The and safety of registered nurses and can

The
impaired nurse has different definitions to people. According to the American
Nurse Association “an impaired nurse is a nurse who is unable to meet the
requirements of the code of ethics and standards of practice of the profession,
has cognitive, interpersonal or psychomotor skill affected by psychiatric
illness and/or drug or alcohol abuse or addition” (ANA, 2017). Many times, when
we hear impaired nurse we think about a nurse who has a substance abuse addiction.

Impaired means functionally poorly or inadequately; we rarely think of a nurse
who has been overworked as impaired. An overworked nurse can result in medical
errors or someone’s life. Inadequate sleep is the result of fatigue that has
the major implications on the heath and safety of registered nurses and can
compromise patient care and the nurse’s health as well. Fatigue can also be
costly on the employer, leading to an increase in health care and workers
compensation cost, early disability, recruitment and training cost, and legal
fees (ANA,2017). Insufficient rest and sleep is widespread in America that the
Center for Disease Control and Prevention considered it a public health epidemic
(Susan Trossman, 2015). In this paper, I will be talking about both drug/alcohol
and overworked impairment on a registered nurse and the damages it can cost.

Chemical
dependency is recognized as one of the leading health problems in the United States.

The general population is one out of nine suffer from this disease; in the
healthcare population, the number increases to one out of seven. Substance
abuse is the overindulgence, or dependence on, addictive substances, especially
with alcohol or drugs. Chemical dependency is described as physical or
psychological dependence on mood altering chemicals, tolerance and relapse (John
P., Hoffmann, 1996). Relapse results in withdrawal symptoms and an obsession
with obtaining more of the substance. Chemicals most often observed to be
addicting are prescribed drugs. The dependency interrupts the person’s ability
to function on a day to day basis. The addicted person will soon be unable to
stop, even though the dependency is destroying his or her life economically and
physically. Physically the person will be more susceptible to infections,
anemia, diseases of the liver, heart, brain and cancer of the liver and throat
(Special Care,2018). A substance use disorder is a progressive and chronic
disease and if left untreated can be fatal.

There
are 2.5 million registered nurses who are employed in the United States, 10% of
those are dependent on drugs or alcohol; 6% will provide care while impaired. The
American Nurse Association estimates that 67% of disciplinary cases brought
before the state boards of nursing are drug related. Nurses and healthcare
professionals are at practically risk for chemical/dependency for the main
reason that drugs are the tools used to treat and help their patients on a
daily basis. Nurses administer medication and dispense mediation every day from
the morning to the end of their shift. Some nursing specialties may have a
higher prevalence of substance abuse because of intense emotional and physical
demands, as well as the increased availability of controlled substances. The
nurse herself or himself may be damaging themselves but when the nurses works
impaired, they are also putting their patients at risk. Nurses are the largest
components of the healthcare workforce. Their sole job has been to take care
for the patients and make sure they are safe. Safety involves making sure the
bed rails are up, right medication is given, and the proper isolation
precautions are given. All of these safety measures will not be attainable by a
chemically impaired nurse. The nurse will most likely be more focused on
themselves instead of their patients. They will neglect their patient from the
proper care they need. Most importantly they will be committing errors that may
even lead to death (TLC projects, 2006).

The
problem of impairment will not only affect the individual, but place the public
and the integrity of the profession at risk. It has been said that anyone
working in the healthcare industry has a high risk for have a drug and
substance abuse. Doctor for examples are the ones who prescribe the drugs and
have access to the drugs. They can easily make a prescription for themselves. A
study published in the Journal of addiction medicine, they found that
self-medication was a leading reason for misusing prescription’s medications
among 55 physicians of the study. These doctors are dealing with overwhelming
stress, physical or emotional pain (Bryan Barajas, 2014). Everyone working in
the healthcare field will experience overwhelming stress but unfortunately a
nurse will be the one who will be experiencing the overwhelming stress more on
a daily basis. Nurses are often the first to treat and last to care for the
patients. This leads to dealing with stress, fatigue and personal problem which
may lead them to turn to drugs and alcohol. The nurse will be faced with
specific risk factors that will increase her chance of developing an addiction.

