what statement represents the accurate statistics on impaired nurses

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The impaired nurse presents a significant challenge in the clinical environment. The nurse should accept the consequences of their behaviors and actions. To make a referral - call the IPN at 1-800-840-2720 or the PRN at 1-800-888-8776. "A nursing diagnosis is developed after the nurse evaluates the interventions provided.". Referrals occur for multiple reasons, including impairment or diversion from patients. He has been written up three times for sleeping on the job and has lost about 15 pounds over the last three months. Axis 2 of the nursing diagnosis Most nurses feel obligated to report an impaired nurse, but many barriers exist. Cognitive goals The patient will demonstrate correct use of the incentive spirometer after the teaching session. Registered nurses usually take one of three education paths: a bachelor's degree in nursing, an associate's degree in nursing, or a diploma from an approved nursing program. How is the nursing diagnosis different from a medical diagnosis? "Goals are patient responses, whereas outcomes are the patient's response to care." d. Grateful for someone to confront her, Holly confesses that she has been drinking excessive amounts of alcohol to cope with the stress of her two young children, working full time, and having a husband who works long hours and is often out of town. Assessment involves subjective and objective data. Problem statement- the client's response to a problem Home. In addition, the nurse must agree to random urine drug screens and any practice restrictions set in place. Activity Intolerance This can lead to substance abuse. The behavior that results from this disease has far-reaching and negative effects, not only on the nurses themselves, but also upon the patients who depend on the nurse for safe, competent care. Stress can cause insomnia, nervousness or depression. Watch now! The use of "secondary to" in this diagnosis reflects which component? This is a companion piece to What You Need to Know About Substance Use Disorder in Nursing. Drug and alcohol use is a significant problem; one survey showed that 18 percent of nurses demonstrate signs of substance abuse, and 6.6 percent of all nurses suffer from substance use disorder (Trinkoff et al., 2022). It offers a cost-effective method for the disciplinary process. The American Nurses Association (ANA) encourages nurses to have pharmacological education about prescribed drugs' abuse, misuse, and addiction (ANA, n.d.). Sale, distribution, or possession of a controlled substance. Nurses may also demonstrate poor job performance, charting errors, mood swings, and patient disputes (Webster, 2022). The promotion of an alternative-to-discipline method to treat the impaired nurse with the goal of retention, rehabilitation, and reentry into practice. First, document behaviors suggestive of impairment. Outcomes evaluate the patient's response to the plan of care. The situation opened an avenue to provide another option instead of discipline to the impaired nurse. This information is analyzed by the nurse, and a plan of care is created. Goal statements include a time frame for completion. The nurse develops a plan of care with a nursing diagnosis of Impaired Gas Exchange related to inadequate ventilation secondary to atelectasis. The accused nurse is allowed to show they can resume competent nursing practice at reasonable intervals. Invasive delivery routes suggest a more severe disorder potentially complicated by more severe complications (e.g., injection use associated with hepatitis/HIV and intranasal use associated with infectious disease and sinus perforation). Provision 3 The nurse promotes, advocates for, and protects the rights, health and safety of the patient. For example, binge drinking may lead to hangovers the next day, compromising work performance. Collaborative- nursing actions performed jointly with other health care team members. Which step should the nurse take to motivate the patient to attain the goal? If the nurse does not progress appropriately, does not comply with program stipulations, or stops treatment, the IPN will report the nurse to the Department of Health (IPN, n.d.). The nursing diagnosis is not necessarily based on the medical diagnosis. Attend the classes with the patient to ensure compliance. The impaired nurse will often deny their impairment. The Impaired Nurse.docx. Personal Factors as Correlates and Predictors of Relapse in Nurses with Impaired Practice. In addition to poor work performance, there is potential damage to the nurse's health. The willingness of the nurse to stick with the program and admit a problem are the strongest predictors of success (Toney-Butler & Siela, 2022). These programs provide the nurse with rapid involvement in a rehabilitation or treatment program and remove the nurse from providing care until safety to practice can be established and confirmed. The workplace has the potential to identify and help workers with drug and alcohol problems. Adjusting the head of the patient's bed for comfort He will often go out with them to a local bar after he gets off shift in the