Impairment
- Impairment is characterized by the inability to carry out professional duties and responsibilities in a reasonable manner, consistent with acceptable standards.
- Impairment is demonstrated by impaired cognitive functioning and memory, altered motorskills, diminished alertness, difficulty making decisions, impaired judgment, and the inability to cope with stressful situations.
When was legislation passed in Florida?
Legislation was passed in Florida on October 1, 1983 allowing a new avenue for addressing impairment in the nursing profession.‐In response to ANA call to action, the FNA lobbied this legislation and was instrumental in it’s passage.
•This set the stage for a non‐disciplinary alternative for nurses with SUD, MH and physical conditions that potentially impaired the nurse
What is the Intervention Project for Nurses (IPN)?
What number state is Florida to create an IPN?
How many states have an IPN?
The Intervention Project for Nurses (IPN) is a Nurse Assistance and Monitoring Program (aka ATD, alternative to discipline)
- Florida was the first ATD program in the USA.
- IPN is the largest such program in the country.
- Many state programs have modeled their programs after Florida IPN.
- Florida is one of 46 states who have such alternative to discipline programs (ATD). (Missouri, Hawaii - in progress)
- IPN functions under a State contract with DOH to provide services to nurses that are in violation of the Florida Nurse Practice Act, F.S 464.
Arkansas, Alaska - no program
FL IPN & The FBON
- An employer can make a referral directly to IPN or the BON, or to both
- A nurse can self‐refer to IPN
- The BON has a contract with IPN, but the BON retains disciplinary authority & oversight
- IPN doesn’t not automatically report a nurse to the BON, unless the BON request data or if the nurse refuses to participate in the intervention process
- no proof of usage req’d to report suspected impairment
Employer’s Responsibility
- Identify suspected impairment/alleged violation of the Nurse Practice Act
- Observe & collect data
- Consult IPN
- Refer to IPN
- Participate in intervention process & monitoring
Colleagues Responsibilities
•BON make it mandatory to report any colleague who appears to be practicing while impaired! ANA Code of Ethics for Nurses
•Be alert to and take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights and best interests of the patient in jeopardy.
•Demonstrate care and Compassion to colleagues
Interpretive Statement 3.5 & 3.6 (2015 Update)
Substance Abuse in Nursing
- For nurses, substance use disorders are the same as the general public: 8% to 10% nationally
- Great risk among nurse anesthetists 9.8%
- ER nurse 3.5 times more likely to abuse substances
- Oncology & administrators more likely to abuse alcohol
- 67-90% of BON disciplinary action related to substance abuse
Nurse Personal Risk Factors
- Greater risk of using prescription drugs than the general population due to inconsistent work schedules, role strain, high work expectation (work load), mandatory overtime
- Personal risks include depression, burnout, HX sexual/physical abuse, family HX of drug abuse
- Other influences include easy access to drugs, enabling peers, lack of education and attitudes towards drug use in general (Pharmacological optimism)
•Most abused substances:
- Nonmedical opiate
- stimulant
- anti-anxiety drug use (due to easy availability)
Specialized knowledge alone doesn’t protect us.
Addiction (Substance Use Disorders)
- Primary and chronic illness that requires treatment
- Brain disease with genetic predisposition
- Phenomenon of craving and compulsion leading to tolerance, withdrawal and cycle of more compulsive use
- Periods of remission and relapse
- Identifiable course and stages
- Impacts the whole person (bio‐psycho‐social‐spiritual)
Treatable ‐‐‐‐‐‐‐‐ Recovery is possible
IPN’s Mission
The mission of the IPN is to ensure consumer health and safety by providing education, monitoring and support to nurses in the State of Florida.
