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whether the impaired person is an active participant in a board-approved program for the treatment of a physical or mental condition. The State of Florida sanctions two methods for reporting an impaired colleague. You can report the colleague to: • The Intervention Project for Nurses (IPN) • Department of Health (DOH), the administrative investigative body of the Florida Board of Nursing. Recognizing Impairment One of the situations that sets healthcare workers apart from and at higher risk for impairment than other professions is that healthcare workers have easy access to controlled substances. Some subspecialties, such as the intensive care, anesthesia, and the emergency department, may afford the healthcare worker an increased opportunity to divert controlled substances due to higher exposure to these substances. The signs and symptoms of impairment are often subtle and it is easy to persuade yourself that the signs/symptoms are caused by something other than drugs. However, it is imperative to the safety of your patients and the staff, that you take these signs of impairment very seriously. The following table depicts signs that may indicate impairment, especially if you see a pattern emerging or a combination of signs. Types Signs or Symptoms Physical • Progressive deterioration in personal appearance • Wearing long sleeves when inappropriate • Diminished alertness, confusion, or memory lapses • Frequent runny nose • Dilated or constricted pupils Material Protected by Copyright • Bloodshot or glassy eyes • Unsteady gait • Slurred speech • Diaphoresis • Frequent nausea, vomiting, or diarrhea • Tremors or shakes, restlessness • Weight gain or loss • Multiple and frequent complaints Emotional/Psychosocial • Increasing isolation or withdrawal from colleagues • Personal relationship problems • Dishonesty with self and others • Intoxication at social functions • Defensiveness (e.g., denial, rationalization) • Inappropriate verbal or emotional responses • Mood swings, overreaction to criticism, overexcitement • Personality change (mood swings, anxiety, panic attacks, depression, lack of impulse control, suicidal thoughts or gestures, feelings of impending doom, paranoid ideation) • Feelings of shame, guilt, loneliness, or sadness • Fearful/paranoid ideation • Panic attacks Behavioral • Impaired cognition • Increasing forgetfulness • Isolation or withdrawal • Mood swings (e.g. erratic outbursts, emotionally labile) Job Performance • Requests jobs in less supervised settings • Seems like a workaholic (e.g. frequently works overtime, arrives early and stays late) • Volunteers to count narcotics • Evidence of tampering with vials or capsules • Makes frequent medication errors • Frequent medication loss, spills, or wasting • Overmedicates compared to other staff • Patients complain of ineffective pain relief • Frequent tardiness • Frequent unexplained disappearances from workplace (NIDA, 2016; Volkow, Koop, & McLellan, 2016; & National Business Group on Health, ND) As shown in this table, these signs and symptoms are not specific to substance use disorders; however, any healthcare worker exhibiting these signs should be investigated, as they cannot give their best care to patients regardless of the cause of the symptoms. Material Protected by Copyright Reporting It is not easy to report a colleague for suspected or known impairment. It is not just the right thing to do, it is the responsibility of healthcare workers to assist their colleagues in recognizing impairment and getting treatment. Many of us project our own feelings and fears into the situation, fearing that we might be wrong, how would we feel if someone reported us and it was untrue. What if the signs are caused by something major happening in their lives and the behavior is not related to substance use? These are valid concerns; however, regardless of the cause of the behavior, your colleague needs help! What are your responsibilities? • Know the signs and symptoms of impaired behavior • Know the factors that put healthcare workers at risk for impairment • Know the reporting laws in your state • Know your facilities policies and procedures • Approach the healthcare worker and ask about the behavior (if within your