| Substance Abuse Among Nurses - Defining the Issue |
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| Written by Debra Dunn | ||||||||||||
| Thursday, 08 June 2006 | ||||||||||||
Page 9 of 10 TABLE 2 Signs and Symptoms of Addiction in Nurses (1-6) Alcoholism Drug addiction Both Psychosocial * Family history * History of back * Fearful, anxious, problems, panic attacks migraines, serious * Feelings of injuries impending doom * Paranoid ideation * Shameful, guilty, lonely, or sad * Defensive (eg, denial, rationa- lization, projection) * Decreasing social life and social interactions and no interest in nonwork activities * Spiritual distress * Financial, marital, and family problems * Frequent emergency room visits and hospitalizations Physical * Odor of alcohol * Runny nose, * Gastrointestinal or cover-ups watery eyes symptoms (eg, (eg, mints, sprays, * Very dilated or nausea, diarrhea) perfumes, chewing constricted pupils * Withdrawal gum, mouthwash) * Weight loss or gain symptoms (eg, on breath * Goose flesh, hangovers) * Flushed and/or diaphoresis * Elevated puffy face * Dizziness or light blood pressure * Bloodshot or headedness * Palpitations, glassy eyes * Regular wearing tachycardia * Unsteady, stiff, or of long sleeves * Hyperventilation listing gait * Steeping on the job * Deteriorating * Tremors, restlessness personal appear- * Evidence of ance (eg, poor nutrition poor hygiene) * Unusual medical * Increasing history (eg, liver medical problems disease, gastritis) * Blackouts Behavioral * Slowed, thick, or * Inappropriate * Impaired cognition slurred speech laughter * Increasing * Use of inappropriate * Decreased forgetfulness humor or concentration * Isolation or persistent morosity * Hyperactive or withdrawal from * Reduced productivity oversedated colleagues * Errors in judgment * Diminished alertness (eg, confused, preoccupied) * Frequent complaints of vague illnesses or injury * Mood swings (eg, erratic outbursts, emotionally labile) * Fails to keep appointments Substance-seeking behavior * Requests night shift * Volunteers to * Requests jobs in count narcotics less supervised * Volunteers to pick settings (eg, up controlled long-term care) substances from * Makes friends with pharmacy an enabler * Signs out medica- * Makes frequent tions for dis- trips to obtain charged or things from large transferred handbag patients * Disappearance of * Signs out more cough medicine controlled medications than coworkers * Makes frequent medication errors with or without altering records * Requests assign- ments as medication nurse * Discrepancies between physician orders, progress notes, and medica- tion records * Fails to obtain cosignatures * Frequently requests other nurses to cosign at end of shift * Frequent unwit- nessed medication loss, spills, or wasting * Evidence of tam- pering with vials or capsules * Opens narcotics box when alone * Overmedicates compared to other nurses (eg, excessive use of as-needed medications) * Volunteers to work with patients who receive pain medication * Prefers to care for patients with decreased levels of awareness * Patients complain of ineffective pain relief * Requests unsuper- vised evening or night shifts Job performance * Excessive use of sick time especially after days off * Absence without notice or last minute time-off requests * Frequent tardiness * Frequent or unexplained dis- appearances from unit (eg, long breaks and lunches, frequent time in bathroom) * Decreased job performance * Negligence in patient care (eg, inattention, rudeness) * Increased difficulty meeting schedules or deadlines * Disorganized, illogical charting * Excessive mistakes (eg, errors of judgment in patient care) * Going on rounds at unusual or inappropriate hours * Elaborate, implausible excuses for behavior * Casually asks physicians for prescriptions * Inappropriate verbal or emotional responses (eg, snapping at colleagues) * Handwriting deterioration * Frequently requests colleagues to cover * Seems like a workaholic (eg, frequently works overtime, arrives early and stays late, does not take breaks, visits unit on days off) (1.) J B Bennett et al, "Team awareness for workplace substance abase prevention: The empirical and conceptual development of a training program," Prevention Science 1 (September 2000) 157-172. (2.) P D Blair, "Report impaired practice-STAT," Nursing Management 33 (January 2002) 24-26, 51. (3.) J Daprix, "The courage to care: Intervening with colleagues who demonstrate signs of impairment," The Florida Nurse 51 (September 2003) 28. (4.) N B Fisk, D A Devoto, "The nurse employee who uses alcohol/other drugs," Nurse Managers Bookshelf 2 (December 1990) 110-129. (5.) S Ponech, "Telltale signs," Nursing Management 31 (May 2000) 32-37. (6.) C West, "A person who is sick deserves the chance to get well," Michigan Nurse (November 1997) 4-6. |
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