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How to Recognize an Impaired Nurse & Get Help for Her/Him

Do You Suspect a Nurse Has a Substance Abuse Problem?

The nurse is the glue that holds most medical operations together. Yet, it has been estimated that as many as 10 to 15 percent of them are substance-impaired while on the job. What should a supervisor do when concerned that a nurse may have an alcohol or drug problem?

An experienced administrator and director of nursing offer the following 10 warning signs.

  1.  Physical changes or alterations in personality. Look for heavy sweating, poor personal grooming and hygiene, trembling hands, trouble with coordination, pupils that are enlarged or smaller, irritability, edginess and vacillating moods.
  2. Long and unexplainable breaks or a high number of absences from work.
  3. Handwriting that is hard to read or that goes downhill over the course of a single shift.
  4. Giving medication to another nurse’s patient while that nurse steps out for a scheduled break.
  5. The nurse is seen at the narcotic dispensary and then immediately afterward heads to the bathroom.
  6. The nurse volunteers to be in charge of medications.
  7. The nurse asks for shifts where they will have less supervision.
  8. Patients in the nurse’s care say they never received pain medication or did not receive sufficient pain medication.
  9. The nurse’s charting is incomplete or not done at all.
  10. Narcotic control forms have erratic or incomplete entries. Pages and entries are out of order or lack properly recorded dates and times.

The priority at all times is the patients’ well-being. Thus, before deciding to confront a nurse about possible substance abuse, make sure that all patients have received adequate attention and appropriate medications. When you do confront, follow this outline.

Look for Written Guidance

Written guidance in the form of employee policies should be available. These policies should address issues like substance abuse on the job and substance use during off-hours that affects job performance. At this point it may be time to contact the state licensing board for further direction.

Make a List of Support Resources

A nurse with a substance abuse problem does not face automatic license forfeiture. There are recovery programs designed specifically for nurses that allow them to hold onto their license and eventually return to work with supervision. Be ready to emphasize support not punishment.

Have a Plan – Be Prepared

Think through when and where you will talk to the nurse. Plan what you will say and know in your own mind what you hope the outcome of the meeting will be. In the event that policy demands drug testing, be prepared to make that happen.

Confront with Grace

During your meeting with the nurse explain what you have observed in a professional tone and manner. Treat the nurse with dignity even if they deny the accusation. Don’t be surprised if a nurse caught red-handed still attempts a denial.

Be Confidential

Reassure the nurse that what you are discussing has been treated with the utmost confidentiality. Substance abuse is treated like other protected illnesses such as hypertension or diabetes.

Emphasize Help

Tell the nurse about the resources available to them. Emphasize your goal of support and help, which will lead to recovery, over taking punitive action. Let the nurse know that help often leads to full recovery and a return to a desirable career.

Posted on July 21, 2014 and modified on April 25, 2019

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