EMPLOYER INITIATIVES

The first step in helping an impaired employee is to have knowledge about addiction as a primary disease that can be recognized and treated. All nurses should be familiar with signs and symptoms, organizational policies and procedures for employee substance abuse, and any assistance that is available through resources such as workplace employee assistance programs.

Since nurses spend a significant amount of time at work, it is the ideal place to address substance abuse issues. For nurses who work in locations where direct patient care is provided, it is especially important for patient safety that systems be in place to prevent, quickly identify, intervene, and assist the nurse when behavior changes occur that may indicate a substance abuse problem or impairment in the workplace.

Education

Many nurses are unaware that substance abuse and drug diversion are serious problems in the workplace. Lack of education about the addiction process and how to recognize the signs and symptoms of a substance use disorder remain two of the most profound risk factors for nurse impairment (Salani et al., 2022).

Broad-based educational efforts should be instituted that focus on the nature and scope of the problem, signs and symptoms of impairment and diversion, and proper ways to respond. Education about substance abuse should be part of the orientation for all new employees and included in yearly competency training.

Educational efforts may include:

  • Annual CE requirement for licensure
  • Annual employee competency training
  • Online education made available through an alternative-to-discipline program
  • Addiction topics introduced at “Lunch-n-Learn” sessions
  • Addiction topics scheduled for nursing grand rounds
  • Annual addiction conferences

Policies and Procedures

Policies and procedures should be in place that assure consistent handling of substance abuse problems in the workplace. Policies should promote safety and provide assistance to employees at risk for substance use disorder.

Workplace policies aimed to prevent, identify, intervene, and assist with substance abuse problems in the workplace may include the following:

  • Pre-employment drug testing
  • For-cause drug testing
  • Fitness-to-practice evaluations
  • How to document and report concerns
  • Employee Assistance Programs (see below)
  • Return-to-practice guidelines
  • Relapse management
    (SAMHSA, 2022; Toney-Butler & Siela, 2022)

Surveillance

Surveillance systems are helpful any time impairment is suspected, and they can also provide evidence to determine if the impairment is associated with diversion of controlled substances.

To help discourage diversion, all employees should be made aware of surveillance systems that are in place to rapidly detect diversion. Automated distribution machines (ADMs) are one example of a surveillance system used in many hospitals. ADMs distribute medication through an electronic system that can audit records and look for inconsistencies and discrepancies. ADMs also have a waste retrieval system in which all unused portions of controlled substance doses are tested to prevent substitution of the medication being wasted.

Employee Assistance Program (EAP)

An EAP is a work-based program that offers confidential assessment, short-term counseling, referral, and follow-up services to employees who have personal and/or work-related problems. The primary goal of an EAP is to get help for employees who need it while maintaining their employment.

CASE

David, a 38-year-old nurse, underwent intervention four years ago for impairment in the workplace and diverting narcotic medication. He was referred to a 30-day inpatient residential treatment program for opioid abuse and followed up by attending an aftercare program in his hometown that included weekly relapse prevention sessions for six weeks.

David has been back at work in the emergency department for three years, and his supervisor considers him to be “one of the best nurses we have.” She remembers that David was a very good nurse even before the intervention, and David is thankful now that his supervisor reported him for impairment before he ended up hurting himself or one of his patients.

David has taken on a role in teaching other nurses about the importance of assisting colleagues to get help for substance use disorder. He recently offered an in-service workshop called “What happens when a nurse seeks help for an alcohol or drug problem?” He talked to the hospital staff about his experience in residential treatment and his aftercare program.

Most of David’s attention during the in-service was focused on discussing the challenges he faced when returning to work. He talked about the shame and guilt he felt for becoming addicted to drugs and how much worse it got when he began diverting narcotics on the job. He talked about how difficult it was to come back to work and how important it has been for his fellow nurses to support him.

David spoke in depth about his contract with the state intervention program and how ongoing monitoring keeps him safe and accountable. He explained that his contract put some restrictions on his license—such as not being allowed to administer narcotics to patients for one year—and that he feels very appreciative of other nurses who didn’t complain about passing pain medications to his patients during that year.

David further explained that his three-year contract included:

  • Weekly “12-step” support group meetings
  • Regular nurse support group meetings focused on relapse prevention
  • Monthly appointments with an approved addiction counselor
  • Random drug screens
  • Worksite monitoring and regular evaluations of his performance at work
  • Restrictions on working in a supervisory role

After his presentation, one of the nurses asked David about the cost of getting help and participating in the state intervention program. David explained that his own 30-day residential treatment program and six-week aftercare program were partially covered by insurance but that he had to pay some of it out of pocket. He added that costs vary depending on the type of treatment (residential, partial hospitalization, intensive outpatient) and according to the treatment provider.

To participate in the intervention program during his three-year contract, David was also responsible to pay for regular appointments with his addiction counselor, random drug screens, weekly nurse support groups, and a monthly fee for participation in IPN. He made it clear that being in a monitoring program does involve a financial commitment on the part of the participant.

Overall, David described his intervention, treatment, and follow-up contract with the intervention program as “the best thing that ever happened to me. It allowed me to get out of practice temporarily in order to focus on getting well and getting my life back in balance, and it taught me how to come back as a better and more accountable nurse.”