The Impaired Healthcare Worker

“Impairment” means to spoil or weaken (something) so it is less effective. 

A co-worker who is impaired by drugs or alcohol can weaken the unit or department where the employee is assigned to work. The often erratic behavior of the impaired member of the healthcare team can chip away at the moral of the department and add additional stress. 

In an effort to ensure safe, competent and efficient delivery of patient care, Marietta Memorial Hospital is committed to maintaining an environment which is free of the adverse effects of alcohol and drug abuse. 

The symptoms are often subtle and it may be difficult to pinpoint a precise reason for your suspicions. There are common behaviors which impaired employees are known to exhibit.

These include how well the employee performs and includes:

  • Absenteeism & tardiness
  • Patterns of absenteeism such as calling off on a Monday or a Friday, after a holiday or after payday
  • Excessive sick leave use
  • Numerous personal phone calls at work
  • Returning late from lunch or breaks
  • Uncharacteristic errors in judgment
  • Frequently needs to leave early—and may give a variety of reasons for needing to leave early
  • Frequent job changes
  • Drunk driving arrests
  • Frequent accidents with numerous visits to the Emergency Department and/or hospitalization

    In addition, employees who have access to medications may have certain patterns:

    • Frequently needs to “waste” a medication, but forgets to have the actual discard witnessed by another employee
    • Often needs to have medications replaced as they accidentally broke a vial or dropped a pill on the floor
    • Consistently documents the administration of pain or nerve medicines for patients who have not needed the medications before or after that particular nurse has cared for the patient
    • Consistently documents the administration of the maximum ordered dosage of medication when others have given lower dosages with good pain control for the patient
    • Consistently has patients complain that their pain medication hasn’t worked when administered by the particular nurse
    • May request a transfer to the night shift (less supervision)
    • May request a transfer to units where narcotics are frequently given (ICU/PACU/surgical unit)
    • Documents administration of medication to patients who are confused and disoriented

    In addition to performance issues, the impaired employee will likely show some outward signs:

    • Sloppy and unkempt appearance
    • Sleepiness, slurred speech, shakiness
    • Smell of alcohol
    • Red or bloodshot eyes
    • Sweatiness

    The behavior of the person may also raise suspicions. The person may be:

    • Irritable and moody
    • Insubordination to supervisors
    • Difficulty in getting along with their co-workers
    • Borrowing money from their co-workers
    • Stealing money from their co-workers
    • Complaints from families/patients/co-workers about the employee’s attitude
    • Neglect of social or family commitments
    • Decrease workload tolerance

    Substance abuse reaches far beyond the individual. The “impaired” person poses a dilemma for their co-workers. Many times, co-workers hesitate to bring the situation to their supervisor’s attention thinking: “What if I’m wrong?” or “I’m not a tattletale!” 

    By not taking action, the situation is allowed to continue. By denying the situation exists, we are allowing the problem to get worse. 

    Sometimes people become ‘enablers’. In trying to protect the impaired co-worker, the co-workers offer excuses for the impaired employee’s behavior, help to cover their mistakes and help to complete their job duties so they won’t lose their job.

    The best approach is to report your concerns about a co-worker to their supervisor. The report should include the facts regarding the behaviors and performance issues you have seen. Don’t make it a personal attack. 

    While caution should be exercised in making allegations as serious as these, your concerns are something which you should discuss with your supervisor. 

    If you suspect a physician is impaired, the nurse manager or supervisor needs to be notified. The incident that lead to the belief that the physician might be impaired will be reviewed. An oral or written report (which will be kept confidential) should be made to the hospital president or medical staff president. The report should be factual and describe the incident(s) that lead to the belief that the physician might be impaired. The person making the report does not need proof of the impairment but must state the facts, which lead to the suspicions. The physician shall not be told who filed the report, nor does he need to be told the specific incidents which are contained in the report.

    Hospital problems with physicians that may be a sign of impairment are:

    • Often late, absent or ill
    • Decreased work/chart performance
    • Inappropriate ordering
    • Unavailable at night for telephone orders
    • Slurred or incoherent over the phone
    • Subject of hospital gossip
    • Unavailable for discussions
    • Heavy drinking at staff functions
    • Altercations with hospital personnel
    • Appears for rounds at inappropriate times
    • Negative patient feedback

    Note: With the priority of patient safety, timely reporting is necessary when a healthcare professional has reason to doubt or question the care being provided by a physician. A healthcare professional shall follow the process as outlined in the Medical Staff Rules and Regulations, IV, General Patient Care, #10 when immediate patient safety is questioned. (Available on mmhforms under MSBylaws and Manuals)

    Marietta Memorial Hospital Policy

    Purpose:

    In an effort to ensure the safe, competent and efficient delivery of patient care and to best utilize the skills and abilities of our employees, Marietta Memorial Hospital will remain an environment which is free of the adverse effects of alcohol and substance abuse. Marietta Memorial Hospital condemns the unlawful manufacture, distribution, dispersing, possession or abuse of any potentially impairing substances including controlled substances or alcohol. Such activities are strictly prohibited at Marietta Memorial Hospital.

    Post Offer Screening:

    It is the policy of Marietta Memorial Hospital that urine (ten panel testing) and/or blood screens will be administered to those persons receiving an offer of employment. 

    Failure to consent to a drug screen will terminate the offer of employment. 

    Candidates will be escorted to MOHP by Human Resources for testing. Specimens will be handled using the chain of custody/split specimen procedure. 

    Positive test results for drug use, other than as prescribed (current prescription within 6 months for the candidate) by a licensed physician, will result in a termination of the employment offer. All positive results will be confirmed by GC/MS.

    Candidates who believe the results to be false have the option of retesting the initial split specimen within seven days with another lab at their own expense, but this would not guarantee re-instatement of the employment offer. Positive results will be sent to the Medical Review Officer at Marietta Occupational Health Partners (MOHP), located in the old Emergency Department area.

    Just Cause Testing:

    It is the policy of Marietta Memorial Hospital that all employees are to report to work fit to perform their assigned duties. This includes being free from the impairing effects of alcohol and illegal prescribed drugs, drug use. All employees may be subject to urine, blood, breath alcohol and/or hair/skin alcohol drug screening for Just Cause. Just Cause includes, but is not limited to, the following:

    • Involvement in a work related accident
    • Returning from extended absence or unusual pattern of absences
    • Repeated pharmaceutical inventory discrepancies occurring during work shifts
    • Observed behavior, such as direct observation of drug/alcohol use or possession and/or physical symptoms of drug and/or alcohol use
    • A pattern of abnormal conduct or erratic behavior such as slurred speech, staggering movement, dilated pupils, odor of alcohol or marijuana, dynamic mood swings, etc.
    • Deteriorating work performance that appears to be related to substance use and does not appear to be attributable to other factors
    • Repeated or flagrant violations of your safety or work rules, which a supervisor determines poses a substantial risk of physical injury or property damage. The violations appears to be related to substance use
    • Arrest, conviction, citation or indictment for a drug-related offense or identification of an employee as the focus of a criminal investigation into illegal drug possession use or trafficking. The employee must notify the hospital within 72 hours of any drug-related conviction.
    • Information provided either by reliable and credible sources or independently corroborated regarding an employee’s substance use.
    • Newly discovered evidence the employee tampered with a previous drug or alcohol test through adulteration, attempted adulteration or specimen substitution.

    If a manager determines that drug/alcohol testing is appropriate, the manager shall notify the Director of Employee Relations and Nursing Supervisor or Administrator of the need to perform a urine drug screen, breath alcohol test or other tests as deemed necessary based on circumstances. The employee's manager/designee will notify MOHP during normal business hours or MOHP on-call number after hours. (If after hours, Human Resources and Administrator should be notified the next day). MOHP will handle all appropriate paperwork. Results of the drug/alcohol testing will be sent to the Director of Employee Health.

    The employee will be suspended without pay until the testing is completed. If the results are negative, the employee will be reinstated with back pay for scheduled time lost. If the employee is impaired and sent home, transportation will be provided. If the employee refuses to have assistance with transportation, local law enforcement will be notified of the employee's impaired condition by the manager.

    Failure by the employee to give the consent to the test may result in immediate discharge.

    If the results are negative, other explanations for the observed behaviors can be discussed by the employee, manager, Medical Review Officer and Human Resources as appropriate.

    If the results are positive, the manager may recommend outcomes ranging from probationary reinstatement, pending the employee's participation in an approved treatment program to immediate discharge.

    If the employee is not terminated, a rehabilitation and probationary program will be defined. Such program will include random testing, counseling, etc.

    Candidates who believe the results to be false have the option of retesting the initial split specimen within seven days with another lab at their own expense, but this would not guarantee re-instatement of the employment offer. Positive results will be sent to the Director of Employee Health.

    Test Results:

    All test results will be treated as confidential medical records. Positive results will be reported as appropriate to licensure board.

    Post Accident Testing

    It is the policy of MMH to conduct post-accident testing (as soon as possible) whenever an accident occurs. We consider an accident as an unplanned, unexpected or unintended event that occurs on our property during the conduct of our business or during working hours, or which involves one of our motor vehicles or a motor vehicle used in conducting company business, or is within the scope of employment and which results in any of the following:

    • A fatality of anyone involved in the accident
    • Bodily injury to the employee and/or another person that requires medical attention
    • Damage in apparent financial loss for the hospital
    • Errors involving patient care

    Upon review of facts/circumstances of above situation, the determination of whether to test will be made.

    It may be decided not to test if:

    • The injury is minor
    • It’s considered reasonable or commonplace to the job function
    • No violation of work rules occurred
    • There is no reasonable suspicion
    • Minor medication errors or needle sticks (unless excessive).

    Candidates who believe the results to be false have the option of retesting the initial split specimen within seven days with another lab at their own expense, but this would not guarantee re-instatement of the employment offer. Positive results will be sent to the Director of Employee Health.

    Returning from extended absence

    It is the policy of MMH to Drug Test employees who have been off work for extended periods of time due to surgery or other serious health related reasons, if there is a reasonable suspicion.

    The situation will be discussed with Human Resources and Employee Health. Employee Health will be involved with the decision and will monitor the situation.

    Candidates who believe the results to be false have the option of retesting the initial split specimen within seven days with another lab at their own expense, but this would not guarantee re-instatement of the employment offer. Positive results will be sent to the Director of Employee Health.

    Employee Assistance Program

    Marietta Memorial Hospital has an Employee Assistance Program (EAP) in place. Personnel Policy 20:13 addresses the EAP. 

    Purpose: The purpose of this policy is to communicate established guidelines for handling of employee behavioral and/or medical problems which are affecting an employee’s job performance and to provide for preventative measures/treatment that is available to the employee. It is the policy of the hospital to ensure that an employee assistance program is developed, implemented and maintained through the establishment of the EAP Advisory Committee. 

    Referrals to EAP

    • Self referral—a referral initiated, without knowledge or suggestions of a department head or supervisor, by the individual in need of help.
    • Management suggested referral—A referral recommended by a supervisor after the supervisor becomes aware that a personal or family issue may be affecting the employee’s job performance. Management suggested referrals may or may not occur in conjunction with disciplinary actions.
    • Management mandated referral—A referral made for serious performance related problems. Mandated referrals arise from a suspension level disciplinary action although not all suspensions will result in a mandated referral.

    All employees, spouses, and dependent children are eligible for assistance from EAP. Dependent children are those under the age of 18 years. Verification may be requested.

    Each employee and each eligible family member is entitled to four counseling sessions per calendar year. These sessions could be group or individual sessions.

    In instances where time off is necessary for treatment or rehabilitation, it may be granted in accordance with hospital policy.

    Using the Employee Assistance program is confidential and will not jeopardize the employee’s job, standing or reputation in any way.

    The employee can refer themselves to the EAP by contacting our participating provider directly at (740) 706-1638 or 374-5424 or (304) 422-7300 or toll free at 1-800-841-7876. For more information, contact Janet Campbell, Employee Health at 5323 or 4915.

Janet Campbell, BSN, MHSA, MSM, RN

Director, Employee Health