|
|
| |
|
 |
| |
|
Our Site is best viewed by Internet
Explorer 4.0 or higher. Some formatting, and functions of our
Site may not work with other browsers. To get/update IE click on the
above logo. |
| |
 |
| |
| |
|
|
 |
 |
 |
| |
| |
GEORGIA NURSES
ASSOCIATION |
| |
|
| |
Nurse Advocate Program |
| |
1-800-GNA-9NAP
(1-800-462-9627) or 404-325-8807 |
| |
|
| |
ANA
Impaired Nurses Resource Center |
| |
|
| |
|
|
|
|
A |
ssesses and accepts the Impaired Nurse in a non-judgmental
manner.
|
|
D |
istrict contact person.
|
|
V |
oices belief in addiction as a treatable disease process with
physical, social, spiritual, and emotional components.
|
|
O
|
pen and objective toward the Impaired Nurse.
|
|
C
|
onsultant for program development. Communicates with other
Advocates and contributes to establishing and maintaining a statewide
network.
|
|
A |
ccountable to the District President and the Georgia Nurses
Association Nurse Advocate Program for the conduct of the program.
|
|
T
|
reatment and entry facilitated with intervention to begin the
recovery process.
|
|
E |
ducator -- To spread the word!!! |
Georgia Nurses Association's Nurse Advocate
Program was established in 1981 as a collaborative effort with the
Georgia Board of Nursing with the express goal of identifying and
supporting nurses living with the disease of addiction.
The philosophical beliefs underlying the GNA
Nurse Advocate Program are threefold. 1Addiction is a disease
process with physical, social and emotional aspects; 2no nurse
should lose their job or license until he/she has had an
opportunity for care; 3there is hope in the treatment of the
chemically dependent nurse.
For further information about the Nurse Advocate
Program you may call our Helpline at 1.800.GNA.9NAP
(1.800.462.9627)
THE IMPAIRED
NURSE
The Georgia Board of Nursing recognizes that
nurses may become impaired primarily as a result of chemical
substance abuse to include alcohol, drugs, narcotics, or any other
mood altering substance.
In order to fulfill its purpose of protecting
the public, the Board is granted the power by law to discipline
the license of the impaired nurse. The Board also has authority to
condition the penalty based upon the nurse's entry into and
completion of a definitive alcohol and drug treatment program.
Based upon documentation provided by treatment rehabilitation
advocates, the Board considers probation, as opposed to revocation
of the license. Probation carries with it Board imposed measures
for monitoring the work performance and continued rehabilitation
of the impaired nurse.
The Board's progressive policy regarding the
impaired nurse does not preclude its regulatory responsibility;
therefore, the Board continues to expect the reporting of apparent
practice problems.
Georgia Board of Nursing - 1982
AMERICAN NURSES
ASSOCIATION
Georgia Nurses Association
ETHICAL STANDARDS:
|
NATIONAL COUNCIL OF STATE
NURSING BOARDS, INC.
Georgia Board of Nursing
LEGAL STANDARDS:
|
- Promote moral and high quality practice.
- Relate to professional practice standards.
- Established by professional association.
- Enforced by professional association.
- Sanctions for violation range from censure
(non-members) to expulsion.
|
- Ensure minimum safe practice.
- Relate to essential practice standards.
- Established by Judicial, Executive, or
Legislative action - Nurse Practice Act.
- Enforced by State government -- Georgia
Board of Nursing.
- Sanctions for violations include license
suspension, probation, revocation.
|
THE DISEASE CONCEPT
Chemical dependency is a controllable disease.
The single greatest obstacle to the treatment of
this disease is the matter of attitudes: the attitudes of the
person with a chemical dependency, the family, friends, employer,
and society at large. The misconception persists that chemical
dependency is not a disease but rather a behavior problem that is
either psychological, ethical, or moral in nature.
Consider, if you will:
It is rare that neighbors increasingly avoid and
mistrust a fellow human being simply because he has heart trouble
or is a victim of crippling arthritis. Nor, do families feel
humiliated or do their best to conceal one of their own merely
because he is ill. Nor, do police commonly put such unfortunate
persons in jail if their illness causes them to fall or to display
other symptoms of an acute attack while in a public place. Yet,
all of these are typical responses to the person with chemical
dependency.
Why is this so?
We all tend to fear, avoid, and sometimes even
to despise that which we do not understand. The sight of an
intoxicated person weaving erratically down the street or the
addict lying disheveled in a stupor arouses responses of either
revulsion and alarm or scorn and contempt in the majority of
people. Seldom does such a spectacle generate compassion.
