Impaired Nurse in Healthcare

Concept of the Impaired Nurse

Introduction

Impaired nurses cannot meet the requirements stipulated by the code of ethics that governs the nursing profession and the standards of professionalism dictated. Typically, impaired nurses neglect their fundamental duty of caregiving to their patients, commit numerous medical errors, and fail in pain management (EMC, 2018). Ideally, impaired nursing may entail drug addicts, drunkards, mentally disturbed nurses, and even sleep enthusiasts (EMC, 2018). Lately, the issue of impaired nursing continues to attract significant attention, given the encumbrances surrounding this problematic situation, which compromises healthcare significantly (Toney-Butler & Siela, 2021). The danger posed by assimilating impaired nurses is the risk of patients losing their lives. Such nurses would be largely incompetent and bound by minor ethical stipulations that compel them to fulfill their duty of care as salient caregivers.

Ethical and Legal Ramifications of Impaired Nurses

Ethical Implications

The healthcare sector has incorporated four fundamental ethical principles that define how it should render its services as caregivers: non-maleficence, beneficence, justice, and autonomy (Feinberg, 2010, p. 623). The philosophical framework of principalism requires that nurses prioritize benefiting their patients and doing everything within their control to ensure that harm is not sustained (Feinberg, 2010, p. 623). Essentially, deontology also comes into play when focusing on the extent to which duties and responsibilities should be performed as required and the condemnation of omission, which tends to result in complications and ethical compulsions (Feinberg, 2010, p. 623). Indisputably, assimilating impaired nurses into the healthcare sector has several ethical ramifications around it, all of which should not be juggled.

As required for nurses and healthcare professionals, the ethical principle of autonomy posits that patients should be thoroughly brought to speed on critical issues surrounding their health (Feinberg, 2010, p. 624). On top of that, it speculates that patients should be allowed to take part in their healthcare as they best understand their health complications and can, thus, provide feasible intervention strategies that would benefit them (Feinberg, 2010, p. 624). To this end, dealing with an impaired nurse is not a reliable guarantee that a patient\\\\\\\'s autonomy would be respected, mainly because impaired nurses tend to complete tasks and \\\\\\\" do what they think is best for the patient\\\\\\\" (Feinberg, 2010, p. 624). When this happens, the autonomy of a patient is highly disregarded, which then implies that the impaired nurse commits an ethical breach.

The principle of non-maleficence asserts that no harm should be done and is considerably supported by the Latin maxim, primum non-nocere, meaning, first, not harm (Feinberg, 2010, p. 624). Healthcare professionals must inflict no harm in patients, mainly requiring them to eliminate any interventions that might cause the same since pain elimination in toto is nearly impossible in health matters. Given this dilemma, pain management strategies such as anesthesia were introduced to cushion patients from pain, especially when undergoing critical surgeries. However, dealing with impaired nurses and requiring them to uphold the non-maleficence ethical principle might be difficult to sustain because their drug-induced states or sleepiness modes might cause them to forget to administer pain management interventions (Feinberg, 2010, p. 624). Therefore, a patient is taken care of by such a nurse would have their health and life compromised immensely.

The ethical principle of beneficence requires that medical professionals do good and benefit their patients by providing the best healthcare techniques to ensure optimal good health (Feinberg, 2010, p. 624). Ideally, this ethical principle is derived from radical non-maleficence and requires nurses to offer patients non-punitive treatment options that warrant their well-being and subsequent health sustenance (Feinberg, 2010, p. 625). However, dealing with impaired nurses who unsuccessfully try to hide their addiction might not be an excellent approach in upholding the beneficence principle because such nurses could risk harming patients, even non-voluntarily (Feinberg, 2010, p. 625). The circumstances surrounding their impairment as nurses make them non-reliable in ensuring that patients benefit fully from their interventions and do not sustain any injuries (Feinberg, 2010, p. 625).

