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Suspect a Nurse of Substance Abuse? How You Can Help Before It's Too Late

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

September 09, 2021

It is hard to quantify exactly how many nurses have a problem with drugs or alcohol. Nursing is a challenging profession, and stressors remain higher than ever. Nurses struggling with substance abuse often work off-shifts or travel, and they may leave employment before assistance for issues can be addressed. They may also develop coping mechanisms that "allow them to cover up their diminished capacity to provide patient care," as one author describes.

Additionally, data are difficult to track because states and institutions define impairment via different metrics.

The American Nurses Association (ANA), as well as many institutions, strives to adopt an atmosphere of alternative-to-discipline approach for treating nurses and nursing students with substance abuse disorders rather than viewing substance use as a crime.

However, nurses should know the policies of both the state and the employer where they work before assuming they are safe from disciplinary action. Nurses have been terminated for ingesting opioids at work in institutions where this violated hospital policy, so it is pivotal to know what your employee manual specifies regarding the use of specific pharmaceuticals on the job.

Do you need two Percocet after gum surgery? Then, logically, you should be resting at home.

Are you planning a celebration the night before working an early shift? Think twice before ingesting alcohol. If a patient believes that you appear to be hung over (or worse, smelling of ethanol) a visit to human resources may be in your immediate future.

Do you volunteer for extra weekends and overtime? Be careful! A mistake while working "extra" could prove costly in more ways than one if a prosecutor subpoenas a timesheet.

It has been estimated that anywhere from 1 in 5 to 1 in 7 nurses may have a problem with drugs or alcohol in the United States. These nurses often work alternate shifts, where symptoms are easier to hide, and patients requiring analgesics may be simpler to locate. Unfortunately for RN's, fatigue is also classified as an impairment by the ANA, so nurses need to be aware of what their individual state mandates before signing up for double shifts.

The Story of Janine

Janine (not her actual name) was one of the nurses that got caught. She always worked the evening shift. Her colleagues were aware of her physical ailments because she complained frequently. Peers did not mind helping her with lifting/moving patients because they empathized with her lower back pain. What they did mind was when she disappeared for long breaks to smoke and take a "break," expecting peers to observe her patients. Where was she?, they wondered. The unit was busy, and no one had time to exit the unit and wander.

I met with Janine briefly to try to help organize her time.

Between our meetings, her dinner absences had been reported anonymously as a possible impairment issue. Although confronting the employee directly is ideal, few nurses feel close enough to the situation to be direct.

Symptoms of impairment may include: appearing inattentive to issues, volunteering to administer narcotics to patients, unexplained absences, smelling of alcohol or mouthwash, glassy eyes or small pupils, unusual relationships with doctors who prescribe medications, repeated errors, changing jobs frequently, and extreme family or home stress, among others. Janine appeared to have a few of these issues, although she was private and made few close friends.

The goal in meeting with Janine was to determine a plan that would allow her to communicate her physical and emotional needs while formulating a successful approach to her work during the evening, including assistance with possible substance abuse (retention and rehabilitation) as suspected by her peers. Janine was open about her need to take hydrocodone with acetaminophen (Vicodin) frequently to control back pain, but there was no evidence that she was taking more than what was prescribed.

I worked with her for several shifts. She was a cheerful, jovial nurse, well liked by patients. She did seem to need frequent breaks to smoke. She lacked attention to detail, and she had difficulty completing tasks prior to signing off for the oncoming shift. Her reports were often confusing.

There was no "secret sauce" to success for Janine. She chain-smoked, which complicated her chronic back pain in the setting of daily opioid use. The nurses who worked with her had performed the correct action in reporting their concerns to an immediate supervisor. Janine's medication use was not the only worry; it was her absences from the unit and her inattention to detail. After all, opioids had been prescribed, and she was within employee confines to take her medication at that institution. From what her employer could determine, there was no evidence of drug-seeking behavior.

Ultimately, Janine chose to leave. She did not want to work through an action plan to improve her performance or to eliminate the lengthy breaks away from the unit.

A few months later, Janine passed away from a sudden respiratory illness.

She lost her job, her income, and, eventually, her life from an addiction to Vicodin. Assistance came too late to save her, although everyone "knew" or believed she had a problem. I would like to believe we could have helped her, but I will never know.

I remember Janine with sadness.

I know there will be another nurse who might benefit from her story. If your colleague is impaired, if you believe your colleague could be impaired, know that you can act.

Please share Janine's story.

Have you worked with an impaired colleague?

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About Diane M. Goodman
Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who works from home contributing to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Diane worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!

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