I am writing this paper over the ethical dilemma of chemical impaired nurses on duty. This subject is an ongoing problem is the nursing profession today that can and has changed a patient’s quality of life, due to mistakes made by a nurse while under the influence. Nurses have access to countless amounts of medications and are trusted to disperse them accordingly. When a nurse violates this code, they are not only taking away from the hospital, but they are compromising their judgment and quality of care, which are two of the main aspects of this job. This has become an epidemic over years, which is why is a topic of discussion for legal and ethical dilemmas. In this paper, I will be covering how a nurse should respond to this dilemma appropriately. Also, how a nurse can recognize the signs and symptoms of a nurse who is chemically impaired.
When dealing with this legal issue, nurses are required to report this in a certain manner to protect their-self and their staff. Tanga (2011) stated the following: Nurses have an ethical duty to protect patients, colleagues, the profession, and community. This ethical responsibility extends to nursing leaders and executives to report an impaired professional and ensure he/she receives the appropriate treatment through BON diversion programs or other professional drug and rehabilitation treatment. Impaired nurses, including nurses who have admitted to unlawful behaviors, should not be allowed to practice and subject patients to potential harm. The NE must safeguard patient safety and provide corrective action in a no punitive manner. (p. 15)
This is not only vital for the patient’s safety, but also necessary for the colleague that is under the influence so they can receive the help and treatment they need. This code provides safety to our patients, while also advocating for our staff.
A nurse that is chemically impaired while working can be compromising patient care in many different aspects. The most commonly thought of might be medication error. Although medication error is a very important topic, that is not the only way one can be compromising care. According to Jouria (2016), “Poor patient care can be described as patient neglect, in which the patient fails to receive the care that should be administered appropriately under the circumstances” (p. 13). This statement confirms that one doesn’t have to make an error to compromise patient care. This is abandonment of a patient, which can be just as lethal as a medication error.
An additional problem with a chemically impaired nurse is how it reflects on the staff and the hospital. Jouria (2016) says “Healthcare workers are often held to a higher standard of expectations than the general population, and this view is not without good reason. Healthcare providers hold considerable responsibility as part of their work. At times, they are involved in life or death situations and their actions may be a deciding factor in whether certain patients live or die” (p. 12). When errors like this are made, it reflects poorly on this hospital by the community. This can potentially hurt the hospital in terms of losing patient business. With that being said, these are a few of many reasons why it is so important to eliminate the use of substances while on the job.
Nurses are trusted to provide the best care possible to all patients. When nurses compromise their judgments, it puts patients and staff in harms way. When a nurse is under the influence of a substance, they are violating the Oklahoma Nursing Practice Act. This is found in section 567.8. Denial, revocation or suspension of license or certification–Administrative penalties, under category B. A nurse under the use of alcohol or drugs while at work has violated the Oklahoma Nursing Practice Act and will get their license revoked (Oklahoma Nursing Practice Act, 2019). Once a license is revoked, there are steps that need to be preformed in order to get the license back and practice nursing again. Oklahoma Nursing Practice Act (2019) states the following: The corrective action may include remedial education, an administrative penalty, or any combination of remedial education and an administrative penalty. The corrective action shall not be considered as disciplinary action. However, the Board may consider a corrective action in an individual's subsequent violation of the Oklahoma Nursing Practice Act, Board rule or corrective action order. (p. 17)
If a situation like this were to arise with a team member in my work environment, I would have to confront it immediately. If it was a friend of mine this was exhibiting this behavior at work, I would still confront it and hope they would understand that it is coming from a place of trying to protect my friend, and the patients. Before I would report team member, I would know the signs and symptoms of substance abuse. According to Darbro (2011), “Signs and symptoms of a prescription-type substance use disorder can include coming to work on days off and volunteering for overtime. Coming to work while on vacation can suggest the need to divert prescription drugs from clinical supplies” (p. 8). After knowing these signs and symptoms, I would talk to the person under the influence before going to my charge nurse. If I were not to report this situation, I would be doing my staff and my patients a disservice. Darbro (2011) states the following: Many states have mandatory reporting statutes or rules and the nurse manager may face action by the board for failing to report misconduct of subordinates. Regardless of the existence of such requirements there is a moral responsibility to the public to report nurses who pose a threat to patient safety. (p. 72)
Many resources express the importance of knowing the signs of substance abuse before reporting an individual. It is important to do so before filing this complaint, so the nurse has an adequate amount of information and proof before making the accusation. The nurse that is chemically impaired is influenced to file a complaint against their self. If someone filed a complaint against that person before they had a chance to turn their self in on their own, they should still contact the Board of Nursing on their own as soon as they can.
