What are the warning signs of chemical dependency?
Listed below are some signs and symptoms that may indicate a nurse is experiencing problems with drugs or alcohol and needs to be referred for help.
Job Performance
— Inconsistent work quality, alternate periods of high and low efficiency
— Increased difficulty meeting deadlines
— Unrealistic excuses for decrease in work quality
— Job shrinkage, doing the minimum work necessary for the job
— Sloppy or illogical charting
— An excessive number of mistakes or errors of judgment in patient care
— Long breaks or lunch hours
— Frequent or unexplained disappearances during the shift
— Lateness for work and/or returning from lunch
— Volunteering to work overtime despite difficulty showing up for scheduled shifts
— Excessive use of sick time, especially following days off
— Absences without notice or last-minute requests for time off
— Repeated absences due to vaguely defined illnesses
Behavior, Attitude, Mood, and Mental Status
— Wide mood swings from isolation to irritability and outbursts
— Difficulty in concentration
— Marked nervousness on the job
— Decrease in problem-solving ability
— Diminished alertness, confusion, frequent memory lapses
— Difficulty in determining or setting priorities
— Isolation from others, eats alone, avoids informal staff get-togethers, or requests transfer to the night shift
— Unwillingness to cooperate with co-workers or inability to compromise
— Avoided contact with supervisor
— Overreaction to real or imagined criticism
— On the unit when not on duty
Medication-Centered Problems
— Consistently volunteering to be the medication nurse
— Offering to hold narcotic keys during report
— Volunteering to work with patients who receive regular or large amounts of pain medication
— Frequently found around medication room or cart
— Insists on administering drugs via intramuscular when other nurses give it by mouth to same patient
— Patient charting reflects excessive use of as-needed pain medication compared to shifts when other nurses are assigned to the same patient
— Patients complaining of little or no relief from pain medications when nurse is assigned to patient
— Use of two smaller tablets of medication to give prescribed dose (two 30 mg codeine tablets instead of one 60 mg tablet)
— Use of larger than necessary dose, wasting the rest (100 mg Demerol when patient is to receive only 50 mg)
— Missing drugs or unaccounted doses
— Frequently reporting spills, wastage, or breakage of medications
— Charting errors include medication errors
— Defensive when questioned about medication errors
[For further information or assistance, call the Colorado Nurse Health Program at (877) 716-0212 or (303) 716-0212, or the program’s Western Slope office at (970) 261-5770.]
Source: Colorado Nurse Health Program, Lakewood. Adapted from Hughes TL, Smith LL. Is your colleague chemically dependent? Am J Nurs 1994; 94:31-35; and Catanzarite A. Managing the Chemically Dependent Nurse: A Guide to Identification, Intervention, and Retention. Chicago: AHA Books; 1992.
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