NOTES

(1.) S Trossman, "Nurses' addictions: Finding alternatives to discipline," American Journal of Nursing 103 (September 2003) 27-28.

(2.) D M Bush, J H Autry, "Substance abuse in the workplace: Epidemiology, effects, and industry response," Occupational Medicine 17 (January-March 2002) 13-25.

(3.) "Alcoholism: Getting the facts," National Institute on Alcohol Abuse and Alcoholism, http://www.niaaa.nih.gov/publications/booklet .htm (accessed 25 Aug 2005).

(4.) J B Bennett et al, "Team awareness for workplace substance abuse prevention: The empirical and conceptual development of a training program," Prevention Science 1 (September 2000) 157-172.

(5.) S Ponech, "Telltale signs," Nursing Management 31 (May 2000) 32-37.

(6.) J Daprix, "The courage to care: Intervening with colleagues who demonstrate signs of impairment," The Florida Nurse 51 (September 2003) 28.

(7.) A M Trinkoff, C L Storr, "Substance use among nurses: Differences between specialties," American Journal of Public Health 88 (April 1998) 581-585.

(8.) A M Trinkoff, C L Storr, M P Wall, "Prescription-type drug misuse and workplace access among nurses," Journal of Addictive Diseases 18 (1999) 9-17.

(9.) D Booth, A K Carruth, "Violations of the nurse practice act: Implications for nurse managers," Nursing Management 29 (October 1998) 35-39.

(10.) G Monahan, "Drug use/misuse among health professionals," Substance Use and Misuse 38 (September-November 2003) 1877-1881.

(11.) N B Fisk, D A Devoto, "The nurse employee who uses alcohol/other drugs," Nurse Managers Bookshelf 2 (December 1990) 110-129.

(12.) M E Stammer, "Understanding alcoholism and drug dependency in nurses," QRB--Quality Review Bulletin 14 (March 1988) 75-80.

(13.) L W Mustard, "Caring and competency," JONA's Healthcare Law, Ethics, and Regulation 4 (June 2002) 36-43.

(14.) D Serghis, "Caring for the carers: Nurses with drug and alcohol problems," Australian Nursing Journal 6 (June 1999) 18-20.

(15.) H Creighton, "Law for the nurse manager: Legal implications of the impaired nurse--Part I," Nursing Management 19 (January 1988) 21-23.

(16.) P Ellis, "Addressing chemical dependency: A need for consistent measures," Nursing Management 26 (August 1995) 56-58.

(17.) J M Supples, "My colleague, my friend: The impaired nurse," Nursing Management 21 (August 1990) 48I, 48L, 48M passim.

(18.) D L Mantel, "Off-duty doesn't mean off the hook," RN 62 (October 1999) 71-74.

(19.) M Kinsley, "A helping hand to freedom: programs help nurses with substance abuse problems get back on the road to recovery," Nursing Spectrum (Nov 15, 2004) 10-11.

(20.) A Taylor, "Support for nurses with addictions often lacking among colleagues," The American Nurse 35 (September/October 2003) 10-11.

(21.) L Finke, et al, "Nurses referred to a peer assistance program for alcohol and drug problems," Archives of Psychiatric Nursing 10 (October 1996) 319-324.

(22.) J Gemignani, "Substance abusers. Terminate or treat?" Business and Health 17 (June 1999) 32-39.

(23.) "Voluntary programs encourage impaired nurses to admit problem," ED Management 9 (December 1997) 147-148.

(24.) D J Mason, "When silence kills," (Editorial) American Journal of Nursing 104 (February 2004) 11.

(25.) E J Sullivan, "Impaired nursing practice: Ethical, legal and policy perspectives," Bioethics Forum 10 (Winter 1994) 20-25.

(26.) P D Blair, "Report impaired practice--STAT," Nursing Management 33 (January 2002) 24-51.

(27.) P L Cerrato, "What to do when you suspect incompetence," RN 51 (October 1988) 36-41.

(28.) D M Flook, "The professional nurse and regulation," Journal of PeriAnesthesia Nursing 18 (June 2003).

(29.) A D Tammelleo, "Legally speaking: Don't be afraid to blow the whistle on incompetence," RN 53 (June 1990) 61-66.

(30.) L E Rozovsky, F A Rozovsky, "Blowing the whistle on incompetence," Canadian Critical Care Nursing Journal 7 (June 1990) 12-13.

(31.) L A Brown, "Your state board of nursing: Friend or foe?" Nursing 32 (December 2002) 48-50.