It is still easy to find communities in the
United States and in Georgia where the standard treatment for
chemical dependency is jail.
Chemical dependency is a disease.
But, do we as nurses simply believe this? Or, do
we retreat, perhaps unknowingly, to the belief that being an
addict or alcoholic is a symptom of some grave mental disorder?
Or, a poor pattern of behavior? Or, the habitual response of a
morally and ethically weak character when confronted with a
difficult and personal or professional problem? None of this is
true, because chemical dependency meets the criteria for a
disease.
WHAT IS A DISEASE?
Medical and nursing literature agree that a
disease can be identified by five specific characteristics: a.) a
disease has identifiable signs and symptoms, b.) it follows a
predictable and progressive course which, if untreated, may lead
to death; c.) it produces consistent anatomical and/or
physiological alterations; d.) its cause or causes may not be
known; and e.) it is a primary condition, not merely a symptom.
CHECKLIST FOR
DETECTING POTENTIAL
CHEMICAL DEPENDENCE IN AN EMPLOYEE
- Absenteeism:
- a.
- Frequent unscheduled short-term absences
- b.
- Higher absenteeism rate than other employees
for colds, flu, gastritis, etc.
- c.
- Absences after payday or days off
- d.
- Inconsistent or increasingly improbable
excess for absences
- e.
- Absences for traffic or home accident injurie
-
- "On-the-job" Absenteeism:
- a.
- Long coffee breaks
- b.
- Physical illness on the job (frequent trips
to Occupational Health Service)
- c.
- Excess time for charting/record keeping
- d.
- "Locked door syndrome" -- excessively long
use of restroom
-
- Difficulty in Concentration:
- a.
- Assignment takes more time (despite
skill/experience)
- b.
- Difficulty in assigning priorities in
clinical caseload
- c.
- Medication errors (wrong medication, wrong
dose, administration to wrong patient)
- d.
- Omitted, illogical, incomplete, or illegible
charting
- e.
- Deteriorating handwriting during shift
- f.
- Errors in transcribing orders and/or taking
verbal orders
- g.
- Overlooking signs of a patient's
deteriorating condition
-
- Inconsistent Work Patterns:
- a.
- Alternate periods of high and low efficiency
- b.
- Becoming or has become less dependable
- c.
- Doing minimal or substandard work in
comparison with peers
- d.
- Frequent requests for help with patient
assignments
-
- Physical/Emotional Problems:
- a.
- Changes in physical/emotional condition
during shift
- b.
- Marked nervousness on the job
- c.
- Excessive sweating
- d.
- Tremors of hand
- e.
- Lack of attention to personal cleanliness or
grooming
- f.
- Reports to duty despite physical or emotional
contraindication
-
- Decreasing Job Efficiency:
- a.
- Omits treatment
- b.
- akes bad decisions or shows poor judgment
- c.
- Lacks usual initiative or enthusiasm
- d.
- Requests change to less supervised shift
-
- Poor Relationships on the Job:
- a.
- Wide swings in mood from isolation to angry
outbursts
- b.
- Uncooperative with coworkers
- c.
- Avoids contact with nurse leader or
supervisor
- d.
- Complaints by patients of irritability,
physical roughness, or verbal abuse
-
- Medication-Centered Problems:
- a.
- Frequently around medication cart or closet
- b.
- Increased use of PRN psychoactive medications
or narcotics recorded for patients
- c.
- Increase in wastage/breakage of controlled
substances
- d.
- Missing drugs, unaccounted doses
- e.
- Seeks out on-duty physicians for personal
complaints of pain, backache, migraines, etc.
- f.
- No dates/times on narcotic sign-out sheets
- g.
- Complaints by patients about decreased pain
relief
-
- Personal Life Interfere with Job:
- a.
- Frequent or excessively long phone calls
- b.
