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Nurse Manager Employer Information

NURSE MANAGER- EMPLOYER INFORMATION

Update on Mandatory Reporting

In 2013, the Georgia General Assembly passed a bill requiring mandatory reporting of impaired nurses by employers to the Georgia Nursing Board. The intent of this bill (House Bill 315) is for employers of registered nurses who suspected or observed a nurse of working impaired/or have diverted medications, to notify the Georgia Board of Nursing Board. The bill, though passed, included language requiring new funding appropriated by an act of the General Assembly for Georgia Board of Nursing to successfully manage the volume of anticipated nurses reported. While in the period of clarification of state funding resources, GNA-PAP continues to advocate for mandatory reporting by employers and strongly encourages employers to report all substance using nurses/employees to the Board.

 

Work Site Crisis Interventions

Initiating a work-site intervention for your employee is usually what the nurse recalls as the event that was ‘the straw that broke the camel's back”. An employer initiated intervention is usually the catalyst needed to get a substance using nurse into treatment and hopefully a stable recovery program. Repeatedly heard from our nurses in recovery is their deep appreciation and level of gratitude towards their employer for taking this difficult and sometimes uncomfortable position of initiating their work-site intervention.

 

A few considerations when initiating a work-site intervention:

1. Prior to engaging in any conversations with a nurse, contact the Human Resource Department for advice on your facility's policy and procedures.

2. Prior to intervention, observe/collect data and documentation of nurse's behaviors (see #5-"Collecting information on missing medications from medical records”).

3. Prior to intervention, identify a second person to participate/witness conversations. GNA-PAP recommends having 2-5 people with direct involvement/concerns with your nurse. Assistance of a recovering nurse may be of extreme value during the face-to-face intervention.

4. Prior to intervention-Rehearse your roles and get group consensus on defining what "the bottom line” is.

5. Prior to intervention, discuss the plan to address barriers for entry into a treatment program. For example, family obligations/childcare, insurance coverage, compensation time away from work.

6. Keep focus on the goal of the intervention - which is to motivate the nurse to seek treatment, who might otherwise not proactively seek help on his/her own.

7. Introduce the existing problem/concern and "stay on course.”

8. Project concern/empathy, but communicate clearly the objective facts with supporting documentation.

9. Allow the nurse to give his/her side of the story. Be alert to any indicators of self-disclosure and the awareness of the magnitude of their  substance use disorder.

10. Document the intervention and hold a debriefing meeting for those who participated in the intervention.

11. Assist other staff members with their concerns, feelings and value towards a co-worker with substance use disorder.

 

 

Collecting Information on Missing Medications from Medical Records

Here are some basic guidelines to consider when suspecting a nurse of diverting medications. First, contact your facilities Human Resource Department for advice on your facilities policies and procedures.

1. Narcotics:

     ·Discrepancies in sign-in sign-out signs or electronic medication dispensing systems (PIXIS)

     ·Wastage (not following procedures for proper discarding or unused drugs and missing documentation of witness discarding of drugs)

     ·Supply records-inconsistent ordering ( amounts, frequency)

2. Medication Records

     ·Discrepancies with doses recorded accurately

     ·Discrepancies with chart notes and narcotic records as to amount of drug administered.

     ·Discrepancies with pain control documentation

3. Documentation-Medical Records

     ·Documentation is not complete, legible or consistent with your facility's policies and procedures

4. Physician/Healthcare Provider Verbal Orders

     ·Documentation is not complete, legible or consistent with your facility's policies and procedures.

5. Anesthesia/Surgical Records

     ·Documentation is not complete, legible or consistent with your facility's policies and procedures

6. Legal Consequences

     ·Unexplained gaps in prior work history

     ·Disciplinary action by past employers

     ·Disciplinary actions from other state licensing boards

     ·Incident reports suggest a questionable behaviors

     ·Attendance Records

7. Personal Information

     ·Legal Consequences-DUI/DWI; failed/missed family financial responsibilities, loss of personal property

 

Reporting to the Board of Nursing

There is a moral responsibility to the public to report nurses who pose a threat to public safety. The high demand for nurses can result in a nurse manager firing an unsafe nurse without reporting to the Board or taking other appropriate actions; thereby, passing this nurse and his/her problems along to the next employer.

Nurse managers can work with the Board to ensure there is mandatory reporting, or rules in place for impaired nurses. If you believe there is information on a nurse's behavior in the workplace, you, as a nurse manager have a moral obligation and responsibility for public safety to notify the Board. Information needed to notify the Board includes:

     ·A definition of reportable events or situations

     ·A description of level of suspicion (there must be first-hand knowledge or reason to believe).

     ·Employment information to include license

     ·Specific details of the incident

     ·Actions taken when incident occurred

The nurse manager is in a unique position to play a primary role in carrying out policies and procedure designed to address substance use disorder in the workplace. It is imperative that all nurse managers educate themselves about substance use disorder and the nursing profession. A nurse manager who is knowledgeable, prepared, proactive, sets clear limitations and is compassionate is likely to be more successful with a nurse whose practice may be unsafe due to substance use disorder.

 

GNA-pap facilitators may be a resource for questions and concerns. Call the Hotline number at 1-800-462-9627. GNA-pap facilitators can provide assistance, education and support with employee intervention.

Questions to Consider in Assessing a Nurse for Substance use Disorder (Click here)

 

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