Several years ago I worked on a nursing unit with a nurse who was suspected of diverting medications for his own use. I was unaware of the problem until I saw someone from the pharmacy department counting the pills in the drawers. Then I got a phone call from the pharmacy asking me if this nurse had worked on the prior shift. I said “Yes.” I never saw him again. The pharmacy had been seeing a correlation between the disappearance of certain medications and the nurse’s working shifts.

What is the risk to the patients of having a healthcare provider on staff who is taking drugs? Our first duty is to make sure the patient is safe. Is the professional too impaired to make safe decisions and judgments? One of my colleagues, a now recovered substance abuser, told me of a time she took Demerol 700 mg and passed out in the nursing unit. She was a nurse manager at the time and luckily was not involved in direct patient care. This amount of Demerol would kill someone else without a tolerance to it.

Statistics about the prevalence of substance abuse in health care workers are hard to come by. The National Council of State Boards of Nursing released numbers that showed that 25% of the approximately 115,000 disciplinary actions in 2006 involved nurses with substance abuse. These figures do not include nurses who entered substance abuse programs to avoid being disciplined. (1) This translated into 15,826 violations, the single most common reason nurses got into trouble.

Nurses with substance abuse problems – questions

• Should an employer fire a nurse with a substance abuse problem?
• Require him or her to enter treatment?
• Remove the employee from patient care areas with access to medications?
• Provide strict supervision of the nurse?
• Require unscheduled drug testing?
• Have a drug-free workplace program in place?
• Ask potential employees if they have ever been fired, and why?
• Avoid making judgments about an employee without an admission of drug use or a positive drug test?

The answer to most if not all of these questions is yes. The employer’s first responsibility is to the patients; to protect them from impaired or incompetent employees. These employees create troubling issues within the work environment. When the impaired professional makes inappropriate decisions or fails to recognize the patient’s needs, liability and injuries can result.

(1) Healing versus safety, HealthLeaders, November 2009, 63

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