The principle of justice was first coined by Aristotle, a significant moral philosopher who contended that \\\\\\\"equals must be treated equally, and unequals unequally\\\\\\\" (Feinberg, 2010, p. 625). Contextually, the medical profession requires physicians to exercise distributive justice to ensure that all patients are taken care of irrespective of their status or background (Feinberg, 2010, p. 625). However, the consolidation of impaired nurses into the healthcare profession fails to ensure that social classes are regarded equally as required by the code of ethics for nurses. For instance, patients from the lower strata in society may fall prey to the incompetence of impaired nurses because they tend to seek medical intervention in large and public institutions, where it is difficult for a report to be implemented (Feinberg, 2010, p. 626). Thus, this means that the poor patients would have to \\\\\\\"deal with the impaired nurses because nothing can be done about it,\\\\\\\" primarily because public institutions nowadays exist to prove their existence.

Alternatively, individuals from the high class would also be affected by impaired nurses through the injustice lens when the impaired nurse is an individual of high social status or even in charge of the elite medical institutions (Feinberg, 2010, p. 626). In such circumstances, it may be difficult to report them for their impairment, owing to the level of their influence and clout medically (Feinberg, 2010, p. 626). In both scenarios, it is sufficient to argue that impaired nurses would fail to provide justice to patients regardless of whether they are assimilated into public or elite medical institutions because they tend to become unbothered by their impact.

Legal Implications

The American Medical Association began working on legally dealing with impaired nurses from as early as the 1970s when it became clear that the issue of impaired nursing was on the rise (Feinberg, 2010, p. 612). Most importantly, most States in America acknowledged the need to develop programs that would steer impaired nurses from the cause of their impairments to improve the healthcare sector (Feinberg, 2010, p. 612). Plausibly, the Oregon Senate medical board was the first to initiate such a movement in 1989 to identify impaired nurses and intervene appropriately to eliminate this quagmire (Feinberg, 2010, p. 612). However, it remained imperative to deal with impaired nurses through the criminal justice system to assert retribution among potentially impaired nurses to discourage them from such incompetence.

Usually, impaired nurses tend to clash with the law like any other substance abusers. However, their cases are more solid because they are generally in blatant breach of duty when they risk their patients\\\\\\\' lives and focus on narcissistic tendencies such as getting drunk while on the job (Feinberg, 2010, p. 612). In most States, nurses found liable for impaired nurses have their licenses revoked and face disciplinary actions for their medically-oriented offenses that place lives at risk (Feinberg, 2010, p. 612). To this end, medical practitioners and the public are required to report any impaired nurses that might be consolidated into the healthcare sector to ensure that they are legally dealt with and discontinued from fulfilling their duties while impaired (Feinberg, 2010, p. 613).

Encountering Impaired Nurses

Coming across impaired nurses today is a common thing, and it is necessary to identify proper measures that would mitigate this issue at its core. According to several surveys conducted among nurses, most of them admitted that they found it difficult to report their impaired colleagues because they feared tarnishing their reputation and, ultimately, making them lose their jobs (Lockhart & Davis, 2021). Typically, the normal thing to do would be to call them out on the behaviors that make them impaired nurses to ensure that they understand the implications of their impairment as nurses. However, this strategy has been less effective, especially when the confrontation is done on a peer level (Lockhart & Davis, 2021).

Therefore, documenting one\\\\\\\'s concerns about a suspected impaired nurse and lodging the concerns with the relevant department for evaluation and mitigation has been proved to be a more effective strategy in dealing with such situations (Lockhart & Davis, 2021). Remarkably, this could include notifying the counseling department, which would then take the necessary measures to veer an impaired nurse from the object of their impairment and ensuring that repeat situations do not present themselves. Alternatively, the Human Resource department could also be looted in to issue a fair warning on the impaired nurses and assure them of their imminent laying off if the behaviors are not improved. Notably, it is unethical to remain mum about the situation as this would breach the ethical principle of beneficence that requires that benefits are accrued to everyone.

