NYSNA Leadership Academy

Module 4: Helping Nurses With Alcohol or Drug-related Problems

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 impaired by the use of alcohol and 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 or related mental health problems. The program also is a resource for schools, organizations, agencies, and healthcare facilities concerned about the effects of alcoholism and drug addiction on the nursing workforce.

The program is staffed by registered nurses who understand both the healthcare workplace and the psychological, professional, and legal problems that are faced by nurses who are affected by addiction.

Information and education about addiction and recovery.

Prevention and identification – strategies to promote prevention and early recognition of addiction in the workplace.

Ongoing support and advocacy through individual contact with specially trained volunteer advocates and attendance at weekly peer support group meetings.

Linkages with treatment providers, Employee Assistance Programs, the state Professional Assistance Program, and interface with regulatory agencies.

Warning 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• Withdrawn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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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
• Been reassigned to another position because of substance abuse problems
• Been terminated from a position because of problems associated with alcoholism or substance abuse
• Left a position while under suspicion of addictive illness

Two offices within 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 license. 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 a 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 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
• Employers may be more receptive to retaining workplace nurses willing to participate

Nurses may contact the PAP at 518.474.3817, ext. 480 or pap@mail.nysed.gov.

• 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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Returning to work

Ideally, readiness to return to work is mutually determined by the treatment provider and the nurse. Re-entry to practice involves determination of license status, employer policies regarding re-entry, the nurse’s substance(s) of choice, and any work restrictions or limitations. One major consideration is that the nurse not be assigned to high-stress situations upon return to work.

Nurses may have not 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 helps treatment staff, as well as the recovering nurse, pursue recovery and resume 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 not the same as the PAP Program. SPAN assists nurses who are faced with the challenges of recovering from addiction and salvaging their professional lives. The program is there on behalf of the nurse, not the state regulatory agencies, and will provide help tailored to the individual nurse.
There is no charge for this service. Funding for the program is provided by a surcharge on all RN and LPN license registrations and administered through the New York State Department of Education.

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 program 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 2013, there are 6 Regional Coordinators, and an Outreach Coordinator, who cover various regions of the state. The regional Coordinators supervise 32 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 and addictions is helpful.

Requirements include:

• Valid NYS nursing license
• New York State Nurses Association (NYSNA) membership
• Participation at a one-day training session
• Participation at bimonthly training meetings
• 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 4: Examination (.pdf format; Adobe Reader required)

Leadership Academy Module Examinations: Online version

• Module Four Examination

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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