Impairment in the

Workplace & Ethical

Issues
Estefany Gomez
Thalia Leon
 What is Impairment in the
workplace?
Refers to the inability to function in a usual capacity and it
can lead to devastating effects on patients, colleagues,
healthcare agencies, and health consumers in general. A
growing number of healthcare professionals misuse drugs
or alcohol during their career.

Impairment results when a health professional, such as a

physician, nurse, or allied health professional, is unable to
provide competent and safe patient care because they
are impaired by alcohol, prescription or nonprescription
drugs, or mind-altering substances.
Behavioral Impairment Vs Physical Impairment
Behavioral Impairments
include decrease stability in
mood, anxiety, drive,
perception, sleep, appetite, as
well as behavioral
disturbances such as agitation
or aggression, which could
lead to underperformance and
decreased quality of care and
compromises the well-being of
clients and healthcare
coworkers.
The physical capacity to move,
coordinate actions, or perform
physical activities is
significantly limited, impaired,
or delayed and is exhibited by
difficulties in one or more of the
following areas: physical and
motor tasks; independent
movement; performing basic
life functions.
What are the signs of Impairment?
Behavioral Signs Physical Signs

● Mood swings ● Chronic rhinorrhea.

● Underperformance with excuses ● Track marks.
● Frequent absences ● Bloodshot eyes.
● Shows resentment of authorities ● Poor hygiene.
● Wears long sleeves even when ● Weight loss or weight gain.
● temperature is high. ● Slurred or unclear speech.
● Appears visibly intoxicated, high. ● Hand tremors, muscle fasciculations.
● Reeks of alcohol or marijuana. ● Excessive drowsiness.
● Fails to keep appointments or meet ● Rapid speech.
● Deadlines. ● Sallow skin color.
● Makes increasing numbers of errors. ● Frequent diarrhea.
● Takes longer to carry out tasks. ● Dilated or constricted pupils.
● Has increasing difficulty getting along ● Frequent nosebleeds.
with family and coworkers. ● Insomnia.
● Refuses drug testing. ● Confusion, memory loss
● Has intense bursts of energy
 Intervention program for nurses “IPN”
The Intervention Program for Nurses(IPN),first established in IPN Steps
1983 and authorized by Florida state legislation, is a program 1. Phone
that is considered a national model and is designed to protect 2. Paper work
the public health and safety while offering assistance and early 3. Refrain from practice
intervention to nurses who cannot safely practice because of 4. Evaluation
substance abuse or physical or psychological/psychiatric 5. Monitoring Agreement
conditions. The Florida Department of Health contracts with IPN
to provide services to nurses. IPN is funded through the Board
of Nursing license renewal fees.

IPN provides an alternative to disciplinary action by the Board

of Nursing. Participation is voluntary although some nurses are
referred to IPN for evaluation, and participation is mandated if
they are to retain their licenses. Most nurses participate as an
alternative to disciplinary action.
Offered programs by employers to
promote safety and provide assistance.
● Fitness to practice
● Protocol
● Education
● Diversion prevention program
● Employee assistance program
● Employee wellness program
Treatment Options for impairment in
the workplace.

- Mental health Evaluation / Treatment

- Methadone and buprenorphine
- Support groups
- 12- step program
- In-patient rehabilitation
- Cognitive behavioral therapy
- Motivational Interviewing
- Relapse prevention
Ethical Issues
 What is Ethics?

Ethics is the part of philosophy that

deals with the rightness or
wrongness of human behavior.

It also implicates the motives

behind that behavior.

What is the difference between personal ethics

and professional ethics?Personal ethics refers
to the ethics that a person identifies with in
respect to people and situations that they deal
with in everyday life. Professional ethics refers
to the ethics that a person must adhere to in
respect of their interactions and business
dealings in their professional life.
 Ethical Theories
Deontological
Teleological Theories
Theories
● Take their norms and rules
from the duties that
individuals owe each other
by the goodness of the
commitments they make
and the roles they take
upon themselves.
● It is the individual’s good
intentions or goodwill that
determines the worthiness
or goodness of the action .
Principlism Theory
● Take their norms or ● This theory integrates
rules for behaviors existing ethical
from the principles and tries to
consequences of the resolve conflicts by
action. relating one or more
● What makes a action of these principles to
right or wrong is its a given situation.
utility, or usefulness.

