8.1 Impaired Nursing Practice

Question 1

Impaired Nurse

Answer 1

Substance Abuse Disorder
- A pattern of behaviors that range from misuse to dependency/addiction to alcohol or drugs
- Alcohol is the most frequently abused substance with younger nurses favoring narcotics.
- Other drugs include benzodiazepines, CNS stimulants (ritalin), pain relievers (oxycodone), short-acting anesthetics (propofol).

Question 2

Substance Abuse

Answer 2

• Prevalence is 10-15 % of all nurses
• Women develop dependence quicker than men and enter treatment with more severe medical, psychological, and social problems.
• More prevalent in ED, critical care, and psychiatric nursing.
• Less prevalent in pediatric, women’s health, school/occupational health nurses.
• Nurse anesthesiologist report rates exceeding 15%

Question 3

Risk Factors

Answer 3

• Substance use usually doesn’t start with licensure. Usually is a problem during school prior to licensing.
• Fatigue
• Age (younger are at higher risk)
• Moderate use of alcohol (increase risk for drug use)
• Family history of addiction
• Role strain
• Burnout/work overload
• Problems with ADLs
• Enabled by peers and managers
• Stress from rotating work schedules and shifts longer than 8 hours
• Lack of control
• Physician prescribing practices
• Access to narcotics at the workplace
• Lack of education on s/s of substance abuse
• Attitude toward drug and drug use

Question 4

National Nursing Organization Stance

Answer 4

• Goal for nurses who have identified SUD, goal is to provide support and treatment, not discipline or loss of license.
• It is ethical duty to report an impaired colleague.

Question 5

AACN Recommendations

Answer 5

• All students should be educated regarding impaired practice
• Policy development in nursing education is needed
• Address prevention and management of substance abuse for students, faculty, and staff
• Provide confidentiality

Question 6

NCSBN

Answer 6

• Support early identification and treatment
• Acknowledge BON reentry programs

Question 7

Definition of Impairment per BON

Answer 7

• Substance abuse
• Physical illness
• Use of prescription medication
• Sleep deprivation
• Psychiatric and mental health issues