The nurse may have problem coming from their home that may lead them to have
poor coping skills and insecurity. This can lead to them having a role strain
or role conflict. They are facing inadequate support at work, burnout and work
overload. They seem to feel like they have a lack control. This can be work
schedules and their job demands that will create stress and fatigue
(Addictions, 2018). Nurses will experience rang of emotions on the job. They
will often handle guilt, despair and anxiety. The demands of a registered nurse
can be draining. A Nursing Times survey found that 63% of participating nurses
experienced physical or mental side effects of job related stress. “Nurses go
from one emotionally and physical demanding situation to another with little
time to decompress,” Patricia Holloran told Modern Medicine Network. Nurses
with this may experience post-traumatic stress disorder. This is a mental
condition that occurs after an individual experiences a traumatic event and its
very common in the health care profession. A 2009 survey published in
Depression and Anxiety found that 22 percent of nurses in the study displayed
symptoms of PTSD and 18% met the diagnostic criteria for the disorder. The rest
of the participants met criteria for burnout syndrome. Many of these nurses
will work more than ten hours of overtime each week. They will eventually lead
to viewing drugs and alcohol as a coping mechanism.

Substance
Abuse has been an issue that has existed for decades. When fentanyl became
available in the clinical practice bac in the 1970’s, the workers abused the
drug. Nurses would draw the opioid from the vials and replace it with saline.

This would lead to overdoses and addiction within the profession. These nurses
were disciplined by their state boards for drug and alcohol abuse. Although
substance abuse had been recognized as a disease, it was not a widely accepted
theory. This lead to a rising of terminations rather than the nurses receiving
the appropriate treatment. It was not until 1980 when hospitals offered
addiction services. The state legislatures approved treatment options for the
healthcare professionals. After this organizations have provided the healthcare
workers with information and education related to substance abuse (Drug rehab,
2018).

Inadequate
sleep will lead to fatigue and this will cause major implications on the health
and safety of the registered nurse that will compromise the care he or she
provides to their patients. Fatigue can also be costly to employers, that will
result in an increase in the health care and workers compensation cost, early
disability, recruitment and training cost, and legal fees. An article from the
American Nurse, John Repique talks about his experience when he was working
long hours at his hospital. He was driving home after working a 12-hour night
shift in a busy emergency department. He was pulled over and was told by the
officer that he had been swerving behind the wheel. He had not been under the
influence of alcohol or drugs but he had been tired from his shift. He states,
“Getting stopped that morning saved my life and possibly someone else’s.” After
this moment, he states that he has been passionate about the issue of fatigue
occurring in the nursing field. John is now one of the 15 nurses who serves on
the steering committee of the American Nurses association on Profession Issue
Panel on Nurses Fatigue. Many nurses work long shifts, sometimes night shifts,
attending school, and juggle family responsibilities. Anna Roger, RN, states
that our society does not value adequate sleep, but rather working long hours (Susan
Trossman, 2015).

Nurses
do work in the hospitals that doctors and patients could not live without,
which comes with an increasing physical and emotional cost.  A quarter of hospitals and nursing homes are
not gratified with their jobs, and more than a third feel burned out. Dean
Jeanne Geiger of a nursing school states that burnout is an occupational
hazard. Overwork leads to the burnout and it reveals how the cost-cutting
priorities of the hospital force their nurses to pay an emotional tax. So, what
is causing overworking in the hospitals? Susan Letvak a professor at the University
of North Carolina at Greensboro School of Nursing states that a patient will
only be admitted in the hospital if they are acutely sick, but once the patient
is getting better and can move on their own, the hospital’s job is to get them
out as soon as possible. Harvard health policy research explains that Medicare
prospective payment system pays a fixed amount for a diagnosis no matter the
length of stay and the need for the open hospital beds. This payment system was
implemented in 1983, and hospitals average length of patient changed from 10
days in 1983 to 5 days in 2013(NeJM Catalyst, 2017). This affects the nurses because
it means their shift will be much harder because its less fulfilling. They have
to be in an out of the patient’s room to get to the next patient with little
communication between them. Nurses are trying to get their patient’s medication
on time and at times this may cause errors because of all the pressure they are
under to get the patients out of the hospital.