To provide an avenue for assistance, rehabilitative efforts and retention of Florida Nurses
Nursing Professionals that IPN Assists and Monitors
- Nursing Students
- Graduate Nurses – exam candidates
- Certified Nursing Assistants (CNAs)
- Licensed Practical Nurses (LPNs)
- Registered Nurses (RNs), Registered Nurses w/ Bachelor of Science in Nursing (RN, BSNs)
- Advanced Registered Nurse Practitioners (ARNPs)
- Certified Registered Nurse Anesthetists (CRNAs)
- Doctoral level nurses (PhDs or other doctoral degrees)
Advocacy and Support for Nurses
- Majority of nurses in IPN avoid disciplinary action
- Non‐public option
- Initial support and education
- Referral to good providers
- Help with accessing treatment options as needed
- Structured nurse support groups (NSG) 120 across the state.
- IPN/FNA Annual Conference
- Didactic training via NSG with (12) CE’s at no cost per year entered into CEBroker.
- Provide advocacy with employers and work site supervisors
- Offer general IPN training to nursing employers and schools of nursing
- Provide 4 hour evidenced‐based training for directors and supervisors. Fit to Perform (co‐sponsor with FNA)
- Mandatory CE…coming
- Financial assistance (in process)
~$1200 program cost - responsibility of IPN recipient
Monitoring Components
- Refraining from practice
- Appropriate treatment referral (approved provider network)
- Execution of IPN AdvocacyContract
- Worksite monitoring at employment site
- Quarterly progress evaluations (employer, facilitator, nurse, treatment provider)
- Structured nurse support group
- Relapse prevention plan
- Assigned worksite relapse prevention modules
- Random toxicology screens
3-5 year program
narcotic administration restriction - 1st year
public record once BON notified
Support Network
Nurse [IPN Participant] →
Case Manager → NSG Facilitator → Toxicology → Treatment Provider → Worksite Monitor → Peer Support
Nurse Support Groups
120+ groups around the state
Life Skills training
40 modules in workbook
Did you know?
- IPN received approximately 900 consultations and referrals per year.
- Currently, there are 1400 nurses participating in IPN.
- 75‐80% of IPN nurses complete successfully.
- 78% of IPN nurses are practicing nursing.
- Of those working, over 90% receive favorable reports.
- IPN recidivism rate in less than 5% (completed participants) who re‐enter IPN.
- The relapse rate of IPN participants in 6‐7%.
- You can contact IPN at any time if you are a current supervisor, employer or prospective employer to get the status of a nurse.
Who’s the Addict?
- Start looking at the nurses that you least expect.
- I’d like to tell you to look for the nurses with red eyes, slurred speech, &/or inappropriate behavior/conflicts with colleagues, but the signs can be more subtle
- Family relationship problems
- Change in work habits (workaholic, lots of OT, tardiness, frequent unexplained disappearances from unit)
- Poor job performance (makes frequent med errors, spills or wasting of meds)
- Financial difficulties
Organizations Specializing in Addictions/Recovery
- International Nurses Society on Addictions - Founded in 1975 for nurses committed to the prevention, intervention, treatment, and management of addictive disorders including alcohol and other drug dependencies, nicotine dependencies, eating disorders, dual and multiple diagnosis, and process addictions such as gambling.
- American Society of Addiction Medicine - An association of physicians dedicated to improving the treatment of alcoholism and other addictions, educating physicians and medical students, promoting research and prevention, and enlightening and informing the medical community and the public about these issues.
•National Organization of Alternative Programs -
Promotes public safety through offering impaired healthcare professionals monitored rehabilitation and recovery as an alternative to license discipline, emphasizing fitness to practice and retention of competent professionals.
- Nurses in Recovery Participants must be a health care professional and either in recovery or have a desire to be in recovery from drug addiction, alcoholism, gambling, codependency, or any obsessive compulsive addictive process.
- Exceptional Nurse - A resource network committed to the inclusion of more people with disabilities in the nursing profession. This Website has a special resource listing for nurses in recovery.
- Hazelden Foundation - Offers a special Health Care Professionals Inpatient Alcohol and Drug Treatment Program.
- National Institute on Alcohol Abuse and Alcoholism - Provides leadership in the national effort to reduce alcohol‐related problems.
