WEBVTT 00:00:01.842 --> 00:00:05.040 position:50% align:middle Sarah isn't sure how she got to this point. 00:00:05.040 --> 00:00:09.680 position:50% align:middle As a nurse, Sarah works in a high-stress environment and recently went 00:00:09.680 --> 00:00:11.580 position:50% align:middle through a difficult divorce. 00:00:11.580 --> 00:00:15.180 position:50% align:middle After a back injury, Sarah began taking pain medications 00:00:15.180 --> 00:00:16.609 position:50% align:middle prescribed by her doctor. 00:00:16.609 --> 00:00:20.460 position:50% align:middle When her prescription ran out, she began borrowing medications 00:00:20.460 --> 00:00:24.960 position:50% align:middle from floor stock, then using medications that should have been discarded. 00:00:24.960 --> 00:00:29.585 position:50% align:middle And now, Sarah is diverting medications intended for her patients and attempting 00:00:29.585 --> 00:00:33.930 position:50% align:middle to conceal that diversion from co-workers and supervisors. 00:00:33.930 --> 00:00:38.187 position:50% align:middle Sarah's story illustrates one of the most serious problems facing 00:00:38.187 --> 00:00:40.250 position:50% align:middle the nursing profession today. 00:00:40.250 --> 00:00:45.390 position:50% align:middle Substance use disorder, nurses who abuse substances pose a unique 00:00:45.390 --> 00:00:47.247 position:50% align:middle challenge to the profession. 00:00:47.247 --> 00:00:51.920 position:50% align:middle The behavior that results from this disease has far-reaching and negative 00:00:51.920 --> 00:00:57.500 position:50% align:middle effects not only on the nurses themselves but also upon the patients who depend 00:00:57.500 --> 00:01:00.510 position:50% align:middle on the nurse for safe, competent care. 00:01:00.510 --> 00:01:05.571 position:50% align:middle Substance use disorder among healthcare providers also creates significant legal 00:01:05.571 --> 00:01:08.716 position:50% align:middle and ethical responsibilities for colleagues who work 00:01:08.716 --> 00:01:10.271 position:50% align:middle with these individuals. 00:01:10.271 --> 00:01:12.271 position:50% align:middle But there's good news too. 00:01:12.271 --> 00:01:17.288 position:50% align:middle When employees think their supervisor knows how to detect substance use and is 00:01:17.288 --> 00:01:20.330 position:50% align:middle willing to do something about it, employee's drinking and 00:01:20.330 --> 00:01:22.032 position:50% align:middle drug use decreases. 00:01:22.032 --> 00:01:26.460 position:50% align:middle Your role as a colleague or supervisor of the nurse who has a substance use 00:01:26.460 --> 00:01:28.450 position:50% align:middle disorder is pivotal. 00:01:28.450 --> 00:01:30.930 position:50% align:middle Be armed with knowledge. 00:01:30.930 --> 00:01:35.380 position:50% align:middle First, identification and reporting of the problem. 00:01:35.380 --> 00:01:37.630 position:50% align:middle Next, intervention. 00:01:37.630 --> 00:01:42.290 position:50% align:middle Then, diagnosis and treatment of the substance use disorder. 00:01:42.290 --> 00:01:46.091 position:50% align:middle And finally, monitoring of the nurse after return to practice. 00:01:46.091 --> 00:01:49.334 position:50% align:middle ♪ [music] ♪ 00:01:52.312 --> 00:01:57.180 position:50% align:middle Substance use disorder encompasses a pattern of behaviors that range 00:01:57.180 --> 00:02:03.190 position:50% align:middle from misuse to dependency or addiction, whether it's alcohol, legal drugs, 00:02:03.190 --> 00:02:04.955 position:50% align:middle or illegal drugs. 00:02:04.955 --> 00:02:10.687 position:50% align:middle Addiction is a complex disease with serious physical, emotional, financial, 00:02:10.687 --> 00:02:12.736 position:50% align:middle and legal consequences. 00:02:12.736 --> 00:02:18.932 position:50% align:middle It can affect anyone regardless of age, occupation, economic circumstances, 00:02:18.932 --> 00:02:21.145 position:50% align:middle ethnic background or gender. 00:02:21.145 --> 00:02:25.680 position:50% align:middle Substance use disorder is a progressive and chronic disease, 00:02:25.680 --> 00:02:29.400 position:50% align:middle but also one that can be successfully treated. 