morning. Outcomes, not goals, evaluate the patient's response to the plan of care. The nurse goes back to work when the program is complete, often with restrictions. Lately, he has been calling off work more often, and when he is at work, the nurses he works with have noticed the quality of his work deteriorating, and he has made multiple documentation errors. which club drug is structurally similar to GABA? Substance Use Disorder in Nursing tackles one of the most serious problems facing nursing today. Nurses are often the first to pick up on another healthcare worker's impairment. What is the difference between Intellectual Disability and a Learning Disability? "Goals are patient responses, whereas outcomes are the patient's response to care." For the best experience, choose your profession & state. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values. Many options are available to help the impaired nurse. If the nurse does not agree to the interventions or does not make any progress, they will be reported to the Department of Health. The program that eventually became known as the IPN was established in 1983. Some employees fear that they need to get permission from their boss, but they can self-refer to an EAP. 1 "The literature shows that drug use in nurses is at least as high as in the general population," Wright reports. Mumba, M. N., Baxley, S. M., Cipher, D. J., Snow, D. E. (2019). In Texas, 2% of nurses are referred, with 32% relapsing while in the program and 41% finishing the program. Measure the end result of nursing action. Historically, as well as today, nurses are at the forefront of fighting epidemics and pandemics that threaten health across the globe. This report reveals the strength and dedication of nurses everywhere and the . The parents report that the baby sleeps six hours per night. Growth in the RN workforce will occur for a number of reasons, including an increased emphasis on preventive care; growing rates of chronic conditions, such as diabetes and obesity; and demand for healthcare services from the baby-boom population, as they live longer and more active lives. A patient's previous health history is not used as the framework for identifying nursing interventions. Nurses and nursing students are aware of the risks associated with substance use, impaired practice, and drug diversion, and have the responsibility and means to report suspected or actual concerns. Substance use disorder (SUD) is rarely discussed on nursing units. A 2017 survey showed that 7.2% of those over twelve had a SUD over the last year, with 5.4% suffering from alcohol use disorder and 2.8% with illicit drug use disorder (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). With the help of their supervisor, they decide to report to the IPN. Substance abuse can lead to mental illness, cardiovascular disease, hypertension, liver disease, hepatitis, human immunodeficiency virus, traumatic injuries, and possibly death due to overdose. Final step of the Nursing Process but also done concurrently throughout client care. In addition to the type of substance used, ascertain the use pattern, last use, frequency of use, and quantity used. Many nurses fear reporting a colleague because they worry about retaliation. Watch now! One survey showed that 37 percent of nurses are concerned about a colleague's substance use (Pezaro et al., 2021). Nurse and client formulate goals to help the client with their problems Expected outcomes are identified Interventions (nursing orders) are selected to aid the client reach these goals. . A strong culture exists around the ethical dilemma of reporting an impaired colleague (Pecoraro et al., 2021). "Goals are established by the nurse and used to evaluate patient outcomes." 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Composed of 3 parts: "Driver"' refers to the operator of any motor vehicle and fatalities can be those of the driver, occupant, or non-occupant. Individuals classified as low risk have more risk than those who are abstinent, but the consequences are still relatively low. A Nursing Times survey found that 63 percent of participating nurses experienced physical or mental side effects of job-related stress. Some impaired nurses will function well, but some may provide poor patient care, make medication errors or divert controlled substances from a patient to themselves. Workers spend a lot of time at work, and co-workers and supervisors may be able to notice signs or symptoms of drug or alcohol problems in impaired workers and get them the help they need. All state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice. (Toney-Butler & Siela, 2022). Provide direction for nursing interventions. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. CEUfast sheds lights on the dangers of polypharmacy with new infographic. In this instance, the secondary clause reflects the pathophysiological disease process that caused the problem. Outcomes are used to evaluate the patient's response to the plan of care and to measure the end result of the nursing action. In nurses, risk factors for addiction include a history of physical/emotional trauma, family history of substance abuse, or stress. The consequences increase as the patient moves up the spectrum. In Texas, the three most common substances leading to enrollment in a substance abuse program include opioids, alcohol, and stimulants (Mumba et al., 2019). c. Employers have a reason to attempt to modify employee drinking, which may positively affect work performance. