9/15/2017. Nursing: Substance Use, Drug Diversion, and Recovery Nancy Rogers, MS, RN-BC, CASAC, CNE. Objectives. Substance Use Among Nurses

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1 Nursing: Substance Use, Drug Diversion, and Recovery Nancy Rogers, MS, RN-BC, CASAC, CNE Objectives Participants will be able to discuss the warning signs of an impaired nurse Participants will be able to understand how drug diversion occurs and how to minimize risks Participants will be able to identify resources available to nurses in NYS who need assistance with addiction Substance Use Among Nurses 8-10% of general population meets criteria for substance use disorder dx Highest rates in emergency care, behavioral health, and nurse anesthetist Highest abuse benzodiazepines and opiates (prescribed) 1

2 Risk Factors Associated with Nurses Role Strain Access Attitude Schedules Signs and Symptoms of Addiction in Nurses Defensiveness Isolation Irritability Difficulty following through with assignments Impaired memory Frequent tardiness or poorly explained absences Signs and Symptoms of Addiction in Nurses Coming to work on days off Volunteering for overtime Coming to work on vacation Incorrect counts Volunteer to administer medications May lack full witnessing of wasting medications 2

3 Diversion How Reporting requirements How Does Diversion Occur? Take medication from stock meds Frequent use of PRN pain meds Failure to Waste Medications Removal under another s sign in Removal of syringes from sharps container Enforcement Agencies in NY Office of Professional Discipline Investigates reports of professional misconduct including criminal conviction Bureau of Narcotic Enforcement Monitors and regulates controlled substances through licensing Investigates drug diversion, illegal sales including theft, forgery, and fraud 3

4 Other Reporting Drug Enforcement Agency (DEA) Food and Drug Administration (FDA) Pharmacy Board Law Enforcement Alternative to Discipline Programs National Organization of Alternative Programs (NOAP) Position Statement Emergency Nurses and International Nurses Society on Addiction New York State Resources For Nurses Statewide Peer Assistance for Nurses (SPAN) Peer Assistance Program (PAP) NYS Office of Professions 4

5 SPAN SPAN s mission is to foster public safety through outreach and education, and is the resource for all New York State nurses affected by substance use disorders. Operates on the belief that every nurse deserves access to treatment, help in preserving his or her license and employment status, and ongoing support throughout the recovery process span@nysna.org SPAN New York State Nurses Association Peer support groups across the state at no out-of-pocket expense to the nurse Expert staff and trained volunteer advocates provide mentorship Advocacy with PAP and regulatory agencies SPAN Support for Hospitals and Agencies Employee education and supervisor training Consultation regarding written policies, procedures and other components of a drug-free workplace program Identification and resolution of fitness-for-work concerns related to nurses affected by substance use disorders Assessment and referral, short-term problem resolution for individual nurses requesting services Facilitation of return-to-work agreements 5

6 Professional Assistance Program (PAP) Operated by NYS Board of Regents through the NYS Education Department Office of Professions Established in 1985 as alternative program to disciplinary action Mission: To protect the public from impaired professionals and to support the professional in recovery PAP: Benefits to Public Approval of treatment plans Monitoring of professionals while license is surrendered Return to practice when safe Monitoring for two years after reinstatement Strict practice conditions PAP: Benefits to Professional Immunity for two charges of professional misconduct: Practicing while impaired Habitual user Consideration of reduction of charges or penalties imposed by other agencies Case Manager assigned 6

7 Recovery Identification of Problem Treatment Reinstatement/Monitoring Employment Support What Do I Do If I Suspect A Colleague? Don t Hide It Don t Cover It Up Don t Bury Your Head In The Sand Help Them Report Theft/Diversion Follow Hospital and Agency Policies Portrait of an Addicted Nurse 7

8 References Alumni-Kinkle, S, (2015). Identifying substance use disorder in nursing, Nursing Management. 46 (12), Bettinardi-Angres, K, Pickett, J & Patrick, D (2012). Substance use disorders and Accessing Alternative to Discipline Programs, Journal of Nursing Regulation, 3 (2), Cadiz, D, Truxillo, D & O Neill, C (2012). Evaluation of a training Program for Nurse Supervisors who Monitor Nurses in an Alternative to Discipline Program. Advances in Nursing Science, 35 (2) Smith, L (2010) Recovery Maintenance Workbook for Nurses, 2 nd edition. Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs (2011). National Council of State Boards of Nursing. Starr, KT (2015) the Sneaky Prevalence of Substance Abuse in Nursing, Nursing 45(3), Tanga, HY (2011) Nurse Drug Diversion and Nursing Leaders Responsibilities, JONA s Law Ethics, and Regulations 13(1) Wright, E.L, McGuiness, T, Moneyham, L.D., Schumacher, J. E., Zwerling, A. & Stullenberger, N.E (2012). Opiod Abuse Among Nurse Anesthetists and Anesthesiologists, AANA Journal, 80 (2),