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   THE CHEMICALLY IMPAIRED EMPLOYEESUBSTANCE MISUSE ã Maladaptive patterns of psychoactive substance abuse with the substanceuser continuing use in the face of recurrent occupational, social,psychological or physical problems and or dangerous situationsMANAGER ROLES: ã  Takes an active role in ensuring patient safety ã Responsibility to help this employee to deal with their diseaseModlin and Monte ã  The exact magnitude of chemical impairment within nursing is not known andvaries widely ã A review of the literature suggests that somewhere between 6-14% of allnurses are chemically impaired ã  The chemical impairement rate of health professionals is generallyacknowledge as being greater than that of the public ã Most frequently abused substance: meperidine, oxycodone, clonazepam,diazepam, morphine, pentazocine, barbiturateRECOGNIZING THE CHEMICALLLY IMPAIRED EMPLOYEEBEHAVIOR CHANGES ã Primary areas1. Personality/behavior changes2.Job performance changes3.Time and attendance changesCHARACTERISTICS CHANGES IN CHEMICALLY IMPAIRED EMPLOYEE1.Changes in Personality or Behaviors ã Increase irritability in patients and colleagues often followed byextreme calm ã Social isolation  ã Extreme and rapid mood swings ã Euphoric recall of events or elaborate excuses ã Unusual strong interest in narcotics or narcotic cabinet ã Sudden dramatic change in personal grooming ã Forgetfulness (simple short term memory loss to black out) ã Change in physical appearance ã Extreme defensiveness regarding medication errors ã 2.Changes in Job Performance ã Difficulty meeting schedules and deadlines ã Illogical or sloppy charting ã High frequency of medication errors ã Frequently volunteers to be medication nurse ã Has high number of assigned patient who complains that their painmedication is ineffective in relieving their pain ã Consistently meeting work performance requirements at minimallevels or doing the minimum amount of work necessary ã  Judgement errors ã Sleeping or dozing in duty ã Complaints from other staff members about the quality and quantity of the employees work3.Changes in Attendance and Use of Time ã Increasingly absent from work without adequate explanation ornotification ã Long lunch hours ã Excessive use of sick leaves or request for sick leave after days-off  ã Frequent calling in to request compensatory time  ã Arriving at work early or staying late for no apparent reason ã Consistent lateness ã Frequent disappearances from the unit without explanationEARLY STAGE ã Use of addictive substance primarily for pleasure ã Substance use does not usually occur during work hoursCHEMICAL DEPENDENCE DEEPEN ã Employee develops tolerance to the chemical and must use greaterquantities more frequently to achieve same effect ã Made a conscious lifestyle decision to use chemicals ã High use of defense mechanism: justifying, denying, bargaining ã Use of chemical substance both at and away from work ã Work performance generally declines in the areas of attendance, judgement,quality, and interpersonal relationship ã Decline in unit morale  unreliable and unproductive workerFINAL STAGE OF CHEMICAL DEPENDENCE ã Employee must continually use the chemical substance even though he/sheno longer gains pleasure or gratification ã Physically or psychologically addicted  employee harbors a total disregardfor self and others ã Employee becomes un predictable and undependableCONFRONTING THE CHEMICALLY IMPAIREDPHASES IN DEALING WITH THE CHEMICALLY IMPAIRED1.Data or evidenced gathering phase ã  The manager collects as much hard evidence as possible to documentsuspicions of chemical impairement in the employee  ã Validate it if possible by a second person2.DIRECT CONFRONTATION ã Denial and anger should be expected ã  The employee must be immediately removed from work environmentand privately confronted with the manager’s perception3.Outlining the organizations plan or expectations ã Disciplinary contract THE MANAGER’S ROLE IN ASSISTING THE CHEMICALLY IMPAIRED EMPLOYEE ã Must be very careful not to assume the role of counselor or treatmentprovider ã Must be careful not to feel the need to diagnose the cause of the chemicaladdiction or to justify its existence ã Identify clearly performance expectation for the employee and to confrontthe employee when those expectations are not met ã Primary responsibility is to see that the employee becomes functional againand can meet organizational expectations before returning to work ã Create an environment that decreases the chances of chemical impairementin the work setting ã Control drug accessibility by implementing, and forcing, and monitoringpolicies and procedures related to medication distribution ã Provide opportunities for the staff to learn about substance abuse, itsdetection, and available resources to help those who are impaired THE RECOVERY PROCESSFIRST PHASE ã  The impaired employee continues to deny the significance of severity of thechemical impairement but does reduce or suspend chemical use
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