I would lobby
my local legislator for funds to make a difference in nursing abusing drugs and
alcohol by making it policy in all hospitals to talk about the issue before any
nurse starts their new job there. I would make a list of all the state and
federal congressional members. Send them information on this issue and
hopefully get a response from a member. I would then raise awareness in the
community by setting meeting for the and have registered nurses speak on behalf
of this issue. If the hospitals were to receive these funds I would like each
hospital to conduct a class about recognizing the signs and symptoms for
someone who might be impaired. In this class I would also like someone who had
been affected by drug or alcohol abuse to come and speak to the class. I would have
recommended nurses to go to therapy at least one a week, because at times we
may think we know how to cope with what we see in the hospitals but in reality,
we don’t and its okay if we need help. It’s been seen as stigma that if we talk
to a therapist we may be mentally sick, but I want the nurses to get rid of
that and know that talking to someone will only better help us a nurse and at
the end only give the right care our patient’s need.  As for lobbying for the fatigued nurse I would
start off by doing the same; speak to state and federal congressional members.

Raise awareness in the community and hold a meeting to talk about what nurse
fatigue is and how it can affect both a nurse and a patient. I would then
contact a member American Nurses Association because they have worked with
nurses across the nation to address fatigue. The member could talk to the
members of the state and federal and this will hopefully make a change in the
hospitals. For example, in Illinois, when they were opening a new hospital they
wanted to prevent fatigue. They made sure each unit had access to a respite
room so that their staff would take a nap or just rest during their break. The
nurses were also offered varies shifts based on their unit, including four,
eight, ten and twelve-hour shifts (Susan Trossman, 2015).

The
reason I chose these two topics was because I feel like many people are afraid
to talk about these topics. They may feel like no one would listen to them.

This is especially seen with nurses who abuse drugs or alcohol. A nurse who is struggling
with a drug or alcohol addiction may not know who to talk to or is afraid to
talk to someone about getting help. Another reason is a nurse might feel like
their colleague might be under the influence but they may not report it because
they might be afraid what can happen to that nurse or themselves. They don’t
want to take responsibility for having that nurse terminated or have their
license removed. The reason I picked nurse fatigue because this a main issue in
any hospital we may step into. We may notice many nurses who are rushing to
give their patients medication, running back and forth or nurses who don’t look
welcoming. When I have gone into my clinical rotation I did notice a few nurses
who did not look welcoming, but it later hit me that maybe because they were
tired and have been overworked. They did not have the energy of a nurse who was
back from her third day of being off. This information can be used in the
clinical setting by making difference in our future nurses. Having the nurses
take classes to learn to cope with everything that will be handed to them. This
may be learning how to cope with death, stress, and much more. Many nurses may
think drugs and alcohol can fix this but that’s because they don’t have the
right coping mechanism.  As for fatigue
this information will also help the future nurses by helping them realize when
they are too tired to drive back home. When they should not pick up that extra
shift to pay of a new car they bought. By informing the nurses and new future
nurses we can make a difference.

In
conclusion, as future nurses we want to be aware of what our future jobs will
hold. We want to be ready for anything that will be thrown our way. But we also
want to have the coping mechanism and know who to talk to when we feel like we
need help. We may encounter a nurse who has a drug and alcohol addiction and we
want to know how to properly go about this situation.  We may have just finished working a busy twelve-hour
shift and feel drowsy behind the wheel. In this case we must know that we cannot
drive home and either take a nap or call Uber. As the future nurses, we should
know when we need to speak up for a good cause so we can make a difference for
the future nurses following us.