and n.d.). If we notice any physical or

and give them a chance to keep
their license without disciplinary action, they need to ensure patient safety
during that process. The fact that the board has no clue whether these nurses
in the program are currently working is a huge issue. The current process is
lacking in many areas.

are multiple ways to address the current trend of nurses battling addiction,
including promoting employee resources, holding colleagues accountable, and
reconstructing the diversion program. These are all different components that
need to be lobbied for in order to improve the current prevalence of unsafe
nurses caring for patients. First of all, nurses need more support from their
employers. Nursing is an emotionally and physically demanding career, which can
be a stressor for addictive behaviors. I personally work at Children’s Hospital
Los Angeles, who does a great job of making their employees feel supported.

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When I was hired, I was informed of their Employee Assistance Program (EAP)
right off the bat. They explained all the resources they can provide to us.

Children’s Hospital Los Angeles also has multiple religious services going on
throughout the day that staff is welcome to attend. The facility does a
wonderful job at giving employees an outlet. The high acuity floors experience
death of children frequently. These floors have a box with a candle inside that
they open when a child passes. The nurses are encouraged to write any memory,
thought, or feeling associated with this death on a piece of paper and put it
into the box. It is absolutely vital that nurses have resources to cope with
the stress of the job.

colleagues need to be observant and hold each other accountable. This is
something that should be stressed upon hire: how to identify substance abuse.

It should be apart of a nurse’s responsibility to identify coworkers that may
be practicing unsafely. Though individuals can be exceptionally good at hiding
their addictions, we should be aware of what to look out for. Some indications
of substance abuse are fatigue, regularly using mouthwash or mints, dilated
pupils, nausea or vomiting, abrupt changes in weight, frequently using the
restroom, and unkempt appearance (, n.d.). Nurses who struggle
with addiction will eventually display behavioral changes as well. Behavioral
fluctuations can include insomnia, inability to concentrate, hyperactivity,
laughing inappropriately, and frequent anger (, n.d.). If we
notice any physical or behavioral deviations from the norm, we should not just
brush them off. Instead, we should have colleagues and patients in our best
interest. Nurses are commonly very close with their fellow nurses, which may
make them reluctant to report strange behavior. Rather than viewing it as
breaking the loyalty to their colleague or friend, nurses should view it as
having them in mind. If the individual is not intoxicated but they are going
through a stressful time in their life, employers should be aware of this in
order to reach out with available resources and support.

the current systems in place for diversion need to be reconstructed. Too many
nurses are let off of the hook for stealing narcotics and providing unsafe
patient care. Virginia has some regulations in place that other states can
learn from. In Virginia, health care facilities are required to report theft of
narcotics to a regulator. The law also demands health care facilities to report
impaired nurses. Failure to report impaired nurses can lead to fines up to
$25,000 (Borns, 2014). Another significant issue is the lack of resources to
hold nurses accountable. A study found that the majority of chief nursing
officers were aware of narcotic theft via the tracking on automated medication
dispensaries, yet were too busy to review the audits (Borns, 2014). Automated
medication dispensaries are built to prevent diversion of medications, yet no
one is monitoring the system in place. Every health care facility should have
individuals who are hired for the purpose of looking at the electronic reports
and monitoring the trends. This individual should be someone who does not know
the nursing staff personally, so no bias is present while reviewing the
reports. Additional lobbying and funding is needed for appropriate diversion
programs that ensure nurses are not working under the influence. We also need
to lessen the time it takes for the Board of Registered Nursing when a nurse is
deemed a “public risk.” There are many changes and improvements that need to be
made in order to address the issue at hand.

is a controversial issue that many do not want to recognize. I chose this topic
because as a future registered nurse, I am passionate about patient safety. I
am shocked at the prevalence of registered nurses working under such unsafe
conditions. We study the side effects of these medications for years in school,
yet many nurses personally disregard them. Nurses should share one common
ground: caring about the patients. Working under the influence of any substance
jeopardizes the patient. In order to attempt reconciling the problem of
addicted nurses in the United States, we need to admit that there is a problem.

Next, we need to raise awareness for the issue. After raising awareness, we can
lobby and obtain the funding needed to make changes.