Position Statement

Model Statement: Alcohol and Other Drug Policy for RNs in NYS Employed in Healthcare Facilities

Introduction

In compliance with Federal Law, it is the policy of (this facility) to implement the requirements of the Drug Free Workplace Act of 1988. Addictive illness is the major public health problem in the U.S.; at least 10% of the work force including nurses are abusing alcohol, prescription, and/or illegal drugs. It is NYSNA’s philosophy that addiction is a treatable disease process.

The institutional policy and procedures apply to nurses who use alcohol or other drugs at work or away from work in a way that negatively affects work performance. These policies and procedures were developed using federal and state law and regulations (Appendix A), ethical guidelines, and an assumption that addicted nurses and their employers have both rights and obligations related to the work environment.

Defining the Problem

Addiction is a chronic, progressive disease with multiple factors that contribute to the disease process. The successful treatment of the disease is multi-focused. Early identification and intervention in the disease process is the foundation of this policy.

When a nurse practices while impaired, the standards of professional practice are not met. Employers of nurses have an ethical obligation and most have a legal mandate to report an impaired nurse to the appropriate legal and regulatory authorities in order to safeguard consumers. Nurses have an ethical obligation to address impairment of a colleague.

Policy Statements

It is the policy of (this facility) to regard addictive disorders as chronic, progressive and treatable illnesses.
It is the policy of (this facility) to refer nurses with alcohol or other drug related problems to the Statewide Peer Assistance for Nurses (SPAN) program: Helpline # 800.457.7261
It is the policy of (this facility) to make all efforts to assist nurses with addictive disorders in their endeavors to seek treatment and return to the workforce.
It is the policy of (this facility) to treat drug diversion for personal use as a consequence of the addictive disease process. Therefore, the nurse found diverting drugs for personal use is given an opportunity to be treated for an illness rather than face discipline.
It is the policy of (this facility) that a nurse using prescribed or over-the-counter substances that result in impaired job performance may be placed on medical leave of absence until the substance is no longer medically needed or the nurse is medically cleared to return to work.
It is the policy of (this facility) to secure resources necessary to achieve and maintain a drug-free and alcohol-free environment.
It is the policy of (this facility) that the unauthorized use, sale, purchase of alcohol or other drugs in the workplace, is strictly prohibited and will result in disciplinary action should the nurse fail to comply with testing requests and expert recommendations.
It is the policy of (this facility) to comply with legal and regulatory mandates of the New York State reporting laws regarding a suspension, restriction, termination, curtailment, or resignation of employment or privileges of a licensed nurse when the impairment is alleged to have been caused by a drug or alcohol related problem.

SPAN Services: Helpline # 800.457.7261

SPAN can facilitate advocacy and linkages to supportive resources such as New York State’s Education Department Professional Assistance Program (PAP). A nurse may be able to prevent permanent adverse actions against his or her nursing license by applying for admission into the PAP as long as there is no patient harm. The nurse may be referred for a professional evaluation, formal treatment or encouraged to attend self help and SPAN support groups. SPAN support groups are held in various locations statewide. SPAN also offers information and education about addiction and peer assistance.

Employers are encouraged to monitor employee compliance with treatment, PAP recommendations and to mandate both as a condition of returning to practice. Failure by the nurse to comply should be addressed in accordance with the conditions of their return-to-work agreement, SPAN and PAP recommendation and applicable law.

For additional information, such as sample return to work agreements, visit our web site at http://www.nysna.org/programs/span/span_home.htm

The goal is to return the nurse to effective, efficient and safe practice through sustained abstinence from all mood altering substances.

Education

It is the policy of (this facility) to require all nurses to complete annual education on addiction. In addition, supervisory nursing personnel will be required to receive annual education in addictive disorders recognition and management of employees whose practice may be impaired by alcohol or other drugs.

Fitness for Duty

(This facility) believes that nurses must be fit for duty to provide safe care to patients. Fitness for duty is determined by effective job performance and absence of signs and symptoms of impaired practice.

Fitness for duty shall be determined by a designated person based upon reasonable and observable considerations and in good faith.

Confidentiality

The policy of (this facility) will adhere to the federal confidentiality regulations. Written consent to release information regarding alcohol or drug addicted nurses will be obtained in accordance with the regulations. When management requires feedback regarding a nurse’s level of participation and cooperation with a treatment provider or an employee assistance program, written consent will be obtained. Limits to confidentiality may be necessary in the following instances:

To meet legal reporting requirements.
When nurses represent a serious and real danger to themselves or patients.
The nurse will be advised in writing when a report is made to a legal regulatory agency.

