Early Intervention Program Health

Transcription

1 Early Intervention Program Health For more information contact: Jacinta MacKinnon, RN, MN, FRE Consultant, Early Intervention Program Health ext

2 CRNBC s Regulatory Philosophy Right touch and relational regulation describes how the College of Registered Nurses of British Columbia (the College) does its work (Bayne, 2012). Righttouch regulation is the minimum force required to achieve regulatory compliance and public protection. Relational regulation reflects the belief that prevention and risk reduction are the best ways to achieve public safety. The College has put relational right touch regulation into action with The Early Intervention Program Health. This approach calls for collaboration with stakeholders including nurses, government, employers, the labour union and the public. Right touch regulation requires CRNBC to: 1. provide public protection by identifying risk to the public before it occurs; 2. quantify risk when it is present and manage risk through remediation whenever possible; 3. be fair and transparent in processes and outcomes; 4. be collaborative with registrants and other stakeholders; and 5. use evidence to inform actions. Walking Right-Touch Regulation: The Early Intervention Program Nurses who continue to work when they are ill can put the public at significant risk. In British Columbia, when a health condition affects a nurse s ability to meet professional standards, there is a requirement to report this to the College. Historically, such conditions have often gone unreported due to stigma associated with having an illness and fear about what action the College would take against a nurse. To encourage reporting, the College established the Early Intervention Program Health to enable nurses who are suffering from a health condition, such as depression, dementia, head injury or addiction, to voluntarily remove themselves from practice and seek treatment. Entry into the program is 2

3 private and confidential. This program proactively helps protect the public from harm as the nurse is not practicing when they are ill. Nurses participating in the program require medical approval before returning to their practice. The College monitors nurses in the program for compliance with medical treatment recommendations. The College continues to monitor nurses when they return to nursing practice to ensure they remain healthy and well. 84 % of nurses in the program are self-referred. Program Development The program used action research to: 1. review nurses presentation of addiction and other health concerns; 2. review what happened when a nurse with an illness was reported; 3. identify barriers to reporting to CRNBC; 4. develop, implement and evaluate changes to address the barriers. Program Goals The program goals are to: 1. improve public protection from unsafe nursing practice; 2. ensure that provincial legislative reporting requirements are met; 3. ensure that nurses who meet the diagnostic criteria for a health condition remove themselves from nursing practice; and 4. ensure all medical treatment recommendations are fulfilled before a nurse returns to his or her nursing position. 3

4 Relationship to public protection The Early Intervention Program s relationship to regulation and public protection is clear. If nurses are not fit to practice nursing because of an untreated health condition they must remove themselves from practice and convert to non-practicing registration with the College. If nurses do not remain engaged in treatment recommendations provided by a medical expert, their registration status remains non-practicing. These actions result in the public being protected from unsafe nursing practice. Program Design Development of the College s Early Intervention Program involved collaboration with medical experts, employers, disability managers, and the British Columbia Nurses Union (BCNU). The program ensures that nurses, who meet the diagnostic criteria for addiction, or any other health condition, are: 1. reported to the College; 2. assessed by a medical expert; 3. engaged in all treatment recommendations; and 4

5 4. are not practicing nursing until cleared to do so by a medical expert. Referral into the program is not treated as a formal complaint. As a result, it is not permanently noted on a nurse s registration record. If it is determined that a nurse is not complying with the program requirements, the matter will be referred into the College s formal complaint process. Results The Early Intervention Program Health statistics demonstrate that the program was needed, that the program is working, and that the program assists the College to meet its mandate of public protection. From 2011 to 2014, participation in the program went from 6 nurses to 129 nurses. This increase demonstrates that the program is working and provides strong support for the College's mandate of public protection. Participation in the Early Intervention Program accounted for 17% of all incapacity cases in 2011, growing to 83% in

6 Removing the stigma: Percentage of EIP cases compared to cases requiring formal discipline Implications of the Program Early data indicates that the program is contributing to an increase in public protection. In 2012, 73% of the Early Intervention Program Health files were self-reported. This number grew to 84% in This is encouraging as it may be an early indication that the program helps diminish the stigma linked to addiction and other health-related issues. Additionally, some of these selfreports may be the result of other professionals (regulated under the HPA) encouraging nurses to come forward and convert to non-practicing, given the support and benefits offered by the program. Future Work The College will continue to evaluate the program with participants and stakeholders, from both a quantitative and qualitative perspective. Qualitative questions include: Why does a nurse self-report? Does the program address the stigma associated with health problems? The College is establishing additional resources for improved education and is considering developing other types of programs that provide early public protection from unsafe nursing practice. 6

