STEPS TO MAKING A REPORT

When planning to intervene in a case of suspected impairment, the first step is knowing state laws and rules pertaining to substance abuse and impairment in the workplace. It is also important to be familiar with and to follow the organization’s policies and procedures relating to substance abuse and impairment.

Observing and Documenting

Next, nurses can follow these steps when they begin to notice possible impaired practice:

Observe job performance; be aware of signs and symptoms of impairment that are common in the workplace.
Look for patterns of behavior indicating possible impairment that are consistent over a period of time.
Document (date, time, place, witnesses) any inappropriate behavior; be concise and include objective, clear, and factual information:

What happened?
Who was involved?
When did the incident occur?
How was it discovered?
Where did it occur?
Were there any witnesses?

Confronting the Nurse

Supervisors should be involved in planning an intervention and taking steps to respond to concerns about impairment in the workplace.

Planning and participating in an intervention is a critical responsibility of the nurse manager, and it should never be implemented alone.
It is important to develop a careful plan of action before implementing an intervention and also important to secure help.
Interventions should focus on documented facts.
The primary objective of an intervention is to request the nurse refrain from practice until a fitness-to-practice evaluation has been completed (IPN, 2023).
To assure safety, a nurse who is impaired should never be left alone and should not be permitted to drive.

Calling in the Report

In Florida, any licensed nurse who suspects another nurse is practicing while impaired is responsible for reporting. In hospitals or other healthcare environments, reporting may be most appropriate to the clinical manager or nursing supervisor, who then assumes the responsibility of reporting to either the Florida Department of Health or IPN. Reporting to either entity fulfills the mandatory reporting obligation. A nurse may also contact IPN for a confidential consultation. IPN can be reached by calling 800-840-2720.

CASE

Lisa is the charge nurse on the evening shift at a small community hospital outside Jacksonville. She is concerned about James, a registered nurse who has been missing work frequently with vague complaints. When James does come to work, his appearance is disheveled, and he seems to have difficulty focusing on the tasks in front of him. During the shift, James disappears a lot, and the other nurses frequently have to go find him to get him to attend to patient needs.

Lisa is familiar with Florida’s mandatory reporting law regarding impairment but is having difficulty determining the best course of action in this situation. She believes this change in James’s behavior may be caused by the increased stress from his home situation, but there is also the possibility that it could be related to substance use.

Lisa takes action by paying close attention to James’s patterns of behavior. She begins to document any inappropriate behavior and shortly thereafter calls James into the office for a discussion. Lisa talks to James about his behavior, difficulty focusing on patient care, disheveled appearance, and the concerns raised by colleagues that James seems to disappear frequently.

As Lisa expected, James responds by becoming defensive and denying any problems with his behavior. In an angry outburst he says, “Everyone is out to get me here, so maybe it’s best for me to just resign” and gets up to walk out of the office. Lisa calmly requests that James sit down, and she explains that no one is out to get him. Lisa gently says, “James, you’ve been under a lot of stress lately, and we only want to help support you in getting some help for yourself.”

After a lengthy conversation with Lisa, James admits that he has been impacted by psychological stress and unable to provide safe patient care, and he agrees to take time off work. Before leaving Lisa’s office, James makes two important phone calls: one call to his husband to pick him up and take him safely home and the other to IPN to schedule an evaluation.