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post-partum depression; Penny denies depression but does admit to being tired and since the birth of her baby, she has been having more migraines than usual. She says she is reluctant to take any medications for the migraines as she is breast feeding. The co-worker accepts Penny’s explanation and does not report her to the unit management team. Material Protected by Copyright Several weeks later, patients are complaining of inadequate pain relief when Penny is caring for them, despite the fact they are routinely receiving pain medications. An audit of the patient’s medical records and the automated medication dispensing machine is conducted. This audit shows that all the patients are postsurgical teenagers with oral and intravenous medications. Additionally, when Penny is caring for them, they are receiving more medication and achieving less relief than when other nurses are caring for them. As Penny’s manager what would you do? A. Assume that Penny is making the patient move about more and therefore they need more medication and should expect less relief? B. Assume that Penny is diverting medications and report her to security C. Meet with Penny and discuss the complaints D. Do nothing as you have no proof of wrong doing Assuming anything or doing nothing is not effective management. Discussing the complaints with Penny is the best option. She may have a good explanation of the situation. Penny begins crying and saying she is sorry. As you listen, Penny tells you a story of incisional pain after the birth of her child and how she became dependent on Percocet for pain relief. She also explains that medication for the increasing severity of her migraines was not working. She began to take the postsurgical patients to have access to the pain medications. She began diverting one or two tablets a day, but was now up to diverting several tablets, often enough to take some home to get through the night. She was replacing the tablets with Tylenol when giving the medication to the patient. Penny is contrite and asks if she is going to be terminated and lose her license. She says that her husband cannot support the family without her income. What do you tell Penny? A. That she is terminated effective immediately B. You are reporting her to the Department of Health C. You are doing nothing because she told you the truth and you know she will stop this behavior D. You want her to self-report to the IPN, if she does not, you will You understand that Penny has a substance use disorder and needs professional help. You explain to Penny that you have two options for reporting. You recommend reporting to the IPN as this is a treatment program instead of disciplinary action. You review Penny’s options with her; including that the PICU would support her decision to get help and she would still have her job upon successful completion of the treatment program. Penny calls her sister to come pick her up and calls the IPN. After successful completion of the program, Penny returns to work and becomes an advocate for impaired nurse detection training. Conclusion Substance use disorder is under reported and is an occupational hazard for healthcare workers. It is everyone’s responsibility to recognize signs and behaviors associated with impairment. A culture of caring and support is necessary to remove the stigma related to substance use disorders. Material Protected by Copyright Each state and Board of Nursing has regulations and processes in place to address substance use disorder. Research has shown that discipline does not work and participation in a treatment program can increase the successful recovery from substance use disorders. Take care of yourself and your colleagues, learn to recognize the signs and symptoms, discuss your concerns with the colleague or your management team (whichever is indicated in your policy), and report your colleague to the appropriate authority in your state. In Florida, the IPN is the designated impaired healthcare worker program. Impairment in the workplace can have severe consequences. There are many sources of impairment such as fatigue, life stresses, use of drugs (over the counter, prescription, illicit), consumption of alcohol, etc. This White Paper discusses the
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