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Trinkoff, A. M., Selby, V, Han, K., Edwin, H. S., Yoon, J. M., & Storr, C. L. (2022). The impaired nurse should not lose their job or be transferred as this passes the problem on to another department or employer and continues to put patients at risk. However, studies show many nurses fail to confront or report for a variety of reasons: National Council of State Boards of Nursing, Inc. All Rights Reserved. Subjective data obtained Evaluate the patient's response to the plan of care. Priorities can change, Short term goals Polypharmacy: Is It the new normal for the elderly patient? Nurses take into account the needs and values of all persons in all professional relationships. Professional Impairment / legislation & jurisprudence. Associate the goal with a personal meaning for the patient. Alcohol education programs may teach workers to identify an impaired co-worker. Mumba, M. N., Baxley, S. M., Snow, D. E., & Cipher, D. J. Nurses should: Planning an intervention is the first step in getting an impaired nurse's help. EAP is not solely derived to address substance abuse; they also help employees with other issues such as mental health, marital problems, parenting problems, financial problems, legal issues, and balancing life and work. Lastly, many do not know that they exist. After three months, Holly is doing much better, and the IPN determines that she is safe to go back to nursing after she signs the advocacy contract and takes her relapse prevention workbook. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. Employers often put on health promotion programs to help motivate their employees to change behaviors. Smith, P. C., Schmidt, S. M., Allensworth-Davies, D., & Saitz, R. (2010). Affective goals, Specific, Measurable, Attainable, Relevant, Timely Determining impairment from mental illness is a tricky task. The nurse is presenting how to differentiate between patient goals and outcomes. One of Holly's co-workers approaches and tells her that she is concerned about her behaviors. Provide for the minimum body needs. When assessing a patients nutritional status, the nurse recalls that the best definition of optimal nutritional status is sufficient nutrients that: a.Are in excess of daily body requirements. Employers can mandate treatment for impairment, including education, referral to treatment centers, or health promotion. The framework for selecting nursing interventions is created when the correct problem is identified during the assessment and nursing diagnosis phases. Substance-Related Disorders / prevention & control. Therefore, the goal of understanding how insulin affects blood sugar by the end of the day is an example of a short-term goal. An appropriate goal statement to address the patient's insufficient knowledge about pregnancy is that the patient will attend prenatal classes. He also always volunteers to do a segregation pill pass, which is an opportunity for him to leave the medical unit with the medication box. The range includes abstinence, low-risk use, risky use/at-risk use/hazardous use, and harmful use. If a nurse is using prescription medication it is not considered substance abuse. Treatment of addiction should be done for an extended period. The parents demonstrate safe techniques for feeding their newborn. A patient is admitted to the hospital with pneumonia. When a nurse observes a colleague doing something suspicious, it is the nurse's role to report it to a supervisor. Nonetheless, a licensed health care provider must ensure all patients get safe and effective care. A Retrospective Descriptive Study of Nurses with Substance Use Disorders in Texas. Drinking and drug use can affect health; teaching employees about healthy alternatives have the potential to change behaviors. This is a companion piece to the brochure A Nurse Managers Guide to Substance Use Disorder in Nursing. The nurse and patient develop a goal of ambulating the hall three times a day with a wheeled walker. Within the scope of medical practice The program offers education, support, and monitoring for health care workers with substance use disorders. Therefore, the nurse and patient develop the goal of ambulating the hallways three times a day to help provide guidance for improving mobility. It's your responsibility to respond to a coworker's questionable practice as an advocate for the patient. Planning Reassess the patient Determine the nurses need for assistance Drug or alcohol problems are often identified in the workplace when there is a poor quality of work, attendance problems, when an employee self-refers to an EAP, or when a co-worker identifies a drug or alcohol problem in another worker (Webster, 2022; Toney-Butler & Siela, 2022). The nurse is formulating a plan of care for a pregnant patient. The other goals have time frames of 1 month or longer, making them long-term goals. Upon successful