If you receive notice that you are the subject of a complaint, contact the BON immediately. The investigation, from initial complaint until board decision, will be handled in a fair and just manner. Your BON has an established process in place to ensure your rights under the law. A BON representative will describe the details to you and answer any questions you may have. (“State and Territorial Boards or Nursing,” 2018).
This ensures that one is being compliant with the Boards of Nursing and can make the process easier than if one was to deny the allegation. It also shows accountability for ones actions, which is a characteristic all nurses are expected to have. While nurses know the consequences possible to come when working under the influence of substances, they also know the consequences that can arise when not reporting it. With that being said, it is important for patient safety to document this situation, it can also help the nurse potentially avoid additional charges, which can help them have a better chance of regaining their license back.
This dilemma can be an awkward situation for nurses to encounter. Research by Killion and Dempski (2006) says the following: Coworkers of an impaired nurse often struggle with the ethical issue of whether or not to report their suspicions. Reasons cited for not reporting include loyalty, uncertainty, fear of jeopardizing another’s job, fear of being labeled a “whistle blower,” and feelings of inadequacy regarding what to do or say. (p. 119)
Nurses form a bond with their coworkers and may not want to come across as “telling on” a fellow coworker. Although it could be a tough ethical dilemma, it is now a legal matter to report this. Killion and Dempski (2006) says, “The ethical dilemma has been resolved, however, by the legal obligation to report, as mandated by many state reporting laws” (p. 119). This helps ease the uncomfortably of contemplating on whether to report someone, even if it is a friend. It is also important to remember that when reporting a fellow team member, it should be reported to the charge nurse first, and then followed by the Board of Nursing. The nurse manager is the person responsible for taking it into further action.
Another problem among high stress and long hour jobs, like nursing, is overuse of a medication that is prescribed to them. When starting as a new nurse and put on a night schedule, it is liable that they may have some difficulty finding the right sleeping pattern. What if a nurse has a prescription for Adderall, but is taking it to stay awake and focused during a night shift? Where do someone draw the line in an ethical dilemma? McColl (2018) says the following: Stimulants and caffeine can boost performance acutely but do not address the underlying sleep deprivation and thus are not a viable long-term solution. Furthermore, concern over the side effects, addiction and performance degradation with current pharmacologic interventions makes their safe use discouraged (para 13).
This statement reiterates the blurred lines of “safe” versus “misused”. Some nurses may have attention or hyperactive problems that they need medication for. Others may not need it, and may over use it due to fatigue, wanting an extra kick, or many other reason. How can you separate the two? McColl (2018) also states that “Amphetamine abuse is defined as non-medicinal use of amphetamines for euphoria, well being, sharpening of attention and increased levels of energy” (para 10). Nurses can be aware of signs of amphetamine abuse and keep in mind if the nurse in question has a prescription or not. This can help decrease the incidences of misuse of prescription medication in the work place.
This topic over ethical dilemmas has taught me that nurses are held to a rightfully strict standard of code. As stated before, due to the fact that nurses are working with people needing assistance with their health, It is extremely important that nurses are focused and alert, with a clear mind. This is a hard or even impossible to achieve when under the influence of drugs and alcohol. When nurses come to work while under the influence, they are putting patients lives at risk while also putting their job on the line, as well as possibly having a felony charge on their record. Nurses are there to be care takers to patients in need. Its important that each and every nurse keeps that in mind when walking into work everyday, and before taking something that could impair their judgment, and possibly costing someone their life.
- Killion, S. W., & Dempski, K. (2006). Legal and ethical issues (2nd ed.). Sudbury, MA: Jones and Bartlett.
- MEdIC: Case of the Night Shift Stimulants – Expert Review and Curated Community Commentary. (2019, March 31). Retrieved from https://www.aliem.com/medic-case-night-shift-stimulants-expert-review-commentary/
- Darbro, N. (2011). Substance use disorder in nursing: a resource manual and guidelines for alternative and disciplinary monitoring programs. Chicago, IL: National Council of State Boards of Nursing.
- Tanga, H. Y. (2011, March). Nurse Drug Diversion and Nursing Leaders’ Responsibilities. Retrieved from https://nursing.ceconnection.com/files/NurseDrugDiversionandNursingLeadersResponsibilitiesLegalRegulatoryEthicalHumanisticandPracticalConsiderations-1382031396195.pdf
- Jouria, J. M. (2016, July 10). Recognizing Impairment In The Workplace. Retrieved from https://nursece4less.com/Tests/Materials/N217Materials.pdf