● Explaining the resources available to help nurses and other employees who are dealing with substance use disorder obtain the help that they need in order to recover. There are several reasons nurses do not report colleagues suspected of SUD. These include the following (NCSBN, 2018): ● Fear that colleagues will lose their jobs if they are reported. ● Lack of explicit policies and procedures that address SUD, impairment, addiction, and reporting of such issues. ● A work environment that lacks compassion and willingness to help impaired nurses recover In addition to protecting patients, employers have ethical and legal obligations to help nurses and other employees whose functioning is impaired due to substance use. State boards of nursing often have assistance programs designed to protect patients and save the lives and careers of those dealing with substance use disorder. Nurses must review the options offered by their respective state board of nursing. These programs are generally designed to be confidential, nonpunitive, and therapeutic. Economic impact SUD is costly for society, with billions of dollars spent on lost work productivity, drug law enforcement, and healthcare expenses. Research shows that excessive alcohol intake costs the U.S. about $223 billion annually in healthcare expenses, law enforcement costs, and lost productivity (DrugAbuse.com, 2019). SUD can significantly negatively impact society and is closely linked to poverty. Paying for an addictive substance can be expensive, regardless of the substance being used. For example, a six-pack of beer costs $5; if consumed daily, this costs $150 per month. That is about $1,000 in six months. Persons using more expensive drugs such as cocaine may spend more than $10,000 annually to support their SUD and addiction (DrugAbuse.com, 2019).SUD is the most expensive for vulnerable individuals. For example, research shows that a pack of cigarettes daily can cost 10% of a family’s monthly income (DrugAbuse.com, 2019). Treatment goals The goal of identification and intervention is to encourage nurses with substance use disorder to participate in appropriate treatment and alternative programs rather than face punitive actions. Research shows that early identification and referral of persons to treatment programs leads to the following (NCSBN, 2018): ● Increased success in a treatment program. ● Better outcomes after treatment. ● Reduced time practicing with an undetected substance use disorder. ● Reduced number of relapses. ● Improved social and interpersonal functioning. ● Reduced threats to public health and safety. Treatment and monitoring programs generally require that the nurse sign an agreement that identifies the responsibilities of the nurse and the treatment facility (NCSBN, 2018). Nursing Consideration: Mandates may vary or change depending on individual state laws and specific programs. Therefore, nurses must understand that to receive current information, they must carefully review any alternative program mandates before participating. In order to enter into an alternative treatment program, the nurse must meet the following requirements (NCSBN, 2018): ● Abstain from all alcohol and alcohol-containing products unless prior approval is obtained from the alternative program. ● Abstain from drug use, including all over-the-counter medications and other mind-altering substances, unless lawfully prescribed with prior approval of the alternative treatment program.
Healthcare Consideration: Misuse and abuse are distinct from medication mismanagement problems, such as forgetting to take medications and confusion or lack of understanding about proper use. Medication mismanagement problems can also have severe consequences for patients, but they have different risk factors and typically require different types of interventions (SAMHSA, 2018). The impact of substance use disorder is costly not only to directly affected healthcare workers but also to their families, colleagues, and the organizations for which they work. The cost can be measured in the potential loss of jobs; loss of income; and damage to health, which can result in increased medical expenses. Substance abuse also compromises interpersonal relationships with family members and friends, as well as professional relationships with colleagues and employers. Interpersonal costs may be evaluated as they relate to divorce, termination of interpersonal relationships, compromised professional collaborations, and loss of emotional support systems. Loss of job productivity is common among those with addictions (DrugAbuse.com, 2019). The effects of SUD on interpersonal relationships can be devastating. Several signs may indicate how substance use is harming interpersonal relationships. Most relationships will not show all of the signs. However, even one of the following signs indicates that the person using drugs and/or alcohol needs help. Many arguments about substance use or issues relating to SUD (e.g., financial problems, failure to fulfill responsibilities at home) are occurring. Loved ones find themselves “covering” for someone abusing substances, such as reporting to an employer that the person using the substance is sick and cannot come to work. The substance user says they drink or use drugs to reduce stress related to arguments about substance use. Loved ones begin to consume alcohol and/or use drugs because they believe that such activities are the only ones, they can do with the person who is abusing the substance. While under the influence of drugs and/or alcohol, the person with SUD begins to display violent behavior toward loved ones. The person with SUD and loved ones must be drunk or high to show affection toward each other. People with SUD and loved ones avoid encounters with other friends or family members to hide the substance use problem. The effects of substance use disorder can seriously compromise safety culture. Nurses dealing with substance use disorders cannot provide safe and appropriate patient care if their ability to function is impaired. Healthcare organizations must ensure that effective systems and processes are in place to prevent drug diversion and protect patients from safety threats due to impaired nurses. It is essential to maintain a drug- and alcohol- free working environment. Equitable policies and procedures must be applied across the organization (NCSBN, 2018): ● Defining impaired work performance, how to recognize it, the consequences of working in an impaired state, the consequences of failing to report impaired colleagues, and interventions to help the impaired person recover. ● Educating all employees regarding policies and procedures and how to implement such policies and procedures correctly. ● Establishing policies and procedures that provide safeguards regarding confidentiality; nurses and other employees must believe that they can communicate their concerns without fear of retaliation. ● Providing continuing education programs that deal with the topic of impairment and SUD. ● Establishing mandates that all employees attend continuing education programs that deal with the topic of substance use disorder; such education must be appropriate for each employee’s education, training, and roles that they fulfill.
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Book Code: AUS3024
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