Often nurses are uncomfortable or unsure about reporting possible substance use disorder in colleagues. Reasons for hesitancy include a lack of education about substance use disorders and how to spot them, reluctance to get someone in trouble or negatively affect their career, and not knowing how or where to make a report.
Common persistent myths about impaired nurses can also affect decisions about reporting, including the following:
Nurses do not seek help for themselves for a variety of reasons including stigma, fear, an inability to ask for help, or an erroneous belief that they are successfully self-treating for the root problem. Denial is the usual response, and in general it takes the intervention and insistence of colleagues and/or family and friends to get a nurse to enter treatment (Smith, 2017).
In one study, fear and embarrassment and concerns about losing one’s license were the most highly rated barriers to seeking help for substance use disorder and mental illness. Other reasons included concerns about confidentiality, lack of awareness of treatment programs, too ill to seek help, lack of money to pay for treatment, lack of insurance, and not having a healthcare provider (Cares et al., 2015).
Respondent suggestions for overcoming those barriers included greater knowledge about how to seek support; steps to take to maintain one’s license; more confidentiality; support of professional colleagues, friends, and spouses; greater knowledge of treatment services; lower cost of treatment services; insurance coverage; and a confrontation or intervention by family, friends, or colleagues (Cares et al., 2015).
Understanding the basics of substance use disorders and their potential signs and symptoms as well as knowing your ethical and legal responsibilities under Florida law will help prepare you for reporting impairment in your workplace.
If you see a practice that is unsafe or unprofessional you need to document objective information about that practice, determine the risk, share that risk with another, and take appropriate action (Smith, 2017), which will usually be to report the problem to your nurse manager or to another person specified by your facility’s policies and procedures.
Nurse managers play a critical role in this process by making sure their staff are knowledgeable about SUDs, risk factors, and signs and that they understand facility policies and procedures for reporting. Having a sense of the baseline behavior of staff members may allow the manager to more quickly notice important changes. If there is an immediate danger to a patient, action must be taken right away to remove the impaired nurse from the workplace following facility procedures.
An objective report contains details of things you can see, hear, smell, touch or feel, and their descriptions won’t vary from one person to the next. Avoid including opinions, emotional reactions, conclusions, and theories. Include physical descriptions and focus on the ability of the person to care for patients (to do their job). Supervisors might ask themselves “Is their practice safe and professional?” In other words, focus on the person’s performance.
Remember that changes in performance or behavior that you document can have multiple causes. Your job is not to diagnose but to report signs of impairment—unsafe work practice—to prevent harm to patients and others (Smith, 2017; Alunni-Kinkle, 2015; NCSBN, 2014, 2011; Thomas & Siela, 2011).
Documentation should include:
When a substance use disorder is suspected, reports should be reviewed for patterns of signs and behaviors, especially negative appearance, mood changes, interpersonal problems, patient complaints, frequent unit absences, and charting review (NCSBN, 2011).
The AANA outlines a procedure in which objectively documented evidence is gathered and thoroughly reviewed and, if that evidence supports substance use disorder, an intervention is arranged to remove the person from practice. Ideally an intervention is planned ahead of time with a trained interventionist and other supporting personnel present and details worked out. Rules for privacy and confidentiality as well as facility policies must be observed (AANA, 2017).
In Florida an impaired nurse can be reported to the Intervention Project for Nurses (IPN) (non-disciplinary approach) or directly to the Department of Health/Florida Board of Nursing (disciplinary approach). The IPN is Florida’s state designated impaired practitioner program, known as an alternative to discipline (ATD) program, which will be discussed in the next module. The ultimate goal of ATDs is to protect patients and return nurses to the workplace. Their use is supported by research and experience and recommended by many professional groups including the ANA, the AANA, the NCSBN, ENA, and INTNSA (Strobbe & Crowley, 2017; Alunni-Kinkle, 2015; NCSBN, 2011; Monroe & Kenaga, 2010).
Steps in the IPN process include the initial referral call, consultation/intake, intervention/evaluation, appropriate treatment, and 2 to 5 years of monitoring (Smith, 2013).
A nurse who refuses participation in the IPN, discontinues treatment, or fails to progress once in the program will be reported to the Department of Health (DOH), which is the investigative entity for the Florida Board of Nursing. The DOH will conduct an investigation of the allegations, provide the nurse an opportunity to respond or defend; if a violation is found, a hearing (informal or formal) is held and, depending on the result, a disciplinary action may be imposed.
A closer look at the process and reasoning for each step is available in this video from the NCSBN: https://www.ncsbn.org/426.htm