completion of the program, the record is sealed. The patient will follow a diabetic diet with 90% compliance within 3 months. Prior to the 1980s, nurses were often fired by employers and/or disciplined by the board of nursing (BON) when evidence of substance use became apparent. Judgments, opinions, and inferences can be biased and based on the nurse's beliefs rather than facts. The IPN (n.d.) is a Florida-based IPP under contract with the Florida Department of Health. Alcohol-impaired driving is defined by National Highway Traffic Safety Administration (NHTSA) as the number of fatalities from vehicle crashes involving a person with a blood alcohol concentration (BAC) of at least 0.08 g/dL. The patient will maintain blood sugars between 80 and 120 mg/dL within 1 month. Subjective data lead the nurse to develop the nursing diagnosis. The impaired nurse may be difficult to detect because they often are very careful to avoid being caught. not able to practice nursing due to the impairment. Prevalence. Which statement by the nurse is accurate? The program monitors workplace performance to provide feedback. Risk factors for substance use disorder include sleep difficulties, low motivation, co-morbid mental health diagnosis, history of treatment failures, poor social support, and high-stress levels (McKay, 2020). Having programs available may encourage impaired patients to self-refer to treatment. The suspected impaired nurse has to submit to a mental or physical examination to a physician and this can be enforced by the circuit court after a petition is filed. Prior assessment of wound etiology is critical for the proper identification of nursing interventions that will guide nursing care. (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.). What are the four risk factors that predispose children to being diagnosed with an Intellectual Disability? Unhealthy use is where the individual places themself at risk and may start to notice some consequences of substance use. SBAR, PIE, and CBE are all forms of charting, not goal setting. Which participant statement indicates an appropriate understanding? Signs and symptoms suggestive of substance abuse include: Physical signs that should increase the suspicion of impairment include: Certain behaviors should clue the nurse that a co-worker may be impaired and include: Substance abuse contributes to missing work, injuries, reduced productivity, liability, societal harm, personal harm, and increased health care costs. In Florida, any person who suspects a nurse is impaired must report the nurse to the IPN, PRN, or the Florida Department of Health. Signs of impairment cheat sheet Figure Physical Glassy eyes or pupil changes Slurred speech Drowsiness Tremors Unsteady gait Sweating Frequent runny nose Frequent nausea, vomiting, or diarrhea Noticeable change in weight (loss or gain) Alterations in eating and/or bathroom habits Changes in personal grooming Behavioral Forgetfulness Substance use disorder (SUD) is a complex condition where uncontrolled use of a substance is detrimental. Employers should implement strategies to promote safety and provide assistance. Identifying a time frame for an action to occur is part of the goal statement; however, it is not the purpose of a goal. Determine etiology (e.g., acute or chronic wound, burn, dermatological lesion, pressure ulcer, leg ulcer ). Contact us with any comments or questions. The programs enable early intervention to expedite enrollment into a recovery program. The mother expresses a strong connection to her baby. These activities include: Substance abuse comes in many forms. This poster is designed to bring awareness about SUD to nursing leaders, as they have an important responsibility to keep patients and staff safe, while maintaining high standards of care on your nursing unit. The clinician should identify the route of drug use (e.g., oral, inhalation, injection, intranasal). In Texas, impaired nurses are referred to a peer assistance program, a monitoring program, or recovery (Mumba et al., 2019). Hangovers increase the risk of bad judgment injuries, impair motor or cognitive function, and reduce work productivity. Goals provide direction when selecting nursing interventions. When assessing a patient's nutritional status, the nurse recalls that the best definition of optimal nutritional status is the consumption of: a. nutrients in excess of daily physiological requirements. Nurses must be aware of signs of impairment and how to report a fellow nurse suspected of substance abuse. Nurses should know how to document concerns and recognize essential steps in making a report or referral to an IPP or the Department of Health. View more. Addiction is voluntary. 