00:02:29.400 --> 00:02:33.450 position:50% align:middle Although alcohol is the drug of choice for the general population, 00:02:33.450 --> 00:02:38.489 position:50% align:middle nurses have increased access to controlled substances contributing to higher 00:02:38.489 --> 00:02:42.660 position:50% align:middle incidents of dependence on them regardless of the chemical. 00:02:42.660 --> 00:02:47.475 position:50% align:middle Mind-altering substances results in long-lasting changes to the brain, 00:02:47.475 --> 00:02:52.660 position:50% align:middle which is why addiction is a chronic and relapsing brain disease. 00:02:52.660 --> 00:02:56.840 position:50% align:middle The earlier substance use disorder in the nurse is identified and treatment 00:02:56.840 --> 00:03:01.443 position:50% align:middle is started, the sooner patients are protected, and the better the chances are 00:03:01.443 --> 00:03:03.367 position:50% align:middle of the nurse returning to work. 00:03:03.367 --> 00:03:06.434 position:50% align:middle ♪ [music] ♪ 00:03:11.370 --> 00:03:15.288 position:50% align:middle Nurses and other healthcare professionals have about the same prevalence 00:03:15.288 --> 00:03:19.770 position:50% align:middle of substance abuse and addiction as the general public, but there are unique 00:03:19.770 --> 00:03:23.856 position:50% align:middle workplace factors that actually increase a nurse's opportunity 00:03:23.856 --> 00:03:25.740 position:50% align:middle and risk for addiction. 00:03:25.740 --> 00:03:30.740 position:50% align:middle Staffing shortages, increased patient acuity and assignment ratios, 00:03:30.740 --> 00:03:34.880 position:50% align:middle demands from administrators and physicians, shift rotation, 00:03:34.880 --> 00:03:36.675 position:50% align:middle and long work hours. 00:03:36.675 --> 00:03:41.180 position:50% align:middle All of these issues make nursing a highly stressful profession. 00:03:41.180 --> 00:03:45.731 position:50% align:middle In addition, some nurses are subject to workplace bullying and verbal abuse 00:03:45.731 --> 00:03:49.740 position:50% align:middle contributing to stress and feelings of powerlessness. 00:03:49.740 --> 00:03:55.256 position:50% align:middle When someone is also experiencing personal problems or lacks effective coping skills, 00:03:55.256 --> 00:03:59.599 position:50% align:middle this job-related stress may contribute to substance use. 00:03:59.599 --> 00:04:04.104 position:50% align:middle Nurses also have relatively easy access to controlled substances 00:04:04.104 --> 00:04:06.325 position:50% align:middle and other drugs of abuse. 00:04:06.325 --> 00:04:11.100 position:50% align:middle Oftentimes, the lack of institutional controls for storing and distributing 00:04:11.100 --> 00:04:16.908 position:50% align:middle narcotics facilitates the improper removal of drugs from floor stock, waste, 00:04:16.908 --> 00:04:21.950 position:50% align:middle or even from a patient's medication supply for the nurse's personal use, 00:04:21.950 --> 00:04:23.577 position:50% align:middle also known as diversion. 00:04:23.577 --> 00:04:28.704 position:50% align:middle Many nurses use their education and experience to treat their own symptoms. 00:04:28.704 --> 00:04:32.536 position:50% align:middle Because of that knowledge, they may have a false sense of confidence 00:04:32.536 --> 00:04:35.938 position:50% align:middle and a belief that they can control their use of drugs. 00:04:35.938 --> 00:04:39.051 position:50% align:middle ♪ [music] ♪ 00:04:42.610 --> 00:04:46.770 position:50% align:middle It's not always easy to recognize unsafe practices in a nurse 00:04:46.770 --> 00:04:48.752 position:50% align:middle with substance use disorder. 00:04:48.752 --> 00:04:53.259 position:50% align:middle Sometimes it's tough to differentiate between the subtle signs of impairment 00:04:53.259 --> 00:04:55.726 position:50% align:middle and stress-related behaviors. 00:04:55.726 --> 00:05:00.455 position:50% align:middle Three things to watch for are behavior changes, physical signs, 00:05:00.455 --> 00:05:02.936 position:50% align:middle and the diversion of drugs. 00:05:02.936 --> 00:05:08.269 position:50% align:middle Behavioral changes can include shifts in job performance like absences from the 00:05:08.269 --> 00:05:13.560 position:50% align:middle unit for extended periods, frequent trips to the bathroom, 00:05:13.560 --> 00:05:18.600 position:50% align:middle arriving late or leaving early, and an excessive number of mistakes 00:05:18.600 --> 00:05:20.890 position:50% align:middle including medication errors. 