplined. When a nurse is under contract from a discipline diversion program she has support and monitoring built in giving her and the facility a good chance of recovery.

IMPAIRED NURSES In conclusion, drug addiction is considered an occupational hazard in nursing. Nurses are in high stress environments with easy access to mind altering drugs. Some nurses fall prey to the

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disease of drug addiction. Treating addiction and any co morbid psychiatric illnesses, as a disease that requires treatment, monitoring, and recovery is effective for not only the nurse but for the facility where the nurse works. Statistics support the discipline diversion approach as the most effective approach to treat impaired nurses. Discipline is not as effective because of the length of time it takes to get through the disciplinary process, the retention rates and the lack of support provided for the disciplined nurse. Discipline diversion proves effective because the nurse is monitored closely for an extended period. This allows the nurse to develop effective coping skills to deal with the stress and temptations of working in a drug rich environment. Supporting recovery allows healthcare facilities to retain the precious resource of trained experienced nurses.

IMPAIRED NURSES References

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Burke, C. (2008, March). Drug Diversion and Abuse: Rx Diversion Costing Health Insurers. Pharmacy Times, 1-2. Copp, M. B. (2009, April). Drug Addiction. RN, 40-44. Griffith, J. , RN, BSN (1999, October-December). Substance Abuse Disorders in Nurses. Nursing Forum, 34(4), 19-28. Monroe, MSN, MS, RN, T. , Pearson, PhD, F. , & Kenaga, PhD, H. (2008). Procedures for Handling Cases of Substance Abuse Among Nurses; a Comparison of Disciplinary and Alternative Programs. Journal of Addictions Nursing, 19(3), 156-161. 10.1080/10884600802306024 Clinical update. Substance abuse: nurses and drugs--off the job. Nursing 1998, 9(ISSN: 03604039), 66-67. Pinto, MSW, S. , & Schub, BS, T. (2009, January 16). Substance Abuse in Healthcare Professionals. In D. Pravikoff, RN,PhD,FAAN (Ed.), Cinahl Information Systems. Ramer, L. M., RN, MSN, CNOR (2008, August). Using servant leadership to facillitate healing after a drug diversion experience. AORN Journal, 2(ISSN: 0001-2092), 253-258. Tranbarger, R. E. (1997, February). A Nurse Executive's Nightmare The Rogue Nurse. Nursing Management, 28 No. 2(002-0443), 33-36.

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