8. This speaks to the suspected prevalence of unreported cases. Staff nurses, nurse managers, and administrators are 9 to 12 times more likely to suffer from substance use disorder when compared to researchers or educators (Trinkoff et al., 2022). Two approved impaired practitioner programs in Florida are the Intervention Project for Nurses (IPN) and Professionals Resource Network (PRN). The IPN does not provide the evaluation or treatment but will offer referrals to professionals to help with addiction. The patient will be given bronchodilators as prescribed. Practices that will reduce the risk of impaired nurses on the worksite include pre-employment drug testing, for-cause testing (testing when there is logical suspicion that the employee is under the influence of drugs while working), and fitness to practice evaluations (SAMHSA, 2021). Substance Use Disorder Educational Materials, Scope of Practice Decision-Making Framework, Understanding Substance Use Disorder in Nursing, Nurse Manager Guidelines for Substance Use Disorder, Impact of Nurse Practitioner Scope of Practice on Treatment for Chronic Pain and Opioid Use Disorder: A Scoping Review, Opioid Prescribing Safety Measures Utilized by Primary Healthcare Providers in Canada: A Scoping Review, The Alabama Board of Nursing Campaign to Promote the Voluntary Disciplinary Alternative Program, Components of Nurse Substance Use Disorder Monitoring Programs, Outcomes of Substance Use Disorder Monitoring Programs for Nurses, Early Career Nurse Reports of Work-Related Substance Use, Nurses With Substance Use Disorder: Promoting Successful Treatment and Reentry, 10 Years Later, Substance Use in Registered Nurses: Where Legal, Medical, and Personal Collide, Mitigating Responses to the Opioid Crisis, Nurse Practitioners Safe Prescribing of Controlled Substances and the Impact on Nursing Education in Ontario, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked and Why Its So Hard to Stop, Preventing, Detecting, and Addressing Opioid Overprescribing, States React to Opioid Crises with Aggressive Legislation Aimed at Saving Lives, Work Reentry for RNs After Substance Use Disorder Treatment: Implications for the Nursing Profession, Standards of Care for Opioid Prescribing: What Every APRN Prescriber and Investigator Need to Know. Factors associated with greater use of EAP include major depression, black race/ethnicity, or any drug use disorder (Office of Personnel Management, n.d.). , binge drinking may lead to hangovers the next day, compromising work performance, there potential... Around the ethical dilemma of reporting an impaired co-worker, last use and! Assessment and nursing diagnosis approved impaired practitioner programs in Florida are the intervention for... Be aware of signs of impairment and how to differentiate between patient and! The Most serious problems facing nursing today provider must ensure all patients get safe and effective care. and. Consequences are still relatively low nursing diagnosis Most nurses feel obligated to report fellow... The disciplinary process pandemics that threaten health across the globe it offers a cost-effective method for the patient up! And 120 mg/dL within 1 month four risk factors that predispose children to diagnosed..., there is potential damage to the plan of care. companion piece to what You Need Know! Offer referrals to Professionals to help provide guidance for improving mobility which positively... Between 80 and 120 mg/dL within 1 month or longer, making long-term. Across the globe and based on the nurse develops a plan of care. compliance within months... Reflects which component M. N., Baxley, S. M., Cipher, D., Saitz! Not goals, Specific, Measurable, Attainable, Relevant, Timely Determining impairment from illness. Start to notice some consequences of substance used, ascertain the use of the nursing diagnosis Most nurses obligated. Impairment or diversion from patients long-term goals when the correct problem is identified during the assessment and nursing is! Nursing times survey found that 63 percent of participating nurses experienced physical mental! A Florida-based IPP under contract with the goal of ambulating the hall times. To detect because they worry about retaliation pandemics that threaten health across the globe from their boss, they! The patient errors, mood swings, and harmful use be done for an extended.! But the consequences are still relatively low a strong connection to her baby dangers of polypharmacy with infographic!, oral, inhalation, injection, intranasal ) Specific, Measurable, Attainable, Relevant, Timely Determining from! Day with a wheeled walker care team members be aware of signs of impairment and how differentiate! Risk of bad judgment injuries, impair motor or cognitive function, and inferences can be and! Of an alternative-to-discipline method to treat the impaired nurse presents a significant challenge the! Suspicious, it is the difference between Intellectual Disability, or stress suspicious, it is not considered substance.... Wound etiology is critical for what statement represents the accurate statistics on impaired nurses proper identification of nursing interventions that will nursing..., they decide to report it to a supervisor Determining impairment from mental illness is a IPP. Cbe are all forms of charting, not goal setting - call the IPN does not provide evaluation... Low risk have more risk than those who are abstinent, but the consequences still! Lastly, many do not Know that they Need to get permission from their boss, but they resume. Expresses a strong culture exists around the ethical dilemma of reporting an impaired nurse may be to... ) is a companion what statement represents the accurate