00:05:20.890 --> 00:05:26.340 position:50% align:middle Behavioral changes can also include subtle changes in appearance that escalate 00:05:26.340 --> 00:05:32.400 position:50% align:middle over time, wearing long sleeves in warm weather, increasing isolation 00:05:32.400 --> 00:05:37.930 position:50% align:middle from colleagues, inappropriate verbal or emotional responses or 00:05:37.930 --> 00:05:42.550 position:50% align:middle diminished alertness, confusion or memory lapses. 00:05:42.550 --> 00:05:47.209 position:50% align:middle When nurses are using drugs and unable to obtain them from a treating physician, 00:05:47.209 --> 00:05:51.200 position:50% align:middle they may turn to the workplace for access or diversion, often 00:05:51.200 --> 00:05:53.850 position:50% align:middle causing narcotics discrepancies. 00:05:53.850 --> 00:05:59.318 position:50% align:middle These might include incorrect counts, large amounts of wastage, 00:05:59.318 --> 00:06:04.241 position:50% align:middle numerous corrections of records, frequent reports of ineffective 00:06:04.241 --> 00:06:09.320 position:50% align:middle pain relief from patients, offers to medicate co-workers' patients 00:06:09.320 --> 00:06:15.240 position:50% align:middle for pain, altered verbal or phone medication orders, and variations 00:06:15.240 --> 00:06:20.020 position:50% align:middle in controlled substance discrepancies among shifts or days of the week. 00:06:20.020 --> 00:06:24.900 position:50% align:middle Nurse managers and colleagues often don't recognize the warning signs of a substance 00:06:24.900 --> 00:06:27.740 position:50% align:middle use disorder in a nurse co-worker. 00:06:27.740 --> 00:06:32.698 position:50% align:middle They may misread cues and look for other explanations for behaviors. 00:06:32.698 --> 00:06:38.550 position:50% align:middle In fact, many nurses with substance use disorder are unidentified, unreported, 00:06:38.550 --> 00:06:42.050 position:50% align:middle untreated, and continue to practice. 00:06:42.050 --> 00:06:46.490 position:50% align:middle This finding highlights the need for education about substance use disorder 00:06:46.490 --> 00:06:48.590 position:50% align:middle for all staff members. 00:06:48.590 --> 00:06:52.885 position:50% align:middle It's especially important for the nurse manager to be able to address the signs 00:06:52.885 --> 00:06:58.070 position:50% align:middle and symptoms of substance use disorder in a transparent, supportive way. 00:06:58.070 --> 00:07:03.150 position:50% align:middle Nurse managers should work to encourage open dialogue and educate staff that 00:07:03.150 --> 00:07:07.974 position:50% align:middle substance use disorder is a medical condition, not a personal failure. 00:07:07.974 --> 00:07:13.360 position:50% align:middle Nurse managers are also responsible for ensuring that co-workers understand they 00:07:13.360 --> 00:07:17.980 position:50% align:middle have a professional and ethical responsibility to report a colleague's 00:07:17.980 --> 00:07:23.310 position:50% align:middle suspected drug use to the nurse manager and in some states or jurisdictions 00:07:23.310 --> 00:07:24.677 position:50% align:middle to their board of nursing. 00:07:24.677 --> 00:07:27.700 position:50% align:middle ♪ [music] ♪ 00:07:31.100 --> 00:07:37.287 position:50% align:middle A nurse who has harmed patients or like Sarah has created a risk of harm because 00:07:37.287 --> 00:07:42.290 position:50% align:middle of substance use may need to be separated from practice and mandated to seek 00:07:42.290 --> 00:07:45.071 position:50% align:middle treatment and fulfill other requirements. 00:07:45.071 --> 00:07:51.608 position:50% align:middle Many boards of nursing offer non-punitive Alternative-to-Discipline Programs, ADPs, 00:07:51.608 --> 00:07:55.670 position:50% align:middle which are voluntary non-disciplinary opportunities for nurses 00:07:55.670 --> 00:07:57.950 position:50% align:middle with substance use disorder. 00:07:57.950 --> 00:08:02.147 position:50% align:middle ADP approaches which have been in place for more than two decades, 00:08:02.147 --> 00:08:05.747 position:50% align:middle give nurses an opportunity for rehabilitation. 