(32.) B E Calfee, "The state license hearing--Information for empowerment," Revolution 8 (Spring 1998) 20-21.

(33.) "National council compares two regulatory approaches to the management of chemically impaired nurses: An interim report," National Council of State Boards of Nursing 2002 18 (1997) 7, 16.

(34.) H Creighton, "Legal implications of the impaired nurse--Part II," Nursing Management 19 (February 1988) 20-21.

Debra Dunn, RN, MBA, CNOR, is the nurse manager of the OR at St Joseph's Wayne Hospital, Wayne, NJ.

TABLE 1
Definitions (1-11)

Abuse

The level of alcohol or drug use that typically
leads to adverse physical or psychological
consequences.

Alcoholism

Alcohol is a central focus of the person's life and
recovery usually requires treatment and support.
Alcoholism is defined as

* a craving for alcohol;

* the inability to limit the amount of alcohol
consumed; and

 physical dependence (ie, demonstrated by
withdrawal symptoms) and tolerance (ie,
requiring a greater intake to produce the
same effect).

Binge drinking

Consuming five or more drinks on one
occasion.

Chemical dependency

A primary, chronic, progressive disease that can
be fatal if untreated.

Enabler

One who engages in behavior patterns that
facilitate another's continued abuse of alcohol
or drugs.

Impaired nursing practice

The inability of a nurse to perform the essential
functions of his or her practice with reasonable
skill or safety because of chemical dependency
on drugs or alcohol or mental illness.

Intervention

A structured method of penetrating the delusional
system of an impaired individual to help
that person recognize his or her problem and
the need to seek treatment immediately.

Licensure

Licensure is required when specialized knowledge
and independent decision making are required,
such as in nursing. Nursing licenses ensure that
individuals have met minimum requirements for
education, examination, and behavior in order to
perform as a nurse.

* State agencies define the minimal level of
competency for a specific scope of practice
that an applicant must meet for safe practice.

* The agency is responsible for validating that
the applicant has met these requirements
and legally can perform the duties as
defined in the scope of practice.

* If not, the license is not earned or is suspended
or revoked. The agency also has the
right to confer disciplinary actions when
laws and regulations are violated.

Negligence in nursing practice

Occurs when a patient's life is harmed due to
failure on the nurse's part to exercise reasonable
and prudent behavior.

Prescription-type drug misuse

Using prescribed medications (eg, amphetamines,
opiates, sedative/hypnotics, tranquilizers,
inhalants) without a prescription, in greater
quantities or more often than prescribed, or for
reasons other than those prescribed.

Substance abuse

Overindulgence in or dependence on addictive
substances, especially alcohol or drugs.

Substance use

The limited, controlled consumption of a drug
without significant and adverse consequences
to the user.

(1.) C West, "A person who is sick deserves the chance to get
well," Michigan Nurse (November 1997) 4-6.

(2.) H W Chappell et al, "Nursing law violations: A threat to
competent and safe nursing practice," Jonas Healthcare Law,
Ethics, and Regulation 1 (September 1999) 25-32.

(3.) D M Bush, J H Autry, "Substance abuse in the workplace:
Epidemiology, effects, and industry response," Occupational
Medicine 17 (January-March 2002) 13-25.

(4.) M Kinsley, "A helping hand to freedom: Programs help nurses
with substance abuse problems get back on the road to recovery,"
Nursing Spectrum (Nov 15, 2004) 10-11.

(5.) J B Bennett et al, "Team awareness for workplace substance
abuse prevention: The empirical and conceptual development of a
training program," Prevention Science 1 (September 2000) 157-172.

(6.) A M Trinkoff, C L Storr, "Substance use among nurses:
Differences between specialties," American Journal of Public Health
88 (April 1998) 581-585.

(7.) A M Trinkoff, C L Storr, M P Wall, "Prescription-type drug
misuse and workplace access among nurses," Journal of Addictive
Diseases 18 (1999) 9-17.

(8.) N B Fisk, D A Devoto, "The nurse employee who uses alcohol/other
drugs," Nurse Managers Bookshelf 2 (December 1990) 110-129.

(9.) P D Blair, "'Report impaired practice--STAT,'" Nursing Management
33 (January 2002) 24-26, 51.

(10.) P L Cerrato, "What to do when you suspect incompetence," RN 51
(October 1988) 36-41.

(11.) D M Flook, "The professional nurse and regulation," Journal of
PeriAnesthesia Nursing 18 (June 2003) 160-167.


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