NYSNA Leadership Academy
Module 4: Helping nurses with alcohol or drug-related problems
Module Four Links
- Services offered through the SPAN program
- Signs and Symptoms
- Typical Scenarios
- Legal issues for nurses who abuse drugs or alcohol
- When Can the Licensee Return to Work?
- The Statewide Peer Assistance for Nurses Program
- Making a Referral to SPAN
- Volunteer Nurse Advocates
- Module Four Examination
Nurses helping nurses
The Statewide Peer Assistance for Nurses (SPAN) program was created by NYSNA in 1992 to provide resources for nurses whose practice was in danger of being impacted because of the use of alcohol or other drugs. In 2000, a state law established the program for all RNs and LPNs in the state. NYSNA was awarded the state contract to administer the SPAN program in 2001.
The SPAN program is a free resource for individual nurses who are affected by an alcohol or drug-related problem and related mental health problems. The program is also a resource for schools, organizations, agencies, and healthcare facilities concerned about the effects of alcoholism or drug addiction on the nursing workforce.
The program is staffed by masters prepared professionals who understand both the healthcare workplace and the psychological, professional, and legal problems faced by nurses who are affected by addiction.
The mission of the SPAN program is:
- to heighten awareness and understanding of drug related concerns for nurses and the healthcare community.
- to create a balance between the needs of the nurse and the needs of the nurse’s patients.
The philosophy of the SPAN program is that every nurse deserves:
- access to treatment;
- help in preserving his or her license and employment status; and
- ongoing support throughout the recovery process
Services offered through the SPAN program
- Information and education about addiction and recovery. Regional Coordinators (RC) provide inservice education to nursing students and hospital staff about addiction among nursing professionals.
- Prevention and identification strategies are taught to promote prevention and early recognition of addiction in the workplace.
- Ongoing support and advocacy is available through individual contact with specially trained volunteer advocates and through attendance at weekly peer support group meetings.
- Linkages with treatment providers are offered, such as Employee Assistance Programs (EAP), the state Professional Assistance Program (PAP), and interface with regulatory agencies.
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Signs and Symptoms
A variety of behaviors may be demonstrated in the workplace by a nurse who suffers from a substance use disorder. The following may be warnings signs of chemical dependency.
General Signs and Symptoms
- Defensive
- Withdrawn
- Mood swings
- Decline in quality/accuracy of charting
- Increasingly irritable with patients and colleagues
- Isolated; wants to work night shift; lunches alone; avoids informal get-togethers
- Job shrinkage; does minimum amount of work
- Difficulty meeting schedules and deadlines
- Overachiever or perfectionist
Specific Signs and Symptoms of the Drug-Addicted Nurse
- Consistently signs out more controlled drugs than anyone else
- Often breaks or spills drugs
- Waits until alone to open the narcotics cabinet
- Consistently volunteers to be medications nurse
- Multiple medication errors
- Defensive when questioned about medication errors
- Takes frequent bathroom breaks
- Comes to work early and stays late for no reason
- Volunteers for extra shifts
- Vials appear altered
- Incorrect narcotic count or count inconsistent with pharmacy orders or patient census
- Patients complain that pain medications dispensed by this nurse are ineffective
Specific Signs and Symptoms of the Alcoholic Nurse
- Elaborate excuses for behavior such as lateness to work
- Blackouts; loss of memory of events, conversations, phone calls
- Euphoric recall of events
- Increasingly absent from duty with inadequate explanations; long lunch hours; sick leave after days off
- Calling in to request compensatory time at beginning of shift
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Typical Scenarios
Helen is a 45 year-old nurse, married with three children. She is a well-respected clinical nurse who has worked in the emergency department for the past 15 years. Helen developed back problems several years ago and was prescribed Lortab by her physician which she was initially prescribed to take prior to and after her spinal surgery. There is a notable history of addiction in Helen’s family, but that question never came up since it was not a part of the admission assessment prior to the healthcare provider writing the prescription for the opiate pain medication.
Helen ran out of Lortab and started diverting unused PRN medication from her workplace. She was caught when the employer conducted a random audit and realized that, in her role administering PRN medications, she had been removing more PRN medications than any of the other nurses. The hospital put Helen out on a disability leave since she freely admitted that she was addicted to pain medication and agreed to get treatment.
Jeff is a 38 year-old nurse who has worked in the ICU for 12 years. His dad was an alcoholic and has been in recovery for several years. Jeff‘s wife died 6 years ago from her injuries after a motor vehicle accident. Following that tragedy, Jeff started to drink more and more to cope with his feelings of grief and loss. He began to isolate himself from his co-workers and was often irritable at work. When confronted by a friend and colleague about his self-destructive behavior, Jeff decided to contact SPAN.
After meeting with the Regional Coordinator, Jeff was enthusiastic about the peer support meetings but unsure about getting involved with the Professional Assistance Program (PAP).
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Legal issues for nurses who abuse drugs or alcohol
Many employers are required by law to report to the state any nurse who has been:
- identified or is suspected of being an abuser of alcohol or other drugs;
- reassigned to another position because of substance abuse problems;
- terminated from a position because of problems associated with alcohol or substance abuse; and
- left a position while under suspicion of addictive illness.
Two offices within the State Education Department (SED) have specific functions relating to impaired nursing practice: the Office of Professional Discipline and the Professional Assistance Program:
The Office of Professional Discipline (OPD): OPD investigates and prosecutes licensed professionals charged with mental or physical impairment, incompetence, malpractice or misconduct, including accusations of patient harm. The licensed professional charged with an offense through OPD can anticipate involvement with this disciplinary system for the duration of an investigation. If a license is revoked, a licensee must wait a minimum of three (3) years before applying for license restoration.
The Professional Assistance Program (PAP): Established pursuant to Section 6510-b, Article 130, Title VIII, of the New York State Education Law. PAP is a resource for licensed professionals who “may be temporarily incapacitated for the active practice of a profession”…“and whose alleged incapacity is the result of a problem of drug or alcohol abuse which has not resulted in harm to a patient or a client... .” Professionals may voluntarily and confidentially surrender their licenses. PAP makes it possible for licensed professionals to seek treatment without being subject to professional discipline charges. This immunity is limited to:
- practicing the profession while the ability to practice is impaired by alcohol, drugs;
- being habitually drunk or being dependent on, or an habitual user of, narcotics, barbiturates, amphetamines, hallucinogens, or other drugs having similar effects
PAP is administered by SED through recommendations from the Committee for Professional Assistance. Enrolling in the PAP has several advantages, including:
- the nurse’s license is voluntarily surrendered; this action is confidential and not reflected on the licensee’s permanent record;
- license restoration occurs when participants and treatment personnel determine a return to practice is safe for the practitioner and the public, and such application for restoration is approved by the PAP;
- the PAP provides structure and motivation to maintain sobriety; and
- employers may be more receptive to retaining workplace nurses willing to participate in the program.
Nurses may contact the PAP at 518.474.3817, ext. 480 or e-mail.
Nurses who are accepted in the PAP program are monitored for a minimum of 2 years after they return to work by a workplace monitor and a toxicology monitor. The nurse also may have a treatment monitor.
NYS Department of Health Bureau of Narcotic Enforcement (BNE): The Bureau of Narcotic Enforcement is concerned with unlawful use of controlled substances. BNE representatives may investigate suspicions of the theft or diversion of controlled substances in any setting. BNE investigators report to OPD findings that implicate a licensed professional.
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When Can the Licensee Return to Work?
Ideally, readiness to return to work is mutually determined by the treatment provider and the nurse. Re-entry into practice involves the determination of the:
- license status;
- employer policies regarding re-entry;
- nurse’s substance(s) of abuse; and
- work restrictions or limitations of the licensee
One major recommendation is that the nurse not be assigned to high-stress situations upon returning to work.
Nurses may not have surrendered their licenses while in treatment, and for these individuals, recommendations and follow-up by treatment professionals may be crucial in the difference between relapse and maintaining sobriety.
For nurses who have surrendered licenses, understanding PAP’s regulations and monitoring assist treatment staff, as well as the recovering nurse, to pursue recovery and resume their practice.
The SPAN Program has developed a model re-entry to work agreement.
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The Statewide Peer Assistance for Nurses Program
The SPAN Program is separate from the PAP Program. SPAN assists nurses who are faced with the challenges of recovering from addiction and, at the same time, salvaging their professional lives. The program is there to benefit the nurse, not the state regulatory agencies, and will provide help tailored to the individual nurse.
There is no charge to the nurse for this service. Funding for the program is provided by a surcharge on all RN and LPN license registrations, and the program is administered through the New York State Department of Education.
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Making a Referral to SPAN
Any nurse, manager, administrator, union representative, colleague, friend, or relative of a nurse may contact SPAN if they are uneasy about a nurse’s alcohol or other drug use by calling our toll-free (in NY and NJ) helpline at 800.45.SPAN1 (800.457.7261).
In other states, call 518.782.9400, Ext. 265. A SPAN staff member will contact a caller within one business day.
Once the nurse in question contacts SPAN, a Regional Coordinator (RC) will meet with them to complete an assessment and determine what services and/or linkages will be a priority. Often the SPAN staff will accompany nurses to their first peer support group and introduce them to colleagues with similar issues.
Nurses who wish to participate in SPAN must sign a participation agreement and a release of information form. SPAN contacts are confidential to the extent authorized by law. No information is disclosed without the signed permission of the participant.
As of 2009, there are 6 Regional Coordinators who cover various regions in New York State. The Regional Coordinators supervise 25 peer support groups that have been established throughout New York State. One goal of the SPAN program is to have a support group within one hours’ drive of every nurse.
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Volunteer Nurse Advocates
The “peer” in the Peer Assistance Program is provided by volunteer nurse advocates who support fellow nurses who are struggling with substance abuse problems. SPAN volunteer nurse advocates assist in restoring participants to safe, effective practice. A commitment of 8 hours per month is required and training is provided. No experience is necessary, although knowledge in the areas of treatment, group counseling, and addictions is helpful.
Requirements include:
- valid NYS nursing license;
- participation at a one-day training workshop;
- participation at three to four annual training meetings; and
- donating 8 hours per month to advocate activities.
New training dates are added throughout the year. For information, call 800.45.SPAN.1.
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Module Four Examination
Leadership Academy Module Examinations: Print version
- Module 1:
Examination (.pdf format; Adobe Reader required) | 
Examination (.doc format) - Module 2: Examination (.pdf format; Adobe Reader required) | Examination (.doc format)
- Module 3: Examination (.pdf format; Adobe Reader required) | Examination (.doc format)
- Module 4: Examination (.pdf format; Adobe Reader required) | Examination (.doc format)
Leadership Academy Module Examinations: Online version
When you have finished studying this module, you may complete the online examination. You are required to achieve a minimum score of 80% on the exam in order to continue onto the next module. After successful completion of each module and examination, you will be notified by a member of the EPR Program staff that you may continue.
When you have completed all five modules and examinations, you are eligible to apply for consideration as a candidate to become a Fellow in the Leadership Academy.
Applications to the Leadership Academy will be mailed to those members who have completed all five modules in Tier One. The final decision regarding applicants selected to become a Leadership Fellow is made by the NYSNA Board of Directors. We wish you success in your pursuit to become a leader in the New York State Nurses Association.
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