The Issue of Addiction and Substance Abuse Among Nurses

In considering how to best combat the problem of substance-abusing nurses, it is important to note that, very likely, no one single strategy will prove to be effective in all instances. Indeed, the vast majority of chemical dependency professionals agree that a multifaceted and holistic approach is best when helping the addicted to manage their symptoms and observe a healthy lifestyle. With this having been said, the author had discussed a number of different methods which could be employed concurrently in an effort to mitigate the negative outcomes which are likely to ensue as a result of nursing personnel practicing while impaired.

Many facilities have begun observing an “alternative to discipline” mentality when addressing the issue of the impaired nurse (Monroe & Kenaga, 2011). While the author’s facility already does take a similar stance on the matter, it is important for staff to be well aware of this upon beginning their role within the organization. Unlike many other organizations which are instructed to avoid asking questions related to social habits during the interview process for instance, the author’s place of work is encouraged to do so in order to ascertain any life history which may be pertinent to the nurse’s role in working with chemically dependent patients. The time spent during employee orientation may be an appropriate occasion to educate new staff on company policies related to substance abuse. Indeed a more proactive approach to this issue will very likely prove to be much more helpful as opposed to discussing such policies with a drug-abusing employee only after a significant medical error or negative patient outcome has ensued as a result of impaired nursing practice.

One shortcut that the author and many of his colleagues are guilty of engaging in on occasion is in the “pre-pouring” or the setting up of medications prior to administration and as New (2014) points out, this practice oftentimes can allow a drug diverter easy access to controlled substances that are no longer locked in a narcotics drawer, even if just for a few minutes. While the facility’s nursing leadership has repeatedly proscribed such practices, they continue to take place from time to time and so members of the leadership team should also educate staff on how such shortcut methods not only increase the likelihood of medication variances but can also magnify the chances of certain medications getting into the wrong hands.

The author has also discussed with management the importance of educating staff on the behavioral signs which are frequently associated with impaired nursing practice and drug diversion such as wastage of entire doses, poor judgment, or prolonged and frequent bathroom breaks (New, 2014). The author had suggested providing employees with this information in a number of different ways such as during monthly nursing meetings or by providing new employees with literature or other educational handouts during the orientation process. While nursing staff at the treatment facility is naturally cognizant of the signs and symptoms of substance intoxication and withdrawal, such signs which are perhaps more pertinent to a coworker who is struggling with chemical dependency are oftentimes an area which nurses, particularly new graduates, are not adequately prepared to recognize.

Yet another practice at the author’s place of work which perhaps warrants improvement relates to the destruction of prescription medications following a patient’s discharge from the facility. Generally speaking, a patient’s unused medications are left on the director or nursing’s (DON’s) desk so that they can be destroyed by the DON at a later time. While this method is no doubt convenient, it allows a drug diverter an overwhelmingly large amount of time to take whatever medications he or she wishes and while these drugs are never “narcotics”, as the author frequently explains to his own patients, any drug can be abused, even those with a so-called “low abuse potential”, when not taken as prescribed or as instructed on the bottle. Clearly, the facility would benefit from a more standardized method of drug destruction which accounts for the type and amount of medications to be wasted.

A final element of the author’s plan for change relates to the instillation of security cameras in medication storage areas. The author recognizes that there certainly exists a financial consideration with this strategy. The facility’s risk manager had been spoken with in regards to this matter and he had assured the author that he planned on mentioning this idea during the next monthly management meeting.

The author’s place of work observes a traditional organizational structure such as with a myriad of different departments, each with its own manager reporting to the institution’s executive director. According to the facility’s risk manager, the company believes in giving people “second chances” and this is evident in the many individuals it employs who have perhaps had a drug or alcohol-related legal history. In seeking permission to implement his plan, the author was required to speak with a number of different individuals including the facility’s DON and human resources representative. It is these individuals who will then discuss the author’s ideas and objectives with upper management members in order to solicit their feedback and approval.

While the author will not be personally seeking approval from a committee, the company’s leadership members do hold a monthly management meeting and safety meeting and it is in these venues where the author’s ideas are to be discussed. While the interdisciplinary collaborative practice (ICP) project mainly relates to nursing personnel, it is important to note that the majority of the author’s sti work equally as well for other departments of the healthcare facility, including chemical dependency counselors or even ancillary staff. Not unlike a handful of the nursing employees, many of these other members of the patient care team also have a history of substance abuse, thus are also at an increased risk for experiencing relapse and having substance abuse affect their job performance. In considering possible strategies for this project, the author had not only solicited feedback from his management team but had also asked his peers and subordinates for their input as well. The author had recognized that in order to be successful, the thoughts of the entire interdisciplinary team would have to be taken into consideration. As the plan continues to be implemented, the author also anticipates that it will need to remain flexible in order for it to be modified as needed so that it can best meet the needs of the facility and its many employees.

Ideally, the project will be implemented without the need for any sort of conflict resolution strategies; however, this will very possibly not be the case. With this said, the author will need to recognize that his opinions are bound to be different from certain others’, thus being open to feedback and constructive criticism will be important. It will also be critical for the author and his colleagues to focus on areas of common interest, such as patient safety, rather than being preoccupied with personal differences. The author feels as though he has been able to empower others by asking for their input and validating their feedback. As a result of this project, the author is confident that all of the nursing staff’s knowledge of the addictive process can be enhanced and that this new understanding will also be of benefit when working with substance-abusing patients.

In terms of problem-solving strategies, it was important for the author to clarify what exactly the issue was with his coworkers so that these other individuals could better see why a plan of correction was in order. Additionally, while the literature review had suggested a myriad of ideas for how to combat the problem of impaired nursing personnel, many of them simply were not financially feasible or practical for the author’s place of work. With this said, the author was also required to speak with his management team in order to determine which strategies may be most effective and useful at the facility.

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