Nurses who are deemed unfit for duty will be referred for alcohol and drug testing and assessment, and referral to one or a combination of the following:

employee assistance program/employee health service
outside or inside workplace alcohol/drug abuse expert

Drug Testing

When a drug test is necessary, it shall be conducted by a laboratory that is certified by the state or federal government health authorities as a laboratory qualified to perform forensic drug testing according to the following guidelines:

Any testing for alcohol and other drug use should be done only when there is reasonable suspicion or objective documentation that job performance is or has been impaired by alcohol or drug usage. Testing should not be done as a random procedure or general policy.
When a supervisor or designee, who has been trained to identify drug and alcohol impairment, has reason to believe that a nurse may be under the influence of alcohol or controlled drugs while on duty, the supervisor or designee may require the nurse to submit to a confidential toxicology test. The supervisor or designee will have documented the behavior that provides the basis for test request.
As part of a back to work contract, random screening may be required.

Refusal to Comply With Drug Testing or Treatment

Refusal to comply with alcohol or other drug testing or evaluation and treatment will result in immediate suspension from work. The suspension may be lifted if the nurse goes to an OASAS approved provider for an evaluation and follows through on any referral or treatment plan. Continued refusal to comply with drug testing will result in termination.

Regulations require reporting to the New York State Education Department’s Office of Professional Discipline any nurse whose job status has changed due to suspicion of alcohol and other drug use or diversion.

Hiring Recovering Employees

This facility adheres to the Americans with Disabilities Act. Employees will not be discriminated against because of a past alcohol or other drug abuse problem. (This facility) may request recovering individuals to comply with a back to work contract.

Approved by the NYSNA Board of Directors, 3/31/94. This document was developed under the direction of the Committee on Impaired Nursing Practice and is modeled after the Model Drug Policy of the Nurses Association of the Counties of Long Island, Inc. The Statewide Peer Assistance Committee, in collaboration with SPAN staff, revised this statement. Approved by the NYSNA Board of Directors 1/11/06

APPENDIX A

Laws and Regulations Regarding Substance Abuse and the Workplace

Bibliography

I. Federal

Code of federal regulations, Title 42, Public health. Part 2 - Confidentiality of alcohol and drug abuse patient records.

Title 42 of the Code of Federal Regulations governs the confidentiality of alcohol and drug abuse patient records. It provides the rules for records security, disclosure of information, patient notification, and restrictions on use.

United States code. Title 41, Public contracts. Chapter 10, Sections 701-707, Drug free workplace.

A law that requires all employers who accept contracts of more than $25,000 or grants from the federal government comply with this law by:

informing employees of the drug policy and keeping records of new employees’ receipt of the policy;

providing a drug free awareness program;

requiring that employees convicted under a criminal drug statute notify the employer of the conviction who then reports this information to the federal government.

United States code. Title 42, The public health and welfare. Chapter 126, Sections 12101-12213, Equal opportunities for individuals with disabilities.

A law prohibiting discrimination against the handicapped, which means physical or mental impairments, including drug addiction and alcoholism. It specifies that the facility make “reasonable accommodation” that would permit an employee to fulfill job responsibilities with some modifications to the work setting or schedule.

II. State

McKinney’s consolidated laws of New York, annotated. Book 16, Education. Section 6510-b, Temporary surrender of licenses during treatment for drug or alcohol abuse.

Under this law, licensed professionals have the opportunity to protect their licenses by applying for temporary surrender of the professional license while undergoing treatment and rehabilitation for alcohol and other drug abuse and dependencies. Acceptance into the program requires participation in monitoring program and adherence to guidelines.

McKinney’s consolidated laws of New York, annotated. Book 44 Public health law. Article 28, Hospitals; Section 2803-e, Reporting incidents of possible professional misconduct.

Public Health Law 2803-e requires administration in Article 28 facilities to report to the Department of Health (DOH) health care professionals who have been suspended or have had their training or employment privileges restricted or curtailed or who have voluntarily or involuntarily resigned to avoid charges of impairment, malpractice, or misconduct. There is immunity for good faith reporting of these professionals.

Official compilation of codes, rules and regulations of the state of New York. Book 8 Education (A). Part 29, Unprofessional conduct; Section 29.1, General provisions.

These regulations describe unprofessional conduct professionals licensed to practice in New York state.

Official compilation of codes, rules and regulations of the state of New York. Book 8 Education (A). Part 29, Unprofessional conduct; Section 29.2, General provisions for health professions.

These New York state regulations describe unprofessional conduct for the health professions.

Official compilation of codes, rules and regulations of the state of New York. Book 10 Health (A-1a). Part 80, Rules and regulations on controlled substances; Section 80-110, Notification by licensee.

New York state regulations on controlled substances (Section 80.110) states that persons authorized to possess controlled substances under Public Health Law Article 33 are required to report to the Bureau of Narcotic Control the loss, theft or diversion of a controlled substance.

Official compilation of codes, rules and regulations of the state of New York. Book 10 Health (C). Part 405, Hospitals-minimum standards; Section 405.3, Administration.

Personnel policies in hospitals should have provisions for a physical examination and medical history of sufficient depth to ensure that the employee is not habituated or addicted to mood altering substances, including alcohol.

January 2006

For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.