Learn to spot warning signs of substance abuse
Requiring an employee to be tested for drugs or alcohol on the basis of reasonable cause means more than following just a hunch, says Arlene Maxim, RN, a home care consultant in Grand Rapids, MI. "Although nurses have very good instincts about what is normal or abnormal behavior for employees, it is necessary to document specific reasons for requiring a drug screen," she says. The warning signs of substance abuse that supervisors need to keep in mind fall into three categories: recognizable behavior, abnormal work patterns, and working with others.
Maxim has documented some of the signs to watch for in a handout she uses at seminars and for clients called "Reasonable Cause Checklist for the Supervisor." Some of the signs include:
Recognizable behavior
- Depression
- Anxiety/irritability
- Increased complaints about co-workers, argumentative
- Emotional outbursts (i.e., uncontrolled crying, laughter, screaming)
- Observable changes in mood after breaks
- Withdrawal or abnormally talkative
- Spends more than normal amount of time on the telephone
- Exaggerated sense of self-importance
- Outwardly violent behavior
Abnormal work patterns
- Will avoid discussing work issues with supervisor
- Acceleration in absenteeism and tardiness, particularly on Mondays and Fridays and before, during, and after holidays
- Frequently unreported absenteeism that employee later explains as "an emergency"
- Abnormally high incidence of headaches, "the flu," nausea, etc.
- Frequent trips to the restroom or drinking fountain
- Disappears from the work environment — supervisor unable to easily locate employee
- Frequent requests to leave work early
- High incidence of accidents such as needle sticks, minor auto accidents, etc.
- Inconsistency in quality of documentation, scheduling of visits, etc.
- Lacks ability to concentrate
- Has difficulty remembering instructions or mistakes made
- Takes more than the average time submitting documentation/scheduling visits, etc.
- Demonstrates increasing difficulty in completing complex tasks
Working with others
- Overreacts to actual or perceived criticism
- Displays acts of paranoia
- Other staff members complain about behavior such as asking to borrow money, abusive language, etc.
- Increased patient or family complaints about abnormal behavior
Maxim points out that supervisors also must document physical indicators in addition to patterns of behavior that exist. "Physical indicators must be present in order to determine reasonable cause for drug screening," she says. Physical indicators that should be documented include any or all of the following:
- Pupils constricted or dilated
- Flushed skin
- Abnormal, involuntary eye movement
- Unsteady gait
- Smell of alcohol
- Slurred speech
- Obvious needle marks
- Abnormal body odors
- Red or watering eyes and nose
- Complaints of vertigo or syncope
- Drowsiness
- Muscle twitching
- Sweating or yawning
- Possession of drug paraphernalia and/or substance that appears to be drugs or alcohol
Maxim recommends that in agencies with more than 50 employees, a reasonable-cause checklist and form be signed by two supervisors, one of whom is trained to recognize the signs or symptoms of substance abuse. For agencies with fewer than 50 employees, only one supervisor’s signature is adequate, she advises.
Requiring an employee to be tested for drugs or alcohol on the basis of reasonable cause means more than following just a hunch, says Arlene Maxim, RN, a home care consultant in Grand Rapids, MI. Maxim has documented some of the signs to watch for in a handout she uses at seminars and for clients called Reasonable Cause Checklist for the Supervisor.
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