THE CHEMICALLY IMPAIRED EMPLOYEE

SUBSTANCE MISUSE

• Maladaptive patterns of psychoactive substance abuse with the substance

user continuing use in the face of recurrent occupational, social,
psychological or physical problems and or dangerous situations

MANAGER ROLES:

• Takes an active role in ensuring patient safety

• Responsibility to help this employee to deal with their disease

Modlin and Monte

• The exact magnitude of chemical impairment within nursing is not known and
varies widely

• A review of the literature suggests that somewhere between 6-14% of all

nurses are chemically impaired

• The chemical impairement rate of health professionals is generally

acknowledge as being greater than that of the public

• Most frequently abused substance: meperidine, oxycodone, clonazepam,

diazepam, morphine, pentazocine, barbiturate

RECOGNIZING THE CHEMICALLLY IMPAIRED EMPLOYEE

BEHAVIOR CHANGES

• Primary areas

1. Personality/behavior changes

2. Job performance changes

3. Time and attendance changes

CHARACTERISTICS CHANGES IN CHEMICALLY IMPAIRED EMPLOYEE

1. Changes in Personality or Behaviors

• Increase irritability in patients and colleagues often followed by

extreme calm

• Social isolation
 • Extreme and rapid mood swings

• Euphoric recall of events or elaborate excuses

• Unusual strong interest in narcotics or narcotic cabinet

• Sudden dramatic change in personal grooming

• Forgetfulness (simple short term memory loss to black out)

• Change in physical appearance

• Extreme defensiveness regarding medication errors

2. Changes in Job Performance

• Difficulty meeting schedules and deadlines

• Illogical or sloppy charting

• High frequency of medication errors

• Frequently volunteers to be medication nurse

• Has high number of assigned patient who complains that their pain
medication is ineffective in relieving their pain

• Consistently meeting work performance requirements at minimal

levels or doing the minimum amount of work necessary

• Judgement errors

• Sleeping or dozing in duty

• Complaints from other staff members about the quality and quantity of
the employees work

3. Changes in Attendance and Use of Time

• Increasingly absent from work without adequate explanation or

notification

• Long lunch hours

• Excessive use of sick leaves or request for sick leave after days-off

• Frequent calling in to request compensatory time

 • Arriving at work early or staying late for no apparent reason

• Consistent lateness

• Frequent disappearances from the unit without explanation

EARLY STAGE

• Use of addictive substance primarily for pleasure

• Substance use does not usually occur during work hours

CHEMICAL DEPENDENCE DEEPEN

• Employee develops tolerance to the chemical and must use greater

quantities more frequently to achieve same effect

• Made a conscious lifestyle decision to use chemicals

• High use of defense mechanism: justifying, denying, bargaining

• Use of chemical substance both at and away from work

• Work performance generally declines in the areas of attendance, judgement,

quality, and interpersonal relationship

• Decline in unit morale unreliable and unproductive worker

FINAL STAGE OF CHEMICAL DEPENDENCE

• Employee must continually use the chemical substance even though he/she
no longer gains pleasure or gratification

• Physically or psychologically addicted employee harbors a total disregard

for self and others

• Employee becomes un predictable and undependable

CONFRONTING THE CHEMICALLY IMPAIRED

PHASES IN DEALING WITH THE CHEMICALLY IMPAIRED

1. Data or evidenced gathering phase

• The manager collects as much hard evidence as possible to document

suspicions of chemical impairement in the employee
 • Validate it if possible by a second person

2. DIRECT CONFRONTATION

• Denial and anger should be expected

• The employee must be immediately removed from work environment

and privately confronted with the manager’s perception

3. Outlining the organizations plan or expectations

• Disciplinary contract

THE MANAGER’S ROLE IN ASSISTING THE CHEMICALLY IMPAIRED EMPLOYEE

• Must be very careful not to assume the role of counselor or treatment

provider

• Must be careful not to feel the need to diagnose the cause of the chemical
addiction or to justify its existence

• Identify clearly performance expectation for the employee and to confront

the employee when those expectations are not met

• Primary responsibility is to see that the employee becomes functional again

and can meet organizational expectations before returning to work

• Create an environment that decreases the chances of chemical impairement

in the work setting

• Control drug accessibility by implementing, and forcing, and monitoring

policies and procedures related to medication distribution

• Provide opportunities for the staff to learn about substance abuse, its
detection, and available resources to help those who are impaired

THE RECOVERY PROCESS

FIRST PHASE

• The impaired employee continues to deny the significance of severity of the

chemical impairement but does reduce or suspend chemical use
SECOND PHASE

• The impaired employee begins to see that the chemical addiction is having a
negative impact on his/her life and begins to want to change

THIRD PHASE

• The person examines his/her values and coping skills and works to develop
more effective coping skills

LAST PHASE

• People gain self awareness and they develop coping skills that will help them
deal more effectively with stressors

STATE OF BOARD OF NURSING TREATMENT PROGRAMS

DIVERSION PROGRAMS (INTERVENTION OR PEER ASSISTANCE PROGRAMS)

• Voluntary, confidential programs for nurses whose practice may be impaired

due to chemical dependence or mental illness

GOAL: Protect the public by early identification of impaired nurses and by

providing these nurses access to appropriate intervention programs and
treatment services