Prevention Surveillance and Investigation of Controlled Substance Misuse in the Workplace: The Nurse Leaders' Role

Sunday, 22 July 2018: 11:35 AM

Deirdre O'Flaherty, DNP, RN, NE-BC, APRN-BC, ONC
Nursing, Surgical Services, Lenox Hill Hospital, New York, NY, USA
Seon Lewis-Holman, DNP, ACNS-BC
Nursing Education Lenox Hill Hospital, Northwell Health System, New York, NY, USA
Irene Macyk, PhD, RN, NEA
Nursing, Lenox Hill Hospital, New York, NY, USA

The opioid epidemic is a pressing public health issue with an estimate of 2 million Americans in 2014 reporting abuse or dependence. Prevalence of misuse or abuse in the nursing population parallels the general population, The American Nurses Association (ANA) estimates that 6-8% of nurses use alcohol or drugs to an extent that is sufficient to impair professional performance.

The evidence supports that Warning Signs of potential diversion are not to be ignored the following; A change in job performance, Request of change in shift, Absences from the unit for extended periods, Frequent trips to the bathroom, Arriving late or leaving early, Making an excessive number of mistakes, including medication errors, should be used as a guide in prevention. Diversion is the theft of drugs, usually drugs that are classified as controlled substances. The American Association of Nurse Anesthetists (AANA) advocates that early identification of the signs and behaviors associated with substance abuse disorder and drug diversion reduces the risk of harm to patients and providers. Nurse leaders should be able to recognize symptoms of impairment with the goal of preventing harm to patients and staff and the oversight of good practice. Risk factors are inherent in our profession. There are several Nursing specialties that are at greater risk of substance abuse such as oncology, critical care, psychiatry and anesthesia because of the emotional and physical toll and ease of access to narcotics. In addition, nurses are at higher risk as the accessibility of drugs, their knowledge of pain management and sense of control. As well as ease of access (Bell et al).

Drug diversion spreads infection from healthcare providers to patients and has the potential of grave outcomes. Tampering or substitution is the most pernicious diversion method as it results in denial of needed medication and may impose the risk of infection of blood borne pathogens from the diverter to the patient. Everyone is affected by drug diversion and we all have a responsibility in prevention. Hospitals have established policies and procedures. Surveillance and development of policies to augment monitoring of controlled substance administration, documentation and wasting are essential in protecting our staff and patients. The nurse leader has a key role in achieving organizational goals. They are the link between the strategic priorities, policy implementation and adherence, safety and the front line staff. Nurse Leaders create a culture and processes that support system initiatives and foster healthy and positive workplace environments. Additionally the nurse manager plays an integral role in developing an empowering work environment by facilitating tools needed for support guidance and in promoting safety. Empowerment is one of those tools and it can be an effective tool that nurse leaders can use to increase the competence and confidence of their nursing team by fostering an environment that supports mutual respect, dignity and compassion. Supportive nurse managers that focus on trust and open communication are more likely to result in a skilled and confident nursing team who are involved in decision making, demonstrate critical thinking and actively promote clinical effectiveness. This can be instrumental in providing an opportunity for team member’s to speak up and to recognize the signs of impairment and learn how to address it appropriately.

Substance abuse within the nursing profession is of significant concern due to the nature of our role as nurses’ and our relationship and interaction with patients and the community we serve. Nurses who are confronted with substance use disorder place patients and themselves at risk; additionally they are not caring for themselves. It is not common for us to imagine that a valued peer may be using substances to cope with stress. Therefore resources to promote prevention and early recognition in the workplace are tools to empower and support our nurse leaders, colleagues, and peers and promote the overall safety of our team. Nurse leaders should be able to recognize symptoms of abuse and diversion to mitigate harm to patients and staff.