Impairment Issues Related to Nursing/Nursing Assistant Practice

1
Impairment Issues Related to Nursing/Nursing
Assistant Practice

• An afternoon of Discussion with the New Hampshire
  Board of Nursing

2
Clint Jones Award Foundation for Healthy
Communities

• This award is given in memory of a man who
  remained dedicated to the nursing profession and
  served as an inspiration for excellence in
  nursing care.

3
Road to Recovery

• Margaret Walker and William Kohut of the NH Board
  of Nursing discuss the board discipline-alternativ
  e program
• Provides an option for a licensee in need of
  assistance with drug/alcohol impairment,
  physical, and mental health issues that
  interfered with practice.
• Remains non-public provided no harm has occurred
  and the individual has self-reported.

4
Diversion Program

• Help nurses that are at a low risk who meet the
  following criteria
• Never been before the Board
• Are not being prosecuted
• Are not on medication
• Have no criminal record
• Have no alcohol or drug violations
• Are recommended by the completed treatment
  program
• They have been recommended by an Independent
  Evaluation
• Have Board Approval.

5
Benefits of Road to Recovery

• Licensees avoid official board action
• Motivates licensees to attend self-help and
  ongoing treatment
• Helps licensees to stay focused and develop
  constructive priorities
• Keeps them employed
• No interruption of skill development.

6
Requirements of R2R

• Duration of the program is 5 years or more
• We know that the longer a person remains in
  treatment the less likely for relapse
• Nurses are required to call-in daily to a
  designated drug testing program (24 tests are
  required yearly)
• Nurses are required to provide monthly
  self-reports
• Nurses are required to provide quarterly reports
  from work and therapists
• Nurses are required to document 3 self-help
  meetings and a Professional meeting per week
• Nurses are required to document obtaining a
  sponsor in the 1st month of the program

7
R2R Program Administration

• A transparent data base between Board Staff and
  Coordinator is developed
• Each case is Board approved
• Detailed forms and files are maintained.

8
R2R Program Completion

• Independent evaluation
• Recommendation from treatment provider to include
  accomplishments by the nurse
• Documentation of meetings and reports are up to
  date
• Abstinence for 5 years
• Board approval

9
Sandy

• General overview
• Nature of the profession
• Chemical dependence

10
Situations that place licensees at risk

• _Knowledge deficit by nurses
• _Attitude of professional immunity to
  addiction
• _too smart to become addicted
• _different from others due to
  managing health care of others
• _Predisposition for addiction
• _genetic
• _early trauma
• -scattered psychiatric conditions
• -Stress from professional demands vs. lack of
  self care

11
Situations continued.

• Work injuries requiring pain management
• _Sandwich generation
• _ History of social alcohol and drug use
• _Concept that pills/medication works
• _ knowledge of drug actions, dosages and
  interactions
• _ observation of drug effectiveness in
  their patients, both physical
• and psychological

12
Situations continued

• Nursing culture that accepts self-prescribing of
  medications
• _ Need to appear competent , leading to the
  numbing of feelings of inadequacy
• _Availability of controlled medications
• _License allows addiction to become far advanced
• _ secret of addiction enhanced by having
  license
• _ provides income, identity, easy drug
  access, and cover-up

13
Kelly Behaviors Prior to Discovery

• Alcoholic
• Late for work Frequent absences Mondays
  Fridays
• Last minute sick calls
• Smell of alcohol or mouth wash
• Tremors, Glassy red eyes
• Decreasing attention to personal hygiene
• Unplanned trips to car
• Extended lunch hours breaks
• Difficulty following instructions
• Very Unreliable

14
Kelly Behaviors Prior to Discovery

• Addict
• Volunteers for extra hours/days
• Volunteers for 3rd shift weekends
• Volunteers for sickest patients
• Frequent trips to bathroom
• Volatile behavior
• Very high achiever
• Best employee
• Narcotic counts are frequently off
• Frequent wastage broken vials
• Unobserved wastage
• Patients experiencing increased pain levels

15
Kelly Points of Interest

• Dual diagnosis commonly bipolar
• Sample snatching
• Master manipulators
• Doctorate in Lying

16
Sandy

• Barriers to intervention
• Enabling

17
Intervention Dos

• Treat with dignity and respect
• Take action
• Focus on job performance
• Do not use labels
• Prepare a plan
• Review documentation
• Request help from others
• Ask nurse to listen to all before responding to
  interveners
• Have evaluator options ready
• Expect denial
• Report as necessary to the R2R
• Debrief with interviewers

18
Intervention Do Not

• Just React
• Intervene alone
• Try to diagnose the problem
• Expect a confession
• Give up
• Use Labels

19
Laura and Rebecca Treatment Options

• Inpatient Treatment
• Outpatient Treatment ((IOP)
• Individual counseling with a LADAC
• 12 Step Program Attendance (AA, NA)
• Professional Support Groups

20
Goals of Treatment

• Establish Physical Sobriety
• Create Ongoing Recovery Plan
• Evaluation by an Addiction Specialist

21
Early Recovery

• Fear of Judgment
• Shame Remorse
• Financial insecurity
• Relationship challenges
• Anger

22
Re-entering the workforce

• Interviewing and Self Disclosure
• Typical Contracted Requirements to Return to
  Practice
• Risk of Relapse

23
Roles and Responsibilities

• It is the responsibility of the Board of Nursing
  to ensure safe practice for public safety.
• It is NOT the responsibility of the Board of
  Nursing, The Employer, or any other group or
  individual to ensure that an addicted nurse
  recovers.
• The only person who can ensure recovery is the
  individual themselves.

24
Group Panel

• Discussion and examination of the issues related
  to impairment.
• Support group information.
• Goals and purpose of the Road to Recovery
  program.
• Future direction.