7 For Further Reading Angres, D., Bettinardi-Angres, K., Cross, W. (2010) Nurses with Chemical Dependency: Promoting Successful Treatment and Reentry. Journal of Nursing Regulation 1 (1) Baldisseri, M., (2007). Impaired health care professional. Critical Care Medicine, 35 (2) S106-S116. Doi: /01.CCM Bayne, L., (2012, February). Underlying philosophies and trends affecting professional regulation. College of Registered Nurses of British Columbia. Retrieved from framework.pdf Berge, K., Sappala, M., & Schipper, A. (2009). Chemical Dependency and the Physician. Mayo Clinic Proceedings 84(7), British Columbia Nurses Union. (2012). Retrieved from the British Columbia Nurses Union website. Clark, C., & Farnsworth, J. (2006). Program for Recovering Nurses: An Evaluation. MEDSURG Nursing 15(4), Coghlan, D., & Brannick, T. (2005). Doing action research in your own organization. Thousand Oaks, CA: Sage. College of Registered Nurses of British Columbia. (2005). CRNBC POLICY Manual\Registration, Inquiry and Discipline (RI&D)\RI&D 20 Professional Conduct.doc. Retrieved from the College of Registered Nurses of British Columbia intranet. College of Registered Nurses of British Columbia. (2011). CRNBC Bylaws. Retrieved from College of Registered Nurses of British Columbia. (2012). CRNBC Board Report. Retrieved from the College of Registered Nurses of British Columbia intranet College of Registered Nurses of British Columbia (2012. Underlying Philosophies and Trends Affecting Professional Regulation. Retrieved from Darbro, N. (2005). Alternative Early Intervention programs for Nurses with Impaired Practice: Completers and Non-Completers. Journal of Addictions Nursing. 16, Darbro, N.., (2009 a). Overview of Issues Related to Coercion in Substance Abuse Treatment: Part 1. Journal of Addictions Nursing, 20, Darbro, N., (2009 b). Overview of Issues Related to Coercion and Monitoring in Alternative Early Intervention programs for Nurses: A Comparison to Drug Court: Part 2. Journal of Addictions Nursing, 20, Darbro, N., (2011). Model Guidelines for Alternative Programs and Discipline Monitoring Programs. Journal of Nursing Regulation. 2, Domino, K.B., et al (2005). Risk Factors for Relapse in Health Care Professionals with Substance use Disorders. JAMA, 293,

8 Dupont, R., McLellan, A., White, W., Merlo, L., & Gold, M. (2009). Setting the standard for recovery: Physicians Health Programs. Journal of Substance Abuse Treatment, 36, Galanter, M. et al (2007). Substance-Abusing Physicians: Monitoring and Twelve-Step Based Treatment. The American Journal on Addictions, 16, Health Canada. Ottawa, Canada: Health Care System. Retrieved from Health Professions Act (2 [Unofficial Ministry of Health Services consolidation]. Victoria, Canada: Legislation and Professional Regulation Branch, Ministry of Health Services. Retrieved from Heise, B. (2003). The Historical Context of Addiction in the Nursing Profession. Journal of Addictions Nursing, 14, Langley, G., Nolan, K., Nolan, T., Norman, C., & Provost, L. (1996). The Improvement Guide: A practical approach to enhancing organizational performance. Wiley and Sons, New York, N.Y. Long, M. W. Cassidy, B. A., Sucher, M., & Stoehr, J. D. (2006). Prevention of Relapse in the Recovery of Arizona Health Care Providers. Journal of Addictive Diseases, 25 (1), Merlo, L., & Greene, W. (2010). Physicians Views Regarding Substance Use-Related Participation in a State Physician Health Program. The American Journal on Addictions, 19: Merlo, L., & Gold, M. (2008). Addiction Research and Treatment. Psychiatric Times, 25(7) McLellan, A. T., Skipper, G.S., Campbell, M. & DuPont, R. L., (2008). Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ 2008:337:a2038, 1-6. doi: /bmj.a2038 Monroe, T., Person, F., & Kenaga, H. (2008). Procedures for Handling Cases of Substance Abuse Among Nurses: A Comparison of Disciplinary and Alternative Programs. Journal of Addictions Nursing, 19: Monroe, T., & Person, F. (2009). Treating Nurses and Student Nurses with Chemical Dependency: Revising Policy in the United States for the 21st Century. Journal of Health Addiction, 7: Shaw, M.F., McGovern, M.P., Angres, D.H., & Rawal, P. (2004). Physicians and nurses with substance use disorders. Journal of Advanced Nursing, 47(5),