Nurses Who Use and Abuse Alcohol and Drugs in the Workplace

Safety in the health care of patients is an utmost concern of all nursing associations and institutions, some believe in support and rehabilitation while others impose harsh disciplinary actions.

According to the New York State Nurse Practice Act (NYSNA), "the abuse of alcohol and other substances among health care workers is an unfortunate but real health problem."
Their position is to consider alcohol and drug abuse as diseases and health problems that require treatment.

"Professional nurses who abuse alcohol and/or other drugs endanger their own well-being as well as the health and safety of the consumer."

"Measures taken to address this problem provide protection and assistance for professional nurses as well as promote the safe delivery of health care." The NYSNA's position is to consider alcohol and drug abuse a disease, a treatable health problem.

An example of drug abuse on the job occurred in the 80s when fellow peers noted a nurse leaving the restroom with white powder on her nostrils. She sat at the nurse's station sniffing and rubbing her nose as if nothing happened.

Entering the restroom after this nurse, an empty syringe and bloody alcohol wipe was in the trash with a minute amount of white substance on the sink. After a report to the supervisor, her immediate removal from the ward prevented continued care of patients by the impaired nurse.

The institution allowed the nurse to enter a drug rehabilitation program; upon returning to the workplace, she could not have the narcotic cabinet keys and a colleague gave her patients their narcotic pain medication. One condition of her rehabilitation required periodic drug testing. After treatment, she resumed her role on the unit.

The NYSNA's position on the drug testing issue includes "To provide and promote education...guidance and assistance so all ...nurses can obtain appropriate treatment and regain health." Peer support and confidentiality is especially important.

"Drug testing should only be done if the nurse is observed under the influence and exhibits poor job performances." (NYSNA) Anyone can report their suspicions to the appropriate authority and this includes reports from patients.

One government facility performs random drug testing based on computer generated last four digits of the social security number. This includes all employees in their facilities throughout the nation.

A surgical registered nurse was noticeably away from her position for a long period. Many employees believed she suffered a heart attack but eventually someone broke the confidentiality rule and stated she was in rehabilitation for diverting patients' pain medications. She would inject water, saline or a fraction of the dose instead of their complete dose of analgesic.

Suspicion of diversion occurs when a patient continues to complain of pain after medicated by a particular nurse. This is especially true if the patient obtains relief on other shifts at the same dose and route as the suspected nurse utilized.

The facility allowed her to enter a drug abuse program that she completed but because of rumors, she decided to retire at age 58.

A licensed practical nurse signed narcotics out in the ledger even though the patients did not complain of pain. She chose patients who rarely complained and/or used their pain medications, particularly elderly patients.

She roused suspicion of diversion when these patients never used or denied use of their narcotics on other shifts. In addition, it appeared she listed all names at the same time.

When she completed her shift, she made a major error of leaving the diverted narcotics in one of the empty medication drawers. This warranted an immediately report to the supervisor. The institution gave her two options, resign or be reported to the Board of Nursing.

She resigned and later began working at a nursing home. She did not request or agree to treatment as she claimed she diverted narcotics for her friend with multiple sclerosis. She will have more autonomy without close supervision for diverting narcotics in nursing homes.

The American Nursing Association (ANA) strongly support "alternative to discipline or peer assistance programs". These programs offer rehabilitation and peer support with guidance until the nurse is ready to reclaim his/her position in the facility.

Some facilities allow the nurse to work in other areas of the hospital away from patient care, such as the file or mail room while undergoing treatment. A nurse assistant who could not stay awake on the unit smelled of alcohol with an attempt to cover the smell with mints. He failed the rehabilitation program and retired (not fired) from the facility.

Even a nurse clinical instructor used alcohol in the workplace, carrying it in her thermos. Apparently, the abuse was severe enough to cause tremors of her hands, while observing her students perform important procedures on patients. She resigned.

Many suspected a long-term nursing supervisor of alcohol abuse on the job and her peers attempted to cover it up because she did not work directly with patients. The rumors were quelled after her admission to the same facility for pancreatitis and liver failure due to alcohol abuse. Unfortunately, she expired on her first admission.

The Florida Department of Health and Board of Nurses advocate much harsher penalties of fines ranging from $250 to $1000 depending upon first or second offense. First offense includes an Impaired Nursing evaluation but a 2nd offense means permanent revocation of nursing license.

This is one of the reasons these nurses are not always reported to the board yet are either fired or allowed to resign, ending up in other institutions without a negative remark from the previous facility.

It is easy to divert narcotics that are identical to non-narcotic medications. Some suspicions rose when the patient continued to complain of pain that when the doctor increased the dose on another shift, the patient became lethargic. Now many drug companies are changing the color or shape of their narcotics.

Prior to stricter laws, of locking some "scheduled" medications in narcotics cabinets (these included Lorazepam, Valium, and sleeping pills) these medications were in unlocked medication carts and abused by many nurses.

Once locked in narcotic cabinets and inventoried a noticeable change in demeanor in some nurses who admitted, among peers, to using these medications for stress.

The inventory of all narcotics at the shift's end between an on and off going nurse is the routine of almost all facilities. It is important for each of these two nurses to observe this count prior to signing their signature agreeing the count is correct.

Nurses who abuse narcotics and alcohol benefit from a supportive and rehabilitative program in order to recover from what some believe are diseases. However, the most important responsibility of any institution is the safety of health care to the consumers. The use of alcohol in the workplace is easier to detect and report.

Unfortunately, drug diversion has a long history in our institutions but it is widely believed that an alternative to discipline is the best solution. By inventorying narcotics each shift, a nurse can verify that it is correct or find out why there is a discrepancy before the off going nurse leaves duty.

References:

American Nursing Association. Impaired Nurse Resource Center. http://www.nursingworld.org

Drug testing of professional nurses. New York State Nurse Practice Act. http://NYSNA.org/practice/positions/position19.htm

Florida Department of Health: Florida Board of Nursing
http://www.doh.state.fl.usa.pdf