Ethical Dilemma in Nursing: Chemically Impaired Nurses
Chemically impaired nurse on duty is the ethical dilemma in nursing that I will be writing about in the essay. It can be easy for a nurse to want to be chemically impaired due to stress of trying to keep someone alive and getting them better. As we know nursing is not an easy job and it takes a strong caring person to do it. Even some strong nurses fall though because they have been broken down from stress of working, being understaffed, long shifts, etc. They just want something to take the edge off or to not feel so strongly to ease their day.
“51.1% of Americans drink and as little as one third of them will develop a substance abuse disorder in their lifetime”. Currently it is reported by the American Nurses Association (ANA) that around 10% to 15% of nurses may be impaired or recovering from substance or alcohol addiction. This number increases each year with reports to the state board being made. In Pennsylvania alone it was reported to increase by 31% from 2015 to 2017. Some nursing specialties have seen to have a higher rate of substance abuse such as nurse anesthetists are estimated at 15% that suffer. The trend seems to be shifting to nurses in outpatient services, long-term care, and medical- surgical units are now reporting higher rates of substance abuse rather than specialty nurses though. Nurse anesthetists are more likely to abuse drugs that are readily available to them such as IV opioids while floor nurses are more likely to abuse pill form of medications. Nurses that are seen to be affected the most are young female nurses that are new to the field, but substance abuse can affect anyone no matter age, gender, race, socioeconomic status, or ethnicity.
Chemical impairment can affect anyone’s image but especially nurses because they are meant to be seen as responsible, reliable, and trustworthy. They are at high risk due to job-related stress and easy access to medications. A nurse that is chemically impaired does not have the right judgement to do her/his job even if it seems like he/she is functional while taking unprescribed drugs or medications that impair their thinking. Patients need to feel like they can trust the care they are receiving. If it is suspected that a nurse is chemically impaired, then the charge nurse needs to be notified right away so no harm may be done. A nurse that is chemically impaired while on duty would need relieved of their patients, taken off the schedule, and sent to get help. The nurse’s patients will need to be either redivided or ask for another nurse to come and take his/her patients.
This can make nurses be seen as drug seekers and users even though the majority are not. Especially since people know nurses handle medications every day they work. The patient can feel like they are not getting the care they need or that the nurse can have a slip up while under the influence and accidentally harm them. Quality of care for the patient would decrease due to the nurse not having a clear mind. As I previously said the nurse may not have good judgement or assess a patient correctly while chemically impaired. To keep the patient safe the nurse should not do or take anything that would cloud their judgement, even prescribed medication can do this so the nurse should talk to their doctor if this happens. Patient safety should be the nurse’s number one priority. Some of the signs of impairment can be discrepancies on the medication report, unexplained wastes of narcotics, missed or incomplete documentation, inappropriate behavior, etc.
If a nurse is at work chemically impaired, they should be held accountable for their actions especially if it involves harm to a patient. Nurses know its their responsibility to come to work not under the influence for safety and professional reasons. It is the responsibility of the coworkers of the nurse to report if anything is suspected. There are some nurses that will self-disclose on their own but other nurses may be reluctant to coming forward due to the stigma that may arise or that it may show moral weakness. They may also think that their addiction does not affect them or their work. When a nurse is revealed to be chemically impaired it is better to try to rehabilitate them rather than use a punitive approach. It is estimated that substance abuse cost $600 billion annually due to loss of productivity, criminal justice costs, and healthcare utilization.
It is best to get along with your coworkers because it makes the job easier, but backs should not be turned just because they are a friend. If I was a coworker of a nurse I knew or suspected was chemically impaired while on the job I would report my suspension to the charge nurse or nurse manager. In the event that they do nothing about it I would report it to the house supervisor or keep advancing it up until something was down because I know I wouldn’t want to be a patient with a nurse that was chemically impaired while taking care of me. I wouldn’t want to see the nurse potentially harm a patient knowing I could have prevented it.
Nurses becomes friends fairly easily when they work with each other frequently. If the nurse was my friend and chemically impaired on the job, I would still report them. I would probably ask how they are doing first but I would not hold back the information just because they are my friend. I care about my friends a lot, but I would want to see them get the help they need and protect patients. Just like we do with our patients we need to maintain a non-judgmental attitude toward the coworker, before confronting the coworker reflect on your own thoughts and feelings on the subject. This will help to avoid putting unwanted judgement on the coworker and they may feel less reluctant to speak about their addiction. Hopefully they would do the same even if the nurse was their friend. It is our job to serve and protect our patients even if the protecting is from a fellow nurse. I know that the harm probably wouldn’t be intentional but that doesn’t mean they wouldn’t get in the same amount if not more of trouble. It also costs a lot of money due to loss of productivity, potential legal fees, etc. but when the person seeks treatment every dollar spent for it saves the economy seven dollars in costs to the society and health care.