- "Visitors" or unexplained errands during work
shift
PHYSICAL AND
BEHAVIORAL INDICATORS
ALCOHOLIC NURSE
|
DRUG ADDICTED NURSE
|
- Irritability, mood swings
- May become isolated; wants to work nights,
spends break time alone, avoids staff get-togethers
- Elaborate excuses for behavior, such as
being late for work
- Unkempt appearance
- Experiences blackouts (periods of temporary
amnesia)
- Impaired motor coordination, slurred
speech, flushed face, red or bleary
- Numerous injuries, burns, bruises with
vague explanation
|
- Extreme and rapid mood swings
- Pupillary changes, weight loss
- Activity level changes (i.e., lethargy to
hyperactivity)
- Diaphoresis, pallor
- Wears long sleeves all the time
- Defensive when questioned about medication
errors
- Frequently absent from unit, frequent use
of restroom
- Blackouts
- Usually works evenings/nights
- May request prescriptions from staff
physicians
- Consistently signs out more controlled
drugs than anyone else
- Waits until alone to open narcotics cabinet
- Disappears into bathroom directly after
being in narcotics cabinet
- Often medicates others' patients (i.e.,
while nurse is on break)
- Patients complain that pain medication
dispensed by this nurse is ineffective or patient denies
receiving medication charted
- Always uses maximum PRN dosage
- Initiates an order for a change in PRN
medication
- Violates procedure for wastage of narcotics
- Signs out larger dose than ordered and
wastes excess amount, when required dose is available on unit
- Consistently volunteers to be medication
nurse
- Entries on narcotic control record are out
of chronological sequence
- Discrepancies exist between time drug is
signed out on control sheet and time documented on nurses
notes or medication administration record or not charted in
patient care record at all.
|
JOB PERFORMANCE
CHANGES
ALCOHOLIC NURSE
|
DRUG ADDICTED NURSE
|
- Job shrinkage, does minimum work necessary
- Difficulty meeting schedules and deadlines
- Illogical or sloppy charting
- Errors in judgement
- Slow to response to emergency situations
|
- Frequent medication errors
- Illogical or sloppy charting
- Errors in judgement
- Treatments missed, IV's empty, and other
indicators of declining job performance
|
TIME AND
ATTENDANCE CHANGES
ALCOHOLIC NURSE
|
DRUG ADDICTED NURSE
|
- Increasingly absent from duty without
adequate explanation, long lunch hours
- Calls in to request compensatory time at
beginning of shift
- Frequent "no show" status
|
-
Frequently absent from unit
-
Comes to work early and stays late for no
apparent reason
-
Volunteers for overtime
-
May work two jobs
-
Appears on unit during off-time
-
Never takes breaks
- Intervention: the step from substance abuse to
treatment and, hopefully, recovery.
- Intervention is the means by which to motivate
a nurse who might otherwise not seek help on his/her own.
- Prior to intervention, observe, collect data,
document, and plan the intervention.
- Provide a comfortable environment and
sufficient time.
- Always have a partner (2-5 people with direct
involvement/concern should suffice); the assistance of a
recovering nurse may be invaluable.
- Rehearse your roles. Agree upon consequence --
what will be "the bottom line?"
- Introduce the existing problem/concern and
"stay on course". Relate concern but be objective -- focus on job
performance and personal behaviors.
- Don't moralize, sympathize, compromise, or
accept lies.
- Wait for the nurse in question to give her
story -- be alert to any indicators for help. Remain focused on
the issue at hand and not its causes.
- Be ready with a plan, e.g., a plan for needed
child care, for a replacement worker, knowledge of the nurse's
benefits and comp time, a plan for treatment, an appointment for
treatment, and a plan for someone to accompany the nurse
immediately after the intervention.
- Document the intervention and hold a
de-briefing for those involved.
- Assist other staff concerning knowledge,
feelings, and values.
- Follow-up on treatment or the consequences
agreed upon previously.
COLLECTING
DATA FROM RECORDS OF
HEALTH CARE PROFESSIONALS
- Narcotics
- a.
- Discrepancies in sign-out sheets
- b.
- Wastage (following procedures for proper
discarding of unused drugs, and documentation of witness
discarding)
- c.
- Supply records (stock) -- amounts, frequency
of order
- Medication Records
- a.
- Doses recorded accurately
- b.
- Correspond with notes and narcotic records as
to the amount or drug given
- Progress Notes/Nurses' Notes/Records
- a.
- Appropriate
- b.
- Complete
- c.
- Legible
- Doctor's Orders
- a.
- Appropriate
- b.
- Written for correct patient
- c.
- Complete
- Anesthesia Records/Surgical Records
- a.
- Medication orders -- recorded and appropriate
- b.
- Documentation -- recorded and appropriate
- c.
- Post-op Orders
- Legal/Professional Records
- a.
- Work history in prior positions
- b.
- Disciplinary actions by employer or licensing
board
- c.
- Incident reports (errors or accidents
involving the subject)
- d.
- Attendance records
- e.
- DUI/DWI charges
|
|
|
 |
|
 |
| |
|
|
|
