Provision 3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

Nurses who are challenged with substance abuse problems not only pose a potential threat to those they care for, they have neglected above all to care for themselves. ANA recognizes that the nurse’s duty of compassion and caring extends to themselves and their colleagues, as well as to their patients.

In 2002, the ANA