Employers have been encouraged to promote a drug-free workplace policy to ensure that medical professionals do not partake in the consumption of drugs in the workplace that might prompt impairment (CEU Fast, 2018). However, in such, Employment Assistant Programs (EAPs) should be embraced to assist impaired nurses with their incompetence (CEU Fast, 2018). Referring impaired nursing to EAP programs would come a long way in helping them to seek help on their impairments that render them unfit for the job (CEU Fast, 2018). Most importantly, they enable these nurses to remain vigilant on competence and realize their impact in the healthcare sector, which should not be taken lightly (CEU Fast, 2018).

Risk Factors for Impaired Nurses

More often than not, the tendency to become affiliated with impaired nursing is not a voluntary decision. Mostly, some factors beyond the control of a nurse may push them to seek alternative escape measures that might end up being detrimental to their careers as caregivers and affect the quality of their work. Substance use addiction has been reported to be the primary contributing factor to impaired nursing, as it is mainly used as an escape route from reality (Lockwood, 2020). Some risk factors that might accelerate impaired nursing are psychological, behavioral, social, physical, and role-related risk factors (Lockwood, 2020).

Psychological risk factors encompass depression, anxiety, mental health disorders, low self-esteem, etc. (Lockwood, 2020). A nurse experiencing any of these issues may find it challenging to remain sober from fear of losing their mind if they constantly remain aware of the burdens weighing down on them (Lockwood, 2020). Therefore, they might find it helpful to resort to substance abuse or to oversleep to tame their psychological traumas, which eventually causes them to become impaired nurses.

Behavioral risk factors for impaired nursing include violence and response to peer pressure to consume drugs (Lockwood, 2020). Sometimes, the problem manifests itself from one\\\\\\\'s behavioral management, which differs according to individuals. It then follows that nurses with aggressive behaviors may get entangled in negative behaviors that are notorious for impaired nurses. The peer pressure to consume drugs may be prompted by the circle of peers that one associates with, which has been argued to form a large part of impaired nursing (Lockwood, 2020). While the peers inducing the negative behaviors may come up with ways to deal with their controlled consumption, the victims might be unaware that they are overdoing it, mainly because they would be doing it to seek validation and clout (Lockwood, 2020).

The presence of pre-existing addiction may also count as a risk factor for impaired nursing when relapses occur (Lockhart & Davis, 2021). Pre-existing addiction may cause a nurse to revert to their substance abuse tendencies, especially when facing life challenges that push them in that direction. Tentatively, such situations are driven by disillusionment and the delusional belief that consuming drugs serves as the most effective consolation strategy when one is undergoing difficulties.

Types of Impairment

Drug addiction among nurses counts as the primary type of nursing impairment, mostly because nurses have access to drugs administered to patients (EMC, 2018). Research highlights that nurses hooked to drugs are addicted to opioids, dispensed as prescriptions to patients (EMC, 2018). Because of their strategic position in accessing such medicines, some nurses find it difficult to refrain from consuming these drugs, especially since they are highly available (EMC, 2018). Additionally, mental impairment is expected as a nursing impairment and is caused by mental disorders that stem from psychological traumas (Feinberg, 2010, p. 599). Furthermore, sleep addictions also form the basis of impaired nursing when nurses are enthusiastic about sleeping at the expense of their jo (Feinberg, 2010, p. 599). It is worth mentioning that most of these impairments are caused by problems that face almost everyone. However, what counts in the long run is one\\\\\\\'s ability to exercise self-control and employ informed problem-solving techniques that steer them clear of impairment\\\\\\\'s way.

Impact of Impaired Nursing on Stakeholders

The concept of impaired nursing has colossal effects on patients, co-workers, impaired nurses, and agencies. Patients placed under the care of impaired nurses face the most significant risk because they are incredibly vulnerable and require to be administered with top-notch care and professionalism (EMC, 2018). The standard of care expected from caregivers is usually very high, given the nature of issues dealt with in hospitals. Therefore, a patient under an impaired nurse may have their autonomy disregarded, discriminated, may not benefit fully from the nursing interventions, and maybe inflicted upon considerable harm. Remarkably, these repercussions stem from the absence of ethical standards required from all nurses, which would otherwise be absent with a nurse is impaired.