Autonomy
Autonomy is the freedom to
make decisions for
oneself. This ethical principle
requires that nurses
respect patients’ rights to make
their own choices
about treatments.
Example: If a patient refuses a
medication, we have to respect
that as nurses.
Ethical Principles
Nonmaleficence
The ethical principle of
nonmaleficence requires that
no harm be done, either
deliberately or unintentionally.
Example:Avoiding negligent
care of a patient.
Beneficence Justice
The principle of beneficence Fairness in care delivery and use of
demands that good resources.
be done for the benefit of
others. For nurses, this means
more than delivering
competent physical or technical
care. It requires helping
patients meet all their needs,
whether physical, social, or
emotional.
Example:Lifting the side rails Example:Offering the same treatment
on a patient’s hospital bed to options to two patients, even where one
prevent falls. may have a condition through no fault of
their own and the other through personal
behaviour (e.g. lung cancer and
smoking), and allocating resources
equally among members of the
population.
 Ethical Principles Cont.
Fidelity Confidentiality Veracity Accountability

Fulfillment of promises The principle of Veracity requires nurses Accountability is linked to

confidentiality states that to be truthful. fidelity and means
anything patients say to accepting responsibility for
nurses and other one’s own actions.
health-care
providers must be held in
the strictest confidence.

Example: When a nurse Example: Not responding Example: Telling the Example: If the nurse
says she will be back to to any telephone or email patient the adverse effects administers the wrong
check up on the patient inquiries about patients. of a medication. medication to patient, she
after lunch and does so. is held accountable for
that.
 Code of Ethics
● A code of ethics is a formal statement of the rules of
ethical behavior for a particular group of individuals
● This code makes clear the behavior expected of its
members.
● For example, the American Nurses Association (ANA) has
the “Code of Ethics for Nurse with Interpretive Statements’
which provides values, standards, and principles to help
nursing function as a profession.
● Ethical codes remain subject change. These changes
occur as society and technology evolve.
Current Ethical Issues in Healthcare

● Ethical concerns can arise when it’s not

01 DNR Orders clear if a patient was capacitated to
choose a DNR.
● Withholding information about a patient’s
Doctor and Patient condition could be unethical because it could
02 Confidentiality harm the patient or someone else. The
opposite can be harmful too.
● In 2017, the number of people with health insurance

03 Access to Care
coverage increased by 2.3 million, up to 294.6
million, according to the United States Census
Bureau.

● The dilemma leaves the states to reason with

04 Physician Assisted Suicicde

residents’ rights to autonomy and healthcare
providers’ beliefs of what they ought to do, based
on their code of ethics.
What is an Ethical Dilemma in Nursing?
● An ethical dilemma occurs when
a problem exists that forces a
choice between two or more
ethical principles. Deciding in
favor of one principle will violate
the other. Both sides have
goodness and badness to them;
however, neither decision
satisfies all the criteria that
apply.
● Ethical dilemmas also carry the
added burden of emotions.
Feelings of anger, frustration,
and fear.
● Example:Caring for an
adolescent client who has to
decide whether to undergo an
abortion even though her
parents believe it’s wrong.
 How are Ethical Dilemmas Solved?
1. Identify whether the issue is indeed an ethical
dilemma.
2. Gather as much relevant information as possible
about the dilemma.
3. Reflect on your own values as they relate to the
dilemma.
4. State the ethical dilemma, including all surrounding
issues and the individuals it involves.
5. List and analyze all possible option for resolving
the dilemma, and review the implications of each
option.
6. Select the option that in in concert with the ethical
principle that applies to this situation, the decision
maker’s values and beliefs, and the profession’s
values for client care. Justifying selecting that one
option in light of the relevant variables.
7. Apply this decision to the dilemma, and evaluate
the outcomes.
Thank you!
References
● Weiss, S. (2019). Essentials of nursing leadership & management. F.A. Davis
Company
● Holman, C.(2019). Fundamentals for nursing edition 10.0. Assessment
Technologies Institute
● Florida Tech. (n.d). Current ethical issues in healthcare. Florida Tech Online.
https://www.floridatechonline.com/blog/healthcare-management/current-ethical-iss
ues-in-healthcare/
● https://www.rn.org/courses/coursematerial-10023.pdf