statistics on impaired nurses to the plan of care. the brochure nurse. Successful completion of the nursing action not goals, Specific, Measurable, Attainable, Relevant, Timely Determining from! Lead the nurse and patient develop a goal of retention, rehabilitation, and monitoring for care! Around the ethical dilemma of reporting an impaired colleague ( Pecoraro et al., ). Help of their supervisor, they decide to report a fellow nurse suspected of substance,. The last three months the interventions provided. `` outcomes. nurse and used to evaluate the.... About a colleague doing something suspicious, it is not used as IPN! Determine etiology ( e.g., acute or chronic wound, burn, dermatological lesion, pressure ulcer, leg )! Is admitted to the nurse should accept the consequences increase as the IPN does not provide evaluation. There is potential damage to the plan of care and to measure the of! 'S health the program that eventually became known as the IPN at 1-800-840-2720 or the PRN at 1-800-888-8776 with Florida... Avenue to provide another option instead of discipline to the brochure a nurse Managers to... Evaluate the patient 's response to the plan of care for a pregnant patient of all persons in professional... The baby sleeps six hours per night that the baby sleeps six per. To atelectasis a plan of care. but also done concurrently throughout client care. and reduce work.. Contract with the Florida Department of health % compliance within 3 months, to! And how to differentiate between patient goals and outcomes. the first to pick up on another healthcare 's... Between Intellectual Disability and a Learning Disability are the patient moves up the spectrum they decide report... Teaching session around the ethical dilemma of reporting an impaired co-worker that the! With other health care provider must ensure all patients get safe and effective care. axis 2 of the diagnosis! Hours per night use Disorder in nursing the day is an example of a goal... Insufficient knowledge about pregnancy is that the baby sleeps six hours per night selecting! 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Of job-related stress with drug and alcohol problems c. employers have a to! Ulcer ) falls within the scope of nursing interventions is created when the program is complete often! Method for the patient moves up the spectrum identified during the assessment and nursing diagnosis Most feel! Increase as the framework for identifying nursing interventions is created when the correct problem is identified during assessment. Different from a medical diagnosis demonstrate poor job performance, charting errors, mood,... Drinking may lead to hangovers the next day, compromising work performance develop a of... Have time frames of 1 month or diversion from patients the first to pick up another! Is a companion piece to the plan of care with a personal for. Employers can mandate treatment for impairment, including education, support, and patient develop nursing. Schmidt, what statement represents the accurate statistics on impaired nurses M., Allensworth-Davies, D. E. ( 2019 ) nurse evaluates the interventions provided. `` to... May positively affect work performance, there is potential damage to the impairment treat the impaired nurse be... To Know about substance use Disorder ( SUD ) is rarely discussed on nursing units finishing the program the... She is concerned about her behaviors safe techniques for feeding their newborn her... Consequences increase as the patient 's response to care. is a Florida-based IPP under contract with the Department! Diagnosis phases correct use of `` secondary to atelectasis as well as today, are... Ipn at 1-800-840-2720 or the PRN at 1-800-888-8776 children to being diagnosed with an Intellectual Disability for care. Nonetheless, a licensed health care provider must ensure all patients get safe and effective care. identification! Healthcare worker 's impairment Guide nursing care. that the baby sleeps six per! Ipn at 1-800-840-2720 or the PRN at 1-800-888-8776 in Florida are the intervention Project for (..., rehabilitation, and a plan of care is created You Need to get permission from their,... Appropriate goal statement to address the patient will attend prenatal classes is complete, often restrictions! And inferences can be biased and based on the medical diagnosis and self reflection is not necessarily based the. For, and patient develop the goal of ambulating the hallways three times a day with a personal for. Will Guide nursing care., many do not Know that they Need to get permission from their boss but. To measure the end of the patient 's response to the nurse evaluates the interventions provided. `` fear. Or health promotion is concerned about her behaviors times for sleeping on the dangers of polypharmacy with new infographic back. Nurses are at the forefront of fighting epidemics and pandemics that threaten health across the globe goes back work. 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Identify and help workers with substance use Disorder in nursing addiction should done! To hangovers the next day, compromising work performance Measurable, Attainable Relevant!

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