What are the warning signs of chemical dependency?

Listed below are some signs and symptoms that may indicate a nurse is experiencing problems with drugs or alcohol and needs to be referred for help.

Job Performance

— Inconsistent work quality, alternate periods of high and low efficiency

— Increased difficulty meeting deadlines

— Unrealistic excuses for decrease in work quality

— Job shrinkage, doing the minimum work necessary for the job

— Sloppy or illogical charting

— An excessive number of mistakes or errors of judgment in patient care

— Long breaks or lunch hours

— Frequent or unexplained disappearances during the shift

— Lateness for work and/or returning from lunch

— Volunteering to work overtime despite difficulty showing up for scheduled shifts

— Excessive use of sick time, especially following days off

— Absences without notice or last-minute requests for time off

— Repeated absences due to vaguely defined illnesses

Behavior, Attitude, Mood, and Mental Status

— Wide mood swings from isolation to irritability and outbursts

— Difficulty in concentration

— Marked nervousness on the job

— Decrease in problem-solving ability

— Diminished alertness, confusion, frequent memory lapses

— Difficulty in determining or setting priorities

— Isolation from others, eats alone, avoids informal staff get-togethers, or requests transfer to the night shift

— Unwillingness to cooperate with co-workers or inability to compromise

— Avoided contact with supervisor

— Overreaction to real or imagined criticism

— On the unit when not on duty

Medication-Centered Problems

— Consistently volunteering to be the medication nurse

— Offering to hold narcotic keys during report

— Volunteering to work with patients who receive regular or large amounts of pain medication

— Frequently found around medication room or cart

— Insists on administering drugs via intramuscular when other nurses give it by mouth to same patient

— Patient charting reflects excessive use of as-needed pain medication compared to shifts when other nurses are assigned to the same patient

— Patients complaining of little or no relief from pain medications when nurse is assigned to patient

— Use of two smaller tablets of medication to give prescribed dose (two 30 mg codeine tablets instead of one 60 mg tablet)

— Use of larger than necessary dose, wasting the rest (100 mg Demerol when patient is to receive only 50 mg)

— Missing drugs or unaccounted doses

— Frequently reporting spills, wastage, or breakage of medications

— Charting errors include medication errors

— Defensive when questioned about medication errors

[For further information or assistance, call the Colorado Nurse Health Program at (877) 716-0212 or (303) 716-0212, or the program’s Western Slope office at (970) 261-5770.]

Source: Colorado Nurse Health Program, Lakewood. Adapted from Hughes TL, Smith LL. Is your colleague chemically dependent? Am J Nurs 1994; 94:31-35; and Catanzarite A. Managing the Chemically Dependent Nurse: A Guide to Identification, Intervention, and Retention. Chicago: AHA Books; 1992.