National Council on Alcoholism and Drug Abuse (NCADA)
Ask yourself the following questions:
- Do you lose time from work due to drinking/drug use?
- Is drinking/drug use making your home life unhappy?
- Do you drink/use drugs because you are shy with other people?
- Is drinking/drug use affecting your reputation?
- Have you ever felt remorse after drinking/drug use?
- Have you gotten into financial trouble as a result of drinking/drug use?
- Do you turn to people you normally don't associate with when drinking/using drugs?
- Does your drinking/drug use make you careless of your family's welfare?
- Has your ambition decreased since drinking/drug use?
- Do you crave a drink/drug at a definite time daily?
- Do you want to drink/use drugs the next morning?
- Does your drinking/drug use cause you to have difficulty sleeping?
- Has your efficiency decreased since drinking/using drugs?
- Is drinking/drug use jeopardizing your job or business?
- Do you drink/use drugs to escape worries or troubles?
- Do you drink/use drugs alone?
- Have you ever had a memory loss as a result of drinking/drug use?
- Has a physician ever treated you for drinking/drug use?
- Do you drink/use drugs to build up your self-confidence?
- Have you ever been to a hospital or institution because of drinking/using drugs?
Scoring: If you answered "yes" to:
- 1 of the questions, you may have an alcoholism/drug addiction problem.
- 2 questions, chances are that you have an alcoholism/drug addiction problem.
- 3 or more, you definitely have the disease of alcoholism/drug addiction.
If you think you may have a problem with alcohol or drugs, call National Council on Alcoholism and Drug Abuse (NCADA) at (314) 962-3456 and speak with one of their counselors. If treatment is recommended, be advised that the North Carolina Board of Nursing requires assessment and treatment through a participating treatment provider.
Identifying Substance Use Disorders (National Council State Boards of Nursing)
- Tends to administer more medications, always uses the maximal dose
- Volunteers to give medications
- Demonstrates patterns of excessive wastage and breakage
- Increasing discrepancies in management of controlled substances
- Complaints from patients reporting ineffectiveness of pain medication
- Requests to work evenings, nights, week-ends when there is generally less activity and less supervision
- Exhibits increased anxiety, sudden mood swings, inappropriate anger or crying
- Demonstrates problems interacting with peers and supervisors
- Exhibits forgetfulness or memory lapses
- Makes frequent trips to the bathroom or has other unexplained absences
- Demonstrates patterns of absenteeism, tardiness, and sick calls especially following days off
- Sloppy or illogical documentation
- Shakiness, tremors of the hands
- Slurred speech
- Falling asleep
- Watery eyes, dilated or constricted pupils
- Unsteady gait or staggering
- Runny nose
- Nausea, vomiting, diarrhea
- Weight loss or gain
- Change in dress or grooming – (i.e. Suddenly wears long sleeves/lab coats)
Suspected Impairment Checklist
Download the Suspected Impairment Evaluation Checklist to evaluate a possible impaired practitioner.
When to Refer
What to Consider
If a nurse’s performance is suggestive of a Substance Use Disorder consider the following information:
- Review your facility’s policies and procedures before initiating action unless patients and/or staff are in imminent danger*
- Use your facility chain of command in addressing the issue
- If drug screening is requested, assure adherence to strict chain of custody protocols
- Use the 5 W’s Test in organizing your thoughts
- Who made the complaint? (i.e. Patient, Family, Peers, Colleagues)
- What is the nature of the complaint? (Under medicating, Documentation discrepancies, Excessive wasting patterns, Impaired on duty)
- Where is the location of the incident?
- When did the event occur?
- Why did the events occur? (Possible motivations, Causes)
Referrals should be made to the Board of Nursing when any one of the following situations arise:
- Positive pre-employment drug screens
- Positive results on a “for-cause” drug screen
- Signs and symptoms of impairment including the smell of alcohol on the breath, regardless of whether or not the impairment is alleged to be as a result of the nurse’s own prescription meds
- Reports of excessive use of controlled substances, increased wastage, sloppy or careless wasting, consistent failure to follow facility policies for wasting controlled substances, documentation discrepancies, manipulation of medication dispensing systems
- Any time there is a violation of the Nursing Practice Act
When in doubt, you may call the Board at (919) 782-3211 ext. 271 for further consultation.