This issue is under 567.8 B4 and the peer assistance is under 567.17. The actions taken by the Oklahoma Board of Nursing would have the nurse evaluated and have them join the peer assistance program. “The corrective action may include remedial education, an administrative penalty, or any combination of remedial education and an administrative penalty”. If a patient was harmed the nurse could face charges and get their license permanently revoked. The peer assistance program is voluntary but if the nurse refuses to go through with it for any reason they will not be able to return back to work and lose their license. Treatment works if the person is willing to work on it, it is a continuous battle. People are able to quit on their own due to learned treatment and recovery from a friend, someone who is currently or has been in recovery, or a healthcare professional. “Treatment plans need to be individualized, comprehensive, and biobehavioral to be effective and the typical options are inpatient or outpatient detoxification in a safe environment”.
I have gained knowledge of how substance abuse affects the person doing it and the people surrounding them along with other information about chemically impaired nurses. Before writing this paper, I would have never guessed that it was a rising epidemic. I have heard of nurses with substance abuse, and have known at least one, but did not guess it would be the percentage it is or how much it would cost yearly. $600 billion is a lot of money and that is spent just due to substance abuse. I know that it is my responsibility and the responsibility of other nurses to report any suspicious activity. Some nurses may not feel like they can do that to a coworker especially if they are close friends, but we have to be the advocates for the patients and their safety is what is the top priority. I have a close family member that has a substance use disorder and it has affected them and everyone around them. With this example from the family member I know how tough it can be to confront them about their problem, but it is essential especially for nurses since they are supposed to be care takers and responsible. Over the last semester I had the privilege to have clinicals on a drug and alcohol rehabilitation floor, so I got to see what kind of groups and activities patients did to help fight against their addiction, I even had the chance to share about my past encounters with friends and family members. It was not an easy thing to do but I did feel better having someone to discuss it with. I have also learned that if there is a history of family addiction then that increases your risk of substance use disorders.
In summary substance abuse can affect anyone no matter age, gender, socioeconomic status, ethnicity, or race. Even though addiction does not discriminate young female nurses that are new to the nursing field seem to be affected the most. This is due to the high job stress and access to medications that could potentially be abused. Nurses can be seen as irresponsible drug seekers especially if they are seen chemically impaired while on the job. Treatment is available to the nurse that is having problems with substance abuse and is highly recommended to be able to keep their license although their insurance may not cover every option available. If you suspect or know a coworker is impaired on the job it is your responsibility to turn the nurse in even if they are your friend, you can confront them about it before turning them in but you should not turn a blind eye to it. Refrain from being judgmental and if needed take yourself out of the situation, after the nurse is turned in, if you are unable to be non-judgmental. If the nurse is chemically impaired while on the job they will need to be relieved of their duties, taken off the schedule, and sent to a peer assistance program if they agree to it. Their patients will be needed to be divided up to the available nurses or have a nurse come in. Treatment programs can be successful if the patient is willing to continuously work on their addiction, the treatment plan is individualized, comprehensive, and biobehavioral. The Oklahoma board of nursing has booklet of nursing practice acts that are to be maintained in Oklahoma. $600 billion is lost due to substance abuse every year but when a person seeks treatment every dollar cost, $7 is saved in society and in health care costs.
References
Oklahoma Board of Nursing (2019, Nov. 1). Oklahoma Nursing Practice Act. nursing.ok.gov/actwp19.pdf
- Mumba, M. & Kraemer, K. (2019, April). Substance Use Disorders among Nurses in Medical-Surgical, Long- Term Care, and Outpatient Services. CNE. https://pdfs.semanticscholar.org/16cf/f3bb1f8fd856fb1cefa65c78d78bce7acb2d.pdf
- Mumba, M. (2018, August). Employment Implications of Nurses Going Through Peer Assistance Programs For Substance Use Disorders. Archives of Psychiatric Nursing. https://www.sciencedirect.com/science/article/abs/pii/S0883941717304041
- Lockhart, L. & Davis, C. (2017, June). Spotting Impairment in the Healthcare Workplace. Nursing Made Incredibly Easy. https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2017/05000/Spotting_impairment_in_the_healthcare_workplace.9.aspx
- Perkinson, R. R. (2016). Chemical dependency counseling: A practical guide. Sage Publications.
- Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2016). Policy and Politics in Nursing and Healthcare-Revised Reprint. Elsevier Health Sciences.