00:08:05.747 --> 00:08:10.667 position:50% align:middle Unlike the more traditional disciplinary actions, ADPs have the benefit of avoiding 00:08:10.667 --> 00:08:15.217 position:50% align:middle a long period of investigation in which the nurse can still practice 00:08:15.217 --> 00:08:17.626 position:50% align:middle and still place patients at risk. 00:08:17.626 --> 00:08:21.910 position:50% align:middle Because ADP requirements are determined in a private agreement, 00:08:21.910 --> 00:08:26.060 position:50% align:middle they can help break through the denial of a nurse who fears the public 00:08:26.060 --> 00:08:27.705 position:50% align:middle notoriety of discipline. 00:08:27.705 --> 00:08:31.850 position:50% align:middle Nurses in these programs stay fully accountable to themselves, 00:08:31.850 --> 00:08:37.152 position:50% align:middle a program monitor, a counselor, other nurses, and supervisors. 00:08:37.152 --> 00:08:40.530 position:50% align:middle Sarah is fortunate because when she returned to practice, 00:08:40.530 --> 00:08:45.660 position:50% align:middle her supervisor was well-oriented to her responsibilities in the ADP. 00:08:45.660 --> 00:08:50.830 position:50% align:middle Her supervisor even completed specialized training that increased her knowledge, 00:08:50.830 --> 00:08:55.496 position:50% align:middle sharpened her observation skills, and increased her willingness to assist 00:08:55.496 --> 00:08:57.314 position:50% align:middle Sarah in her return to work. 00:08:57.314 --> 00:09:00.384 position:50% align:middle ♪ [music] ♪ 00:09:05.100 --> 00:09:10.680 position:50% align:middle Treatment for substance use disorder does work and nurses in recovery can reenter 00:09:10.680 --> 00:09:15.460 position:50% align:middle the workplace safely when treatment and monitoring are instituted. 00:09:15.460 --> 00:09:20.881 position:50% align:middle Research demonstrates that substance use disorder is treatable and that successful 00:09:20.881 --> 00:09:25.240 position:50% align:middle long-term recovery is possible for all who maintain a rigorous 00:09:25.240 --> 00:09:27.450 position:50% align:middle relapse prevention program. 00:09:27.450 --> 00:09:33.490 position:50% align:middle Because addiction causes changes in the brain, relapse is always a possibility. 00:09:33.490 --> 00:09:37.690 position:50% align:middle Continuing care activities provide the nurse with professional support 00:09:37.690 --> 00:09:39.322 position:50% align:middle for relapse prevention. 00:09:39.322 --> 00:09:44.180 position:50% align:middle These activities typically include periodic random drug testing and 00:09:44.180 --> 00:09:49.046 position:50% align:middle documented attendance at 12-step programs, professional support groups, 00:09:49.046 --> 00:09:51.520 position:50% align:middle and even individual counseling. 00:09:51.520 --> 00:09:55.217 position:50% align:middle Similar to participation in an Alternative-to-Discipline Program, 00:09:55.217 --> 00:10:00.889 position:50% align:middle the nurse returning to work is subject to very structured and specific guidelines. 00:10:00.889 --> 00:10:05.840 position:50% align:middle A return to work contract will identify a workplace monitor, standards 00:10:05.840 --> 00:10:08.856 position:50% align:middle for work performance, and conditions of employment 00:10:08.856 --> 00:10:10.805 position:50% align:middle and require drug screening. 00:10:10.805 --> 00:10:15.720 position:50% align:middle It may also set restrictions on practice, like restricted access to controlled 00:10:15.720 --> 00:10:19.154 position:50% align:middle substances or not working in the night shift. 00:10:19.154 --> 00:10:22.205 position:50% align:middle ♪ [music] ♪ 00:10:25.531 --> 00:10:29.680 position:50% align:middle Substance use disorder is a challenging and complex issue 00:10:29.680 --> 00:10:31.290 position:50% align:middle for the nursing profession. 00:10:31.290 --> 00:10:35.567 position:50% align:middle But with supportive and educated supervisors and colleagues, 00:10:35.567 --> 00:10:39.440 position:50% align:middle nurses with this disease can be identified more quickly and receive 00:10:39.440 --> 00:10:41.130 position:50% align:middle the help they need. 00:10:41.130 --> 00:10:44.832 position:50% align:middle The combination of identification, successful treatment, 00:10:44.832 --> 00:10:50.790 position:50% align:middle and careful monitoring ensures that the public is protected and allows recovering 00:10:50.790 --> 00:10:54.151 position:50% align:middle nurses like Sarah to safely return to practice. 00:10:54.151 --> 00:10:57.156 position:50% align:middle ♪ [music] ♪