Burned Out or Under the Influence?

This is an excerpt of an article that first appeared in the June 2017 issue of Patient Safety Monitor Journal.

Editor’s note: By the time the general public hears about an impaired clinician, whether it’s a nurse, technician, or physician, it’s usually after something bad has already happened. The infamous case of a New Hampshire technician who stole painkiller syringes and exposed thousands of patients to hepatitis C is just one example. The following is an edited Q&A with Judy Kees, a regional coach leader at Studer Group with human resource executive experience at several health systems. PSMJ spoke with Kees on how to deal with an impaired employee, how to identify the problem before harm is done, and what your obligations are afterwards.
PSMJ: As a whole, how does the healthcare industry do at preventing nurses, physicians, technicians, etc., from working impaired?
Kees: I would like to say we are 100% successful in our efforts. We are not at that percentage. I don’t have an exact number, yet we know some people “slip through.”  That’s why we have policies and procedures in place.
In today’s environment, this is continual work in progress. Ideally, we’d identify history during pre-hire via upfront referencing and licensing verification (if applicable). But that only identifies those with impairment issues which have been reported. Providing safe, high-quality patient care is of highest priority in our industry. As such, we as leaders are trained to watch for disruptive behaviors, monitor actions, and set a regular process and standard to audit our medications and administration records. In organizations where there is a real commitment to coworkers, staff reporting is essential to creating the environment we all seek.
PSMJ: How can you determine when someone is impaired and needs to stop working? Ideally, you’d like to catch them before they make a mistake, but is that always feasible?
Kees: You would look for nontraditional or unexpected behavior. They may have slurred speech; it may be their eyes. It may be that they don’t appear to care anymore or are anxious in their daily routines. In some cases, they are [acting] mean, yelling in their workplace at patients and others.
Another thing is if they’re missing work. An old thing we always researched was, “Are they missing a lot of Mondays and Fridays?” if they typically work Monday through Friday.
You look for those behavior changes, and as you see them, you’ve got to be ready to address the issue and not just say, “Oh, that’s just the way Judy is.” You’ve got to get in there and start dealing with issues as soon as they happen.
We rely on each other as well. I spent a long time in hospitals, and it was important for someone to feel like they could come and talk with me anonymously if they felt something was wrong with one of their peers or someone in another department. A lot of times they’re worried about their anonymity because they don’t want to get anybody in trouble. It’s not unusual during investigatory and discipline session for those in question to ask, “Who told you that?!” You don’t have to say who told you that. “It doesn’t matter” are my famous words—“It’s been reported and I’ve got to consider it.”
Leaders must be out and about, talking with their direct reports, making sure they are appreciated as well as working per organizational expectations/standards. When you do have an occurrence or incident, best practice is to immediately remove them from their work assignment and follow your organization’s policy. That may be immediate substance testing; it may be Employee Assistance Program (EAP) counseling. In either case, you want to temporarily remove them from their assignment, get them taken home, and begin your investigative work.


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