New York State Nurses Association SPAN

Transcription

1 Tracey Brown, Michele Schultz, Becky Eisenhut New York State Nurses Association SPAN

2 1. Identify three reasons nurses are at risk for developing a substance use disorder d 2. Identify two resources available to nurses with substance use disorders 3. Identify three signs and symptoms of substance abuse

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5 Partly genetic Partly environmental

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7 An obsessive, unshakable, compelling, gripping, irresistible drive

8 Biologic Origin Progressive Chronic Predictable Relapses and Remissions Leads to Death

9 A pattern of substance use leading to significant impairment in functioning Recurrent use resulting in failure to fulfill major obligations at work, school or home Recurrent use in situations which are physically hazardous Legal problems resulting from recurrent use Continued use despite significant social or interpersonal problems caused by the substance abuse

10 All criteria i for Substance Abuse Continuation of use despite related problems Increase in tolerance Withdrawal symptoms

11 ADDICTION is a neurobiological disorder in the brain.

12 Flood of endorphins, serotonin p and dopamine produce a rush

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14 It anticipates reward It tells the brain, DO IT AGAIN

15 Even when the person never wants to do it again

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17 Disease Entity Compliance rate Relapse rate Alcohol l addiction i 30 50% 50% Opioid addiction 30 50% 40% Cocaine addiction 30-50% 45% IDDM < 50% 30 50% Hypertension < 30% 50-60% Asthma < 30% 60 80%

18 Early Stage: Increase in use Blackouts Tolerance Attempts to control use

19 Middle Stage: Increased hang-overs Mood swings Withdrawal symptoms Compulsion to use Decreased appetite Attempts to stop using

20 Late Stage: Overwhelming compulsions Poor appetite Continuous use No attempt t to stop Physical consequences: Malnutrition Liver Failure Hepatitis AIDS Leads to death

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24 Early Stage: Lying Broken promises Lack of consideration Minimization Rationalization

25 Middle Stage: Increased lying Manipulation Attendance problems Stealing Irritability Denial Attempts to cover-up loss of control

26 Late Stage: Begging Threatening Violence Neglect of hygiene Unemployment Legal problems Homelessness

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31 What is the incidence of substance-abuse among NURSES? While rates in the general population range from 10% -13%, rates in nurses run as high as 18% (Sullivan & Decker, 2001, Effective Leadership and Management in Nursing) Nurses will have co-workers with addictive disorders

32 High stress - Increased work loads, decreased staffing, double shifts, mandatory overtime, rotating shifts, floating High pressure - Critical Care areas such as ED, ICU, Labor & Delivery Availability - Easy access to drugs of abuse Prone to injury - Back and knee problems Grief Exposure to the suffering of patients and families Self-medicating - Nurses feel competent to medicate patients and themselves

33 What is drug diversion and how do nurses divert drugs?

34 Divert - To direct away from the intended path. Waste Signing out more than needed Signing out under another patient Taking unused prns Siphoning from IV bags Used patches Substitution

35 Defensive/withdrawn/mood swings Decline in quality/quantity of work Increasingly irritable w/ patients and coworkers Job shrinkage Difficulty meeting schedules/deadlines dli Overachiever/perfectionist Intervention for children such as Social Work

36 Increasing time/attendance deficits Elaborate excuses for lateness, absence Blackouts Hangovers Distracted-watching clock

37 Patient complaints of ineffective pain relief Multiple medication errors Defensive about medication errors Frequent bathroom breaks Comes to work early/stays late Volunteers for extra shifts Nodding

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40 Statewide Peer Assistance for Nurses (SPAN) is nurses helping nurses. I i fid i l f It is a confidential resource for nurses affected by substance use problems.

41 1994: NYSNA hires a program coordinator to enact the peer assistance program/pilot program started. 1995: The program is named Statewide Peer Assistance for Nurses (SPAN). 2000: Governor Pataki signs legislation which created a funding stream. 2001: The program was available statewide 2012: 6 RC, 600+ active participants, 30+ peer support groups.

42 SPAN s mission is to be the resource for New York State nurses affected by substance use disorders, while fostering public safety through outreach and education.

43 Every nurse deserves access to treatment, help in preserving his or her license and employment status, and ongoing support throughout the recovery process.

44 Any nurse licensed in New York State (NP, RN, or LPN) Those concerned with the effects of alcohol l and drug related problems on the nurse workforce.

45 Information and education Outreach Ongoing support and advocacy Linkages with community resources A HELPline Mentoring Support groups

46 Director Assistant to the Director Office Coordinator Six Regional Six Regional Coordinators

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48 Call the SPAN HELPline toll-free in NY and NJ SPAN or ext. 265 or

49 SPAN services are offered free of charge A $5/year surcharge on NYS nurses license / registration I think it a wise investment in the present and future of the nursing profession!

50 A nurse calls the helpline or RC directly Assessment Schedule a meeting with the nurse Comprehensive assessment, forms, recommendations Take nurse to first SPAN meeting Nurse then attends weekly support group

51 Open ended group 4-20 attendees 90 minutes Topics include: disease concept, relapse prevention, relationships, PAP, toxicology screens, back to work issues, relapses, benefits of 12 step groups, etc

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53 Professional Assistance Program Office of Professional Discipline Department t of fprofessional Bureau of Narcotic Licensing Services Enforcement

54 Professional Assistance Program (PAP) confidential monitoring program, non-disciplinary and nonregulatory; considered alternative to discipline program Office of Professional Discipline (OPD) may elect to use PAP as disciplinary alternative; can fine, suspend, or revoke licenses; posts disciplinary action on license; OMIG Bureau of Narcotic Enforcement (BNE) Dept. of Health may impose criminal action, or accept as civil penalty usually resulting in a fine; FDA

55 Complaint / Direct Referral Investigation Referral to PAP and/or: Prosecution : Statement of Charges Informal Settlement Conference Professional Misconduct Hearing Regents Action 55

56 Name: Jane Doe Address: 1 Main St., Albany, New York Profession: Pharmacist License# Regents Action Date: December 13, 2000 Action: License surrendered Summary: Licensee admits charge of diverting controlled substances from three different pharmacies. 56

57 Alternative to Discipline Voluntary Monitoring Immunity Available to many professionals Most utilized by nurses

58 To protect the public Support the professional in recovery

59 Expert Advice Referrals Structured Recovery Plan Immunity from two charges of professional misconduct

60 Section Professional Misconduct [3] Practicing the profession while the ability to practice is impaired by alcohol, drugs, physical disability or mental disability. [4] Being habitually drunk or being dependent on, or a habitual user of, narcotics, barbiturates, amphetamines, hallucinogens, or other drugs having similar effects.

61 No Patient Harm Accept Treatment Program Accept Monitoring Diagnosis of Addictive Illness Voluntary surrender (inactivation) of license ( ) 61

62 Immediate License Surrender Rigorous Monitoring Strict Practice Conditions Return of a Trained Professional to Practice

63 Initial Assessment of nurse Referral to different tracks of PAP Letters of support Accompany nurse to PAP hearings Improved monitoring of progress of nurse 63

64 A nurse gets caught diverting Return to practice with restrictions (ie. no narcotic access) as Report to OPD by facility (may also approved by PAP panel involve criminal charges) Monitoring by treatment, Referred to SPAN (can self refer) toxicology, and worksite monitors voluntary Option to apply for PAP (if no patient harm) voluntary Treatment assessment and engagement as recommended Self help and attendance at SPAN support groups encouraged Periodic meetings with PAP Successful discharge from PAP Continued SPAN support and involvement

65 Feeling of uniqueness Role reversal Extremely difficult for helpers to accept help Over identification with work Medical knowledge (fooling urine screens) Manipulative; education/intelligence/may try to intimidate/ speak on an intellectual levell Case management/licensure Issues

66 Learn the language Ask questions Become adept at shifting the patient from an intellectual l level l to a feeling level l Profession vs. identity Public safety/support of professional

67 Abstinence Acceptance of chronic disease concept Relapse prevention/trigger identification Development of support network Development of coping skills Return to profession/work site

68 Difficulty in accepting role of patient May focus on other patients Tendency to intellectualize Issues of guilt and shame Fear of rejection by colleagues Issue of patient t harm

69 Back to work agreements Monitoring Random screens Work restrictions Change of specialty Continued treatmentt t

70 Anyone can express a statement of concern Observation Documentation Factual and objective data Report to supervisor Review and know your P&P

71 Referral to EAP, SPAN, PAP Medical leave instead of termination Return to work agreements Hire nurses in recovery

72 Develop policies and procedures regarding addictive disorders d Education orientation and ongoing Ensure that policies re: witnessing waste are enforced Routinely check computer reports for patterns View diversion as symptom

73 Identification Advocacy by SPAN Intervention and treatment Addiction is a chronic disease Nurse who is closely monitored protection of co-workers and patients Turnover costs % of nurse s salary plus cost of new employee

74 If addiction is a disease, then addicts are patients and punishment is not only ineffective, it is unethical and nontherapeutic. Kevin McCauley, MD, Addiction Specialist, 2010

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76 Tracey Brown: ext: 325 Michele Schultz: ext: 355 Becky Eisenhut: ext: 424 Office number:

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