Substance Abuse and Registered Nurses

Substance Abuse Among Registered Nurses

Introduction

The practice of substance abuse among registered nurses is a threat to the nursing profession. It could compromise the quality of patient care provided and the professional standards of the nursing profession. In the year 2008, 17.8 million Americans were eighteen and overused illegal drugs; 12.6 million users reported to be employed. With the 50% higher rate of substance abuse among registered nurses, these numbers illustrate the severity of this problem. So much so that 1 in 7 nurses is at risk of developing a drug addiction (Epstein, Burns & Conlon, 2010). This paper discusses the dangers posed to patients by drug use among nurses and the Board of Registered Nurses' disciplinary actions on such drug-related matters.

How Impairment Due to Drug Use Can Endanger Patients

Risk factors

The major factor attributed to substance abuse among nurses is stress, which could be physical or emotional. Some form of emotional trauma in childhood and a family history of drug or alcohol abuse are such emotional stresses that could imprint on adult life. Physical stress on nurses is particularly prevalent in the United States due to the nursing shortage. The polls of 2008 demonstrate this shortage clearly as there were only 854 nurses to 100,000 people in the United States. This shortage necessitates practices such as rotating shifts, overtime, and nurses' constant reassignment to different units. The constant demand for nurses and the supply which cannot match up places an excessive workload on the available nurses. Nurses under the protracted influence of such stress are at a high risk of using illegal drugs as a means of relief (Epstein et al., 2010).

Nurses' daily work environment is unpredictable, and alarm situations are highly likely to occur daily. These situations of alarm present a form of psychological stress. Constant exposure to death by the intensive care unit and emergency department nurses creates a highly stressful environment to work. Extended operations in these kinds of environments cause profound psychological stress. The physical stress of the unpredictable work pace and the tasking work demands on these nurses increase substance abuse risk by a significant amount (Trinkoff & Storr, 1998).

Signs and symptoms

The first sign of substance abuse is a deterioration in interpersonal relationships, usually between family and friends. Unjustified absences from work, constant lateness, inappropriate behavior in the workplace, and conflicts with colleagues, staff members, patients, and patients' families indicate changes in work patterns and conduct in the workplace symptoms of substance abuse. A reduction in job performance may occur as the individual becomes less competent to handle duties (Epstein et al., 2010). Changes may also occur in the personal hygiene, emotional stability, and social behavior of an individual committing substance abuse.

Relevance to Occupational Health

The impairments brought on by long term substance abuse increase the likelihood of workplace accidents and injuries. The equipment, materials, and substances in the medical environment are technical and could pose a hazard if mishandled. This can result in economic damages as there are increased claims for health benefits, workers' compensation, and disability claims.

A reduction in the ability to function due to substance abuse reduces productivity and efficiency in the workplace. A greater risk of errors occurring appears, which in the medical environment can be dangerous. There is a decrease in the quality of care provided to patients and an increase in patients' dissatisfaction regarding the medical care provided (Epstein et al., 2010).

To ensure the continued safety and health of the public, hospitals have implemented drug-free workplace programs. These programs aim to restrict substance abuse by enlightening health workers about substance abuse and its dangers while stating the consequences of a violation. Beyond educating health workers about substance abuse, these programs incorporate drug testing and an Employee Assistance Program (EAP) (Epstein, et al., 2010). The EAP is designed to help workers with substance abuse problems through the use of counseling services. The worker is assessed by a licensed counselor who recommends a treatment option and assists the worker during the rehabilitation period.

Disciplinary actions/reinstatement by the Board of Registered Nursing

Correctional methods used to restrict substance abuse among nurses in the past were punitive and meant to serve as deterrents to other perpetrators. These methods have since been abandoned for a better one in many countries globally as the impacts of these methods have been outlined as harmful. The promise of punishment for a request for assistance encouraged pretense and continued to expose patients to substance-impaired nurses. The introduction of non-punitive, confidential assistance is an attempt to provide early intervention for professionals and students suffering from substance addiction (Monroe & Kenaga, 2011).

State Nursing Practice Acts

Each state possesses the legal power to regulate professionals such as nurses within their jurisdiction (National Council of State Boards of Nursing & National Council of State Boards of Nursing, 2011). These regulations are made through the Nursing Practice Acts. These Acts vary from state to state, but they are legislations that ensure public safety and well-being. The functions of the Nurse Practice (NPA) are:

· To define the terms of the law which regulates nursing

· State the composition of the Board of Nursing's members and powers

· Define the educational standards for nursing in the state

· To direct the licensing of qualified nurses

· To outline the disciplinary actions for nurses who violate any of the terms of law defined by the Nursing Practice Acts.

Boards of Nursing are administrative agencies created by statute that regulate nurses' practice to ensure the safety of the public. These agencies enforce the Nursing Practice Acts created by state legislation. These agencies' function is to protect the public from unsafe, incompetent, or negligent nurses by adopting safe nursing guidelines and meting out disciplinary action to violators. The Board also regulates nurse rehabilitation programs.

The Traditional Disciplinary Approach

The disciplinary process for a nurse violating the drug-related conduct of practice starts with submitting a complaint form to the nursing board. The nursing board is the administrative agency tasked with overseeing public safety by weeding out unsafe nurses and practices. The complaint can cover any of the following drug-related violations a nurse can commit:

• Possessing a substance use disorder

• Suffering from a substance-induced impairment during clinical hours

• The diversion of hospital drugs for personal purposes

• Failing a drug test

• Violating a federal or state enacted substance law

• Breaching the provisions of the nurse assistant program.

The evidence of the nurse's violation is presented before the nursing board for deliberation. The nursing board then determines if the nurse violated the nursing profession's professional conduct in that state as defined in the Nursing Practice Acts. A nurse found to be in violation is sanctioned by the nursing board to begin rehabilitation.

Rehabilitation starts with a monitoring program. These are nurse assistance programs in which the nurse must enroll. These programs use counseling and other methods to assist nurses in overcoming drug addictions. After the requirements of the program are met, the nurse is discharged.

Records of the disciplinary action taken against a violating nurse are stored for reference purposes in the National State Boards of Nursing databanks. These records are also required by federal law to be stored in the Healthcare Integrity and Protection Data Bank and the National Practitioners Data Bank.

The Non-Disciplinary Approach

An alternative to the traditional disciplinary attempts, non-disciplinary programs are designed to sanction offending nurses while assisting them. This correctional method has been in use since the 1970s and is adopted by a growing number of nursing boards (National Council of State Boards of Nursing & National Council of State Boards of Nursing, 2011).