Is a Nurse With Mental Illness 'Impaired'?

Carolyn Buppert, MSN, JD

Disclosures

November 18, 2014

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Question

A registered nurse (RN) with mental illness, who was taking medication, overdosed a patient on warfarin. Should an RN with mental illness be practicing in an intensive care unit?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

A nurse with a mental illness who is on medication is not, by definition, impaired or unsuited to practice as a nurse. There are doubtless many nurses with psychiatric diagnoses who take medication and practice successfully. Coworkers don't typically know whether a colleague has a psychiatric diagnosis, or any other diagnosis, because a diagnosis is protected health information.

It isn't the responsibility of a coworker to decide whether another nurse's medical history is affecting his or her performance. Nor is it within the authority of a coworker to decide that a nurse's mistake was caused by an illness or a medication. Whether a nurse is competent to practice is a decision for supervisors to make, based on assessments of the nurse's performance. If a nurse sees another nurse doing something that is unsafe for a patient, the nurse should talk with the colleague and bring a supervisor into the matter. The supervisor can assess the nurse's alertness and performance, and act accordingly.

The Americans with Disabilities Act (ADA) may apply to nurses with psychiatric illnesses.[1] The ADA rule defines "mental impairment" to include "any mental or psychological disorder, such as . . . emotional or mental illness." Examples of "emotional or mental illnesses" include "major depression, bipolar disorder, anxiety disorders (which include panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder), schizophrenia, and personality disorders." If a nurse has one of these impairments, the ADA may apply, and the nurse and the employer can work on accommodations to allow the nurse to continue working. The responsibility for addressing ADA regulations and processes lies with supervisors and human resources departments.

If a nurse truly is disabled by a psychiatric illness, and accommodations would pose a hardship for the employer, then the nurse should be evaluated for disability and go through the process of becoming eligible for disability benefits.

A similar question, in that it addresses nurses' assessment of other nurses, came in this month:

How long can one wait to report a fellow RN to the nursing boards? We had a nurse who was working under the influence of narcotics, which I reported to my supervisor when I discovered Dilaudid missing. While under the influence of this drug, this nurse almost discharged a baby who was in critical condition. The baby was 5 days old and had a heart rate of 68. This nurse was let go about a week after this incident after testing positive in a urine drug test. I recently found out that this nurse was working in another emergency department and I discovered that my hospital's administrators never reported her to the board. I'm worried that she could harm a patient if she has not received help.

The nurse who asked this question might have been correct in her assumption that the other nurse appropriated the missing Dilaudid. Or the reporting nurse could have come to an inaccurate conclusion. The reporting nurse also could have assumed, incorrectly, that the nurse was impaired at work. The reporting nurse completed his or her duty in reporting the observation that Dilaudid was missing.

Whether either of the nurses who made mistakes in these scenarios were impaired and whether their mistakes were related to the impairment is something that another nurse can have an opinion about, and can report to a supervisor, but nurses should be wary of taking on the role of supervisor (unless the nurse is a supervisor), police officer, judge, and jury. A better approach would be to report what the nurse has observed to a supervisor, and let the supervisors do their managerial jobs. Once a nurse has reported observations to a supervisor, the nurse has fulfilled his or her obligation.

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