Recognizing Impairment in the Workplace

CONTACT HOURS: 2

Copyright © 2023 Wild Iris Medical Education, Inc. All Rights Reserved.

BY: 

Loretta Ann Bostic, DNP, MBA, APRN, CRNA; Marcy Caplin, PhD, MSN, RN, CNE

LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this continuing education course, you will be able to recognize and understand how to respond appropriately to signs and behaviors that may be associated with impairment in the workplace. Specific learning objectives to address potential knowledge gaps include:

  • Identify risk factors and signs of impairment in the workplace.
  • Recognize barriers to early identification of impaired nurses.
  • Summarize the essential steps to report or refer a nurse who may be impaired.
  • Discuss the intervention and discipline process related to impaired practice.
  • Describe employer initiatives aimed at prevention and early identification of impairment in the workplace.

TABLE OF CONTENTS

  • Introduction
  • Identifying Impairment
  • Ethics and Impaired Practice
  • Reporting Impaired Practice
  • Interventions
  • Employer Initiatives
  • Conclusion
  • Resources
  • References

INTRODUCTION


Impairment occurs when a nurse is unable to provide safe patient care due to the use of a mood- or mind-altering substance and/or due to the presence of a physical condition or a distorted thought process from a psychological condition (IPN, 2023). Impairment not only endangers patients but also threatens the health and safety of the impaired nurse, puts colleagues at risk, causes a significant financial burden for employers, and compromises the integrity of the nursing profession. A healthcare worker’s impaired performance also puts patients at risk for unsafe care as well as inadequate pain relief and possible exposure to infectious diseases from contaminated needles and drugs (ASHP, 2022).

Nurses are responsible for the safety of patients, and this includes a duty to deliver nursing care without impairment. The American Nurses Association (ANA) strongly advocates for all medical facilities to establish educational programs that teach nurses how to recognize impairment and respond according to state laws and institutional policies (ANA, 2016). Some states have passed legislation requiring all nurses to participate in continuing education on this topic as a condition for licensure.

DEFINITION OF TERMS

The following terms related to impairment are used throughout this course.

Addiction: Compulsive drug-seeking behavior where acquiring and using a drug becomes the most important activity in the user’s life; implies a loss of control regarding drug use and that the person with a substance use disorder will continue to use a drug despite serious medical and/or social consequences (DEA, 2020).

Drug diversion: A medical and legal concept involving the transfer of any legally prescribed drug from the individual for whom it was prescribed to another person for any illicit use, including any deviation that removes a prescription drug from its intended path from the manufacturer to the intended patient (Nyhus, 2021).

Impairment: The inability or impending inability to engage safely in professional and daily activities as a result of a physical, mental, or behavioral disorder (IPN, n.d.).

Psychological dependence: The perceived “need” or “craving” for a drug. Individuals who are psychologically dependent on a particular substance often feel that they cannot function without continued use of that substance. While physical dependence disappears within days or weeks after drug use stops, psychological dependence can last much longer and is one of the primary reasons for relapse (initiation of drug use after a period of abstinence) (DEA, 2020).

Substance use disorder (SUD): A disease of the brain characterized by the recurrent use of substances (e.g., alcohol, drugs) that cause clinical and functional impairment such as health problems, disability, and failure to meet major responsibilities at work, school, or home (Toney-Butler & Siela, 2022).