Employer Best Practices

Six steps for effectively addressing substance use disorders in the health care workplace

While addiction is an equal opportunity disease—striking individuals regardless of gender, race, creed, or class—health care professionals, and especially nurses, stand a greater risk of developing substance use disorders.

As a health care employer, what can you do to mitigate risks associated with employee substance use issues? Stick with best practices, as outlined in the six steps below.

1. Follow policies and procedures

Implementing and enforcing policies and procedures related to employee substance use disorders is a must for health care employers. The goals of these policies and procedures are two-fold: (1) provide the affected employee the best opportunity for sustained recovery; and (2) ensure patient safety.

When a nurse or other health care professional has a potential substance use disorder, timely and corrective action is imperative due to the escalated risk to patient safety. Having well-established policies, procedures, and processes in place allows for a safe and smooth return-to-work transition for the health care professional after treatment, rather than termination of employment and loss of license.

2. Know what impairment looks like

Identifying a substance use disorder requires observation of changes in personality, general behavior, work behavior, and performance, which may include:
  • Slurred speech
  • Lack of coordination
  • Difficulty completing work
  • Missed orders

For nurse professionals, other workplace performance changes may include inaccuracies in medication counts (i.e., narcotics); lack of follow-through; and arriving at work late, leaving early, or disappearing for extended periods of time during a shift. A single symptom may not indicate substance misuse; several in combination could signify an issue.

3. Take action to intervene

A workplace intervention is typically initiated by the employee's supervisor or manager. The supervisor begins by documenting objective, observable behavior or performance concerns. To ensure proper documentation is in place, consult your organization's human resources and legal representatives. This step will help protect the supervisor and your organization from potential legal challenges.

Documentation will also support your intervention conversation with the employee. Substance use disorders are often characterized by denial; thorough, fact-based documentation will serve as a powerful tool to help neutralize the employee's natural reaction.

Once required documentation has been obtained and approved by human resources and legal representatives, schedule a meeting with the employee. Participants should include the affected health care professional, his or her supervisor, a human resources representative, the department head, and an Employee Assistance Program (EAP) representative or interventionist. The purpose of the meeting is two-fold: (1) present the documented facts; and (2) communicate the corrective action plan, which may call for an immediate leave of absence for professional assessment and/or treatment.

After the meeting, notify the appropriate state-level alternative-to-discipline (diversion) program to comply with reporting requirements and provide accountability.

4. Provide support during treatment

Based on a professional assessment, a treatment plan will be developed for the employee. The treatment plan may involve inpatient and/or outpatient care. Studies have shown a greater potential for sustained recovery if a nurse, for example, participates in a treatment program specifically for health care professionals. This specialized care enables health care professionals to share experiences and practice recovery behaviors with peer support.1

5. Develop a return-to-work plan

To ensure a safe and smooth post-treatment return to work transition, schedule a meeting with the recovering health care professional and his or her supervisor along with an EAP representative, human resources representative, a support colleague/buddy, and/or a treatment program representative. Objectives of this meeting include outlining the return-to-work process, identifying immediate next steps, and establishing expectations, such as:
  • Random drug tests
  • Participation in continuing care support groups
  • Attendance at recovery support meetings
  • Ongoing consultation with the nurse's supervisor
  • Monitoring for 36 months or more—dependent on state alternative-to-discipline programs requirements

Another key factor in a recovering nurse's successful return to work is receiving encouragement, support, and guidance from peers.

6. Be prepared for relapse

Although the goal of treatment and monitoring is to provide the best opportunity for lasting recovery, relapse can and does happen. Most relapses occur outside of the work environment but knowing how to manage relapse in the workplace is crucial for both the safety of patients and the well-being of the health care professional. A clear policy regarding the management of relapse is extremely important and should address identification, documentation, intervention, fitness to practice, and referral to assessment/treatment. Signs of relapse but relapse begins long before use. Relapse begins with thoughts, not with substance use. Signs of a full-blown relapse mirror symptoms described under "Know what impairment looks like." The employee's supervisor should continue to monitor job performance, document concerns, and take action as warranted.

Addiction and recovery programs for medical professionalsHazelden Betty Ford Foundation's Nurse Professionals Program
The Hazelden Betty Ford Foundation has specialized addiction treatment programs for health care professionals, including a nurses' program. The nurses' program includes return-to-work support. For more information, go to HazeldenBettyFord.org/Nurses or call 1-866-831-5700. We offer a free, confidential consultation and phone-based assessment.
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