ETHICAL AND LEGAL CONSIDERATIONS

The public puts its faith in nurses, and it is every nurse’s duty to assure safe practice. Ethical practice is the cornerstone for patient safety and quality of care in nursing.

American Nurses Association Code of Ethics

The American Nurses Association’s Code of Ethics for Nurses (ANA, 2015) states, “The nurse’s duty is to take action designed both to protect patients and to ensure that the impaired individual receives assistance in regaining optimal function.” It further addresses impaired practice, focusing on the nurse’s ethical duty to protect the patient, the public, and the profession from potential harm and to ensure the impaired individual receives assistance.

PROTECTING PATIENTS

Provision 3.4 of the Code describes nurses’ professional responsibility to promote patient health and a culture of safety. This includes reporting any errors, near misses, or concerns for the health and safety of patients.

Provision 3.5 of the Code similarly addresses nurses’ ethical responsibility to protect patients by acting on questionable practice:

Nurses must be alert to and must take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights or best interests of the patient in jeopardy . . . and when [such practice] is not corrected and continues to jeopardize patient well-being and safety, nurses must report the problem to appropriate external authorities such as practice committees of professional organizations, licensing boards, and regulatory or quality-assurance agencies.

SUPPORTING COLLEAGUES

Provision 3.6 addresses nurses’ ethical responsibility to protect one another from harm due to impaired practice. It calls for nurses to approach impaired colleagues in a supportive and compassionate manner during identification, remediation, and recovery due to impairment. This includes:

• Helping the individual access appropriate resources
• Following employer policies, professional guidelines, and relevant laws
• Advocating for appropriate assistance, treatment, and access to fair institutional/legal processes
• Supporting the individual to return to practice after recovery

Nurses who report impaired practice should likewise be protected from retaliation or other negative consequences (ANA, 2015).

Florida Law

Florida law addresses issues of impaired practice in nursing, including reporting, discipline, treatment, and recovery. Under Florida law, all licensed nurses must report suspected impairment. Failure to report can lead to disciplinary action by the Florida Board of Nursing and result in serious consequences (FL BON, 2023).

NURSE PRACTICE ACT

The Florida Nurse Practice Act, as set down in the Florida Statutes, chapter 464, section 018, clearly identifies grounds for discipline as it relates to substance use, diversion, and failing to report a colleague who is suspected of being in violation (FL NPA, 2022). The law clearly states that disciplinary action may be taken against a nurse’s license under the following circumstances:

1. Engaging or attempting to engage in the possession, sale, or distribution of controlled substances for any other than legitimate purposes
2. Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition
3. Failing to report to the Florida Department of Health any person who the nurse knows is in violation of the nurse practice act except if the licensee verifies that such person is actively participating in a board-approved program for the treatment of a physical or mental condition, in which case the licensee is required to report such person only to a consultant operating an impaired practitioner program

If the Board of Nursing finds that a nursing professional is guilty of any of the foregoing grounds, the Board may impose penalties that may include probation, suspension, permanent revocation of a license, restriction of practice, administrative fines, or a letter of reprimand.

TREATMENT PROGRAMS FOR IMPAIRED PRACTITIONERS

Florida Statutes, Chapter 456, Section 076, pertaining to health professions and occupations, clearly defines treatment programs for impaired practitioners and designates approved impaired practitioner programs (FL IPP, 2022). (See “Treatment Programs” later in this course.)

When a nurse is reported as being impaired as a result of the misuse or abuse of alcohol or drugs, or both, or due to a mental or physical condition which could affect the nurse’s ability to practice with skill and safety, the nurse can avoid disciplinary action by:

1. Acknowledging the impairment problem
2. Voluntarily enrolling in an appropriate, approved treatment program
3. Voluntarily withdrawing from practice or limiting the scope of practice as required by the impaired practitioner program consultant
4. Executing releases for medical records, authorizing the release of all records of evaluations, diagnoses, and treatment of the licensee, including records of treatment for emotional or mental conditions to the consultant

INTERVENTION PROJECT FOR NURSES (IPN)

The Florida Department of Health (under the authority of F.S. 456.076, described above) has designated the Intervention Project for Nurses as the approved impaired practitioner program for nurses. The IPN is designated through a contract to serve as consultants and to initiate interventions, recommend evaluations, and refer impaired practitioners to treatment providers or treatment programs. The IPN also monitors the progress and continued care that is provided by approved treatment programs and providers (FAC, 2023).