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Recognizing Impairment in the Workplace

Author: Noah Carpenter, MD and Jennifer McAnally, BS, BSN, DNP and Kellie Wilson, PharmD

CE: 2 hours
Rated 4.7 out of 5.0 based on 26970 reviews

Course Summary

Impairment in healthcare is a recognized and ongoing concern that has a negative impact on all members of the interdisciplinary health team. Workplace impairment refers to the inability to function in a usual capacity and it can lead to devastating effects on patients, colleagues, healthcare agencies, and health consumers in general. A growing number of healthcare professionals misuse drugs or alcohol during their career. The rates of substance use are reportedly similar to those of the general population, however the prevalence within the health profession is concerning because of the medical standards and the responsibilities they are held to in the delivery of patient care. Some health specialties have higher rates of substance use and drug diversion, such as anesthesia, emergency medicine, and other interventional areas due to the high-risk environment and accessibility to drugs associated with their roles. Professional agencies, state licensing boards and other institutions provide guidelines for reporting an impaired colleague and for providing assistance to professionals to recover. Assisting clinicians to re-enter a health practice is generally part of such employee assistance and recovery programs. Research is ongoing with regard to the rates of re-entry into practice and how to prevent relapse and workplace impairment within the health professions.

Course Format


Course Syllabus

  I.         Introduction
 II.         Overview on Workplace Impairment
III.         Forms of Workplace Impairment
1.      Substance Use Disorders in Health Professionals
2.      Physical Condition
3.      Psychological Condition
4.      Accommodation for Disabilities
IV.         Impairment and Patient Care Outcomes
1.      Poor Patient Care
2.      Medication Errors
3.      Medication Diversion
 V.         Diminished Health of Impaired Professional
VI.         Identifying Signs of Workplace Impairment
1.      Errors While on Duty
2.      Leaving Early, Arriving Late and Excessive Absences
3.      Patient Rounding and Time Disparity
4.      Patients with Elevated Pain
5.      Dishonesty
6.      Increased Narcotic Usage for Patients
7.      Need for Money
VII.         Physical Symptoms of Impairment
1.      Dilated Pupils
2.      Rhinorrhea
3.      Slurred Speech
4.      Tremors
5.      Unsteady Gait
6.      Sleepiness
7.      Sweating
8.      Fatigue
9.      Weight Changes
10.    Mouth Odor
11.    Nausea, Vomiting, Diarrhea
12.    Mood Changes
13.    Deceitfulness
14.    Poor Concentration and Inadequate Memory
15.    Insomnia
16.    Denial and Defensiveness
17.    Poor Judgment
18.    Frequent Accidents
19.    Reduced Activity Level
VIII.         Essential Steps to Make a Report or Referral
1.      Understanding Signs of Impairment
2.      Observation of Performance
3.      Patterns of Behavior
4.      Document Signs or Symptoms of Impairment
5.      Reporting to a Supervisor
6.      Address the Health Professional
7.      Provide Transportation
IX.         Employer Initiatives to Promote Workplace Safety
1.      Drug-Free Workplace
2.      Employee Assistance Programs
3.      Educational Programs
  X.         American Nurse Association Position Statements
 XI.         Mandatory Reporting Law
1.      Case Example: Florida Nurse Practice Act (464.018)
XII.         Treatment Programs
1.      Assistance Programs
2.      Impaired Practitioner Programs
XIII.         Case Study: Workplace Impairment in the Operating Room
XIV.         Summary


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