186 unit 3 | Professional Issues
expected to be of good moral character. The problem
of addiction among nurses was not discussed until
the 1950s, with addicted nurses receiving little sym-
pathy or treatment from their peers. Research on
addicted medical professionals increased in the
1970s, followed by major help for nurses with addic-
tive disease in 1980. At this time, the National
Nurses’ Society on Addictions (NNSA) task force
and the ANA task force on addictions and psycho-
logical functions jointly passed a resolution calling
for acknowledgment of the problem and guidelines
for impaired nurse programs (Heise, 2003).
Alcohol and drug abuse continue to be major
health problems in the United States. Health-care
professionals are not immune to alcoholism or
chemical dependency. In addition, various kinds of
mental illnesses may also affect a nurse’s ability to
deliver safe, competent care. Impaired workers can
adversely affect patient care, staff retention, morale,
and management time as team members try to pick
up the slack for the impaired worker (Damrosch &
Scholler-Jaquish, 1993). The most common signs
of impairment are (Blair, 2005; Damrosch &
Scholler-Jaquish, 1993):
■Witnessed consumption of alcohol or other sub-
stances on the job
■Changes in dress, appearance, posture, gestures
■Slurred speech; abusive/incoherent language
■Reports of impairment or erratic behavior from
patients and/or coworkers
■Witnessed unprofessional conduct
■Significant lack of attention to detail
■Witnessed theft of controlled substances
■When assigned patients routinely request pain
medication within a short period of being
medicated
Most employers and state boards of nursing have
strict guidelines related to impaired nurses.
Impaired-nurse programs, which are conducted by
state boards of nursing, work with the employer to
assist the impaired nurse to remain licensed while
receiving help for the addiction problem. It is
important that you become aware of workplace
issues surrounding the impaired worker, signs and
symptoms of impairment, and the policies and
reporting procedures concerning an impaired
worker. Compassion from coworkers and supervi-
sors is of utmost importance in assisting the
impaired worker to seek help (Damrosch &
Scholler-Jaquish, 1993; Sloan & Vernarec, 2001).
The National Council of State Boards lists all
state boards of nursing. Information on support
programs for impaired nurses can be obtained
from each state board (ncsbn.org/regulation/
nursingpractice_npa_pennrn.asp).
Upholding the standards of the nursing profes-
sion is everyone’s responsibility. Often coworkers,
noticing a change in another’s behavior, become
protective and take on more work to ease the bur-
den of their coworker. Although it is difficult to
report a colleague, covering up or ignoring the
problem can cause serious risks for the patient and
the nurse. Many state boards make it mandatory
for nurses to report suspected impaired coworkers;
most states accept anonymous reports. In many
states, state law requires hospitals and health-care
providers to report impaired practitioners, but the
law also grants immunity from civil liability if the
report was made in good faith (Blair, 2005; Sloan
& Vernarec, 2001).Microbial Threats
Health-care workers are an at-risk group for several
microbial threats. Severe acute respiratory syn-
dromes (SARS) is a respiratory illness that has
been reported in Asia, Europe, and North America.
According to the World Health Organization,
8098 people worldwide became sick with SARS
during the 2003 outbreak.
SARS begins with a high fever and mild respi-
ratory symptoms. Other symptoms may include
headache, an overall feeling of discomfort, and
body aches. It is not uncommon for the person to
have diarrhea and develop a dry cough. Most
patients develop pneumonia. The virus that causes
SARS is thought to be transmitted most readily by
respiratory droplets. The virus can also spread
when a person touches a surface or object contam-
inated with infectious droplets and then touches
his or her mouth, nose, or eyes. In addition, it is
possible that the SARS virus might spread more
broadly through the air (airborne spread) or by
other ways that are not known. The CDC provides
current information on the handling of SARS in
the workplace (cdc.gov).
Unlike the newer microbial threat SARS, tuber-
culosis (TB) was a leading cause of death among
infectious diseases from the 19th into the mid-
20th centuries. Although TB rates declined in the
1990s, they are currently on the rise as resources
that were committed to fighting the disease were