REPORTING IMPAIRED PRACTICE

In U.S. states and territories, nurse practice acts (NPAs) address issues of unsafe or incompetent nursing practice and delineate regulations and procedures for reporting, discipline, treatment, and recovery. Behavior that puts patients at risk, including impairment by drugs or alcohol while working, is a serious violation of any NPA and is considered reportable (NCSBN, 2018).

When planning to intervene in order to report 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 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.

Making the Report

Anyone who has knowledge of conduct by a licensed nurse that may violate provisions of the NPA, including impaired practice, should report the suspected violation to the board of nursing in that jurisdiction. Such reporting is often mandatory, and a nurse may be required by their NPA to file a report.

Most states require a written report and provide complaint forms and/or reporting telephone numbers, which can be found on the board of nursing website. Reports generally require information to identify the nurse who is suspected of a license violation together with as much detailed information as possible about the situation, including names, dates, times, and places (see “Observing and Documenting” above) (NCSBN, 2018).