To: Ethics Advisory Board
From: Medical-surgical staff nurse
Subject: Substance use disorder
Recently I discovered a colleague on my unit impaired by substance use disorder (SUD). What should I do to protect patients from harm, while keeping the nurse’s health condition confidential? I am also concerned about complying with state laws and following our facility’s employment policies.
From: ANA Center for Ethics and Human Rights
The social contract between the nursing profession and society involves the privilege of being granted a license in exchange for our promise to serve the public’s interest in optimal health. This includes protecting society from the harm of unsafe nursing practice.
While state boards of nursing enforce laws to regulate practice, our profession’s Code of Ethics for Nurses with Interpretive Statements, written and revised by the American Nurses Association (ANA) for roughly a century, goes above and beyond the law. It’s the non-negotiable ethical standard to which nurses adhere.
That standard places the nurse’s first duty to the patient. Provision 3.0 states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” This is a far-reaching provision that encompasses our mandate to protect human research subjects, our authority and responsibility to report adverse events and “near misses,” and our individual and joint obligation to both protect patients from impaired nursing practice and to help sick, impaired colleagues get needed treatment while acting to protect them from undue punishment for being sick.
A growing body of professional standards affirms that SUD alone is not a moral failing or punishable crime. The Code’s Interpretive Statement 3.6 states, “The nurse’s duty is to take action to protect patients and to ensure that the impaired individual receives assistance. This process begins with consulting supervisory personnel, followed by approaching the individual in a clear and supportive manner and by helping the individual access appropriate resources. The nurse should extend compassion and caring to colleagues throughout the processes of identification, remediation, and recovery. Care must also be taken in identifying any impairment in one’s own practice and in seeking immediate assistance.”
Recently, ANA endorsed the position statement from the Emergency Nurses Association and the International Nursing Society on Addictions, which recognizes this stance and calls on facilities to “adopt alternative-to-discipline approaches to treating nurses and nursing students…with stated goals of retention, rehabilitation, and re-entry into safe, professional practice.” Similarly, the National Council of State Boards of Nursing recognizes SUD as an illness in which early diagnosis and treatment results in improved patient safety, recovery, and return to work for the involved nurse.
Nurses frequently assess complex problems, synthesize and reason the multiple intervening factors at play, and act to prioritize the interventions needed to improve the situation. That skill set and our ethical mandate enables any nurse in the situation posed by our writer to work with appropriate supervisors and the ill colleague in protecting patients while helping the ill colleague get the help and treatment needed to holistically heal.
Response by Eileen Weber, DNP, JD, BSN, PHN, RN, member of the ANA Ethics and Human Rights Advisory Board.
American Nurses Association. Code of ethics for nurses with interpretive statements. Silver Spring, MD; 2015.
Emergency Nurses Association, International Nurses Society on Addiction. Joint position statement. Substance use among nurses and nursing students; 2016.
National Council of State Boards of Nursing. What you need to know about substance use disorder in nursing. 2014.