Addressing Nurse Drug Problems

Huge Liabilities for Drug Impaired Nurses or Those Engaged in Drug Diversion

There are 4 million active nurses in the United States with approximately 75 percent being Registered Nurses while the remaining 25 percent are Licensed Practical Nurses.  Unfortunately, at any given time, more than 50,000 nurses are sanctioned by state licensing authorities and excluded from Medicare and Medicaid.  The American Nurses Association (ANA) estimates that approximately 10 percent of nurses, or more than a quarter million, may be substance abusers.  Drug diversion and addiction are major problems among nurses and other healthcare professionals.  Further, the Boston Globe recently reported that 13 Massachusetts nurses performed services without nursing licenses.  A subsequent investigation of health department documents showed that individuals had lied about having nursing degrees or about being licensed in other states.   Others falsely stated they had passed a national nursing licensure exam, completed a nursing education program, and met the nursing practice requirement.  These falsifications raised questions about the background checks made by state regulators and providers.  Some nurses had applied for licenses in other states claiming to be licensed in Massachusetts so they could receive a license in the second state under the “reciprocity” principle (most state nursing boards waive testing requirements if applicants are already licensed elsewhere).  State regulators are currently investigating licenses granted from other jurisdictions under reciprocity.

There are serious consequences for providers employing improperly qualified nurses or nurses who have lost their license.  Treatment from an impaired or unqualified nurse affects patient safety and creates quality of care issues.  This can raise potential for liability including: tort action suits for negligent hiring or patient neglect; enforcement penalties from the OIG; risks to participation in federal programs; and financial penalties.

Causes of Drug Abuse Problems

For nurses, the overwhelming cause for addiction is situational stress from work and home coupled with easy availability.  Nurses face pressure to meet the emotional demand of patients and their families.  They often work long shifts that may be physically taxing and involve life-and-death decisions.  Nurses involved in high-tension work environments experience higher levels of substance abuse.  Many nurses also believe that knowing how to medicate others translates into an ability to self-medicate.

Easier availability of controlled substances may allow nurses to:

• Persuade physicians to write a prescription for them;
• Steal script and forge prescriptions themselves;
• Divert drugs by administering partial doses to patients and saving the rest for themselves;
• Convince co-workers to cosign a narcotics wasting record without witnessing the disposal;
• Obtain drugs for discharged patients; and
• Use drugs that patients refuse or do not request.

Although substance abuse is usually noted first by fellow staff members, they are often reluctant to report it.  This is the reality even though impaired nurses in the workplace present a risk to patient care and safety, the facility’s reputation, and more.  Self-reporting is uncommon due to fear of losing jobs, licenses, and livelihoods.

What to do When Encountering a Problem

Depending on the nature of the problem, there are different courses of action for when a provider discovers a nursing drug issue.  Carrie Kusserow, a health care consultant with 15 years of experience in addressing these types of issues, advises the following:

• If a nurse is impaired by drugs or alcohol, immediately confront him or her with the facts. When confronted about an addiction, most nurses will cooperate and admit to the problem.  It is best to offer treatment and rehabilitation through an Employee Assistance Program (EAP), with the alternative being termination and reporting to the state licensing authority.

• If a nurse is confirmed to be on the OIG List of Excluded Individuals/Entities (LEIE), terminate the individual immediately. Then decide whether the time the nurse worked while sanctioned was significant enough to self-disclose the matter to the OIG.

• If a nurse is found to have engaged in diversion of patient drugs or has fraudulently obtained drugs, providers must terminate the nurse and notify the state licensing board and drug enforcement agencies.

Compliance Officers Tips

1. Properly sanction screen nurses against the LEIE and state sanction databases;
2. Completely verify credentials – particularly for nurses from another state;
3. Implement a policy that mandates reporting a nurse that is impaired or diverting drugs;
4. Promptly investigate all information suggesting drug abuse or diversion;
5. Implement a strict policy to report anyone involved in drug diversion to enforcement and licensing authorities;
6. Create an effective and well publicized EAP;
7. Put in place solid internal controls for wasting narcotic drugs and ensure that employees are following them scrupulously;
8. Operate a hotline that accepts reports of workplace drug and alcohol abuse or diversion;
9. Train employees on how to report workplace problems; and

Perform exit interviews of nurses that include inquiring about drug problems in the workplace.