October FY23

[A Schutter]

This Months article is submitted by Kelsie St. Hill, CRNA it is titled "The Impaired Anesthesia Provider: Strategies to Prevent, Recognize, and Treat Substance Use Disorder Within The Workplace."  Substance use disorder within Anesthesia providers is complex and multifactorial. It is considered the number one occupational hazard for anesthesia professionals.  This article discusses strategies to prevent, treat and recognize substance use disorder.

Here is a link to the article.

Questions for Discussion:
1. Why is it important to report an impaired colleague?  What Feelings/concerns do you think you would experience if you had to report a colleague?

2. Have you ever been in this situation?

[nanci]

1. Why is it important to report an impaired colleague? What Feelings/concerns do you think you would experience if you had to report a colleague?
Providing anesthesia is a career with major responsibilities, high stress, and exposes the provider to controlled substances on a routine basis for patient care. Diverting medications, functional loss of self control and impairment of provider will lead to not only a failure to meet work responsibilities to themselves and their patients, but also impairment will lead to less safety with other aspects of their lives as well. Its important to report an impaired colleague for not only their own safety but for the safety of those around them as well. I would have mixed feelings if having to report a colleague. On one hand I would want to be very sure and not make false allegations or harm another provider in anyway. Yet getting someone the help and assistance they need, may not be in a self space to request the help on their own, and hopefully preventing harm from coming to them, their family and friends, and patients I feel is more important. Helping others in need is what we do as nurses and stepping up to assist our colleagues when they need it most should also be important.

2. Have you ever been in this situation?
I have not yet been in this situation.

[sjsimmons]

1. Why is it important to report an impaired colleague? What feelings/concerns do you think you would experience if you had to report a colleague?

While I feel that reporting colleagues with suspected substance use disorders (SUDs) would be difficult, withholding information about substance misuse from supervisors does a disservice to patients and to the colleague. Most importantly, the impaired provider is caring for an innocent and unconscious patient, which poses a threat to their safety. In addition, the healthy and safety of the provider is also in jeopardy. It is always better to identify and treat illness early in their course to prevent worsening of substance misuse and encourage recovery. Lastly, we have a legal responsibility to report impaired colleagues to the appropriate chain of command.

Unfortunately, providers are often reluctant to report a suspected impaired provider due to fear of feeling responsible for the assigned punishment or loss of job/license or lack of knowledge about how to appropriately report an impaired provider. According to JHH substance use policy, it is the responsibility of supervisors/managers to observe the behavior of employees in the department, document observations using the observed behavior checklist, and consult with the local HR representative to determine whether for-cause testing is appropriate.

2. Have you ever been in this situation?

I have never been directly involved in this situation, but I witnessed the removal of a CRNA during my training as an SRNA. This anesthesia provider was exhibiting signs of substance misuse (consistent use of higher doses than colleagues, personality changes, difficulty with authority, etc.) and, when approached, refused drug testing. I hope, as an anesthesia community, we can continue to take this occupational hazard seriously and protect our colleagues from this disease.

[Anne McNulty CRNA]

1. Why is it important to report an impaired Colleague? how would You feel in this situation?
This is a very difficult situation both professionally and personally. The impaired colleague is a risk to patient safety and a risk to his own safety. The impaired CRNA also needs treatment for his/her disease. The impaired CRNA most likely has personal as well as professional stress. If an intervention is not done with critical policies and components in place, there can be legal implications. All interventions must be carefully implemented, as a colleagues profession and family life will be effected. I would have very conflicting feelings about this intervention. (2) I have never reported an impaired colleague. I have I have worked with four CRNA colleagues that were impaired and eventually were removed from their workplace I have also monitored a CRNA returning to work clinically after rehabilitation for narcotic substance abuse. This was also very stressful,as he relapsed.

[aileenm4]

this is a really important topic
Reporting an impaired colleague provides safety to the provider and to the patients that person is caring for. I feel that if the facts are there and investigation is warranted then your doing whats best for everyone. that provider will be better in the long run no matter the embarrassment because they will be alive! and there is a possibility of a need to change careers due to the high incidence of relapse. I do agree that there is some problems with knowing the correct path to follow to report.
I myself have been involved in reporting a friend/colleague. and I know of many others in my career that have had SUD and relapsed and had to move onto another career and others who have been successful in rehab

[Christine Velarde]

Why is it important to report an impaired provider? It is important to report an individual that is suspected of substance abuse. Impairment can potentially cause harm to a patient. As someone pointed out someone was suspected of drug diversion and immediately escorted off the property. The nursing board reminded us that they are there to protect the consumer, The Hopkins lawyer stated that diversion is considered stealing and therefore will be prosecuted if necessary. Unlike the medical board we are considered guilty until proven innocent. The organization will request you to get a drug screen, go to occupational health and report the event to the board of nursing. You cannot practice as a regular nurse where narcotics or anesthetics are used.

[Wai-Ling Lo]

1. Why is it important to report an impaired colleague? What Feelings/concerns do you think you would experience if you had to report a colleague?
Like everyone has mentioned, reporting an impaired colleague is important and crucial for the safety of everyone including the impaired colleague. I will feel uncomfortable facing/reporting an impaired colleague but it has to be done regardless of my feeling because it is the right thing to do.

2. Have you ever been in this situation?
Yes, I reported a colleague who seemed to be impaired and couldn't function properly at work. The manager removed her from her duty immediately and requested her to go for toxicity screening. She didn't comply and left the hospital without coming back.

[Amy Swank]

1. It's important to report an impaired colleague because it could possibly impact the safety and outcome of the anesthetic experience of the patient under their care.
I just watched an excellent AANA knowledge network talk about this very topic in affiliation with Matt Zinder ( I highly recommend it if you need some free CEUs). It talked about how the RN wife of the impaired CRNA who worked with him, ended up reporting him. Others suspected and did nothing. She knew it was bad when he was giving her father anesthesia an she was literally outside the OR glass, anxious that he was impaired and what that would mean for her father's care while being anesthetized by him. When he finally was reported, and and after much detox rehab, relapse, etc, he realized that she literally saved his life. The right thing to do has to be the priority. These providers aren't unlikeable, unintelligent or unfriendly - which would make it easier to report, right? The lives of their patients and them depend on the brave person who reports them.

I've been in this situation. It took me a while to realize that the excellent hospital based MDA was impaired, but why was he always asking me to give him fentanyl for pre-op? Why was he always sweaty? In car accidents? Another CRNA reported him to the Chief of the anesthesia department after finding him ASLEEP UNDER THE OR TABLE during a case with the drapes up> Do you know what the Chairman of the Anesthesia Department did? Said this Dr. was too beloved by his patients and staff to report, so it took a while. He finally was reported and asked to drug test - but he left the hospital instead. When we googled him, there was his obituary.

Also- I think it's interesting that we have all this craziness about covering our hats and beards but Hopkins doesn't have occasional drug testing? Don't you think that to be odd?

[jswitzman]

It is important to report a impaired provider for the safety of the patient, practitioner and institution
The impaired provider is in hurting, unable to provide safe anesthesia and needs help.
I have been in the situation and it is not easy.
It is important the impaired provider doesn’t go home alone bc they are at a high risk for self harm. A plan should be in place to help the provider. We owe it to our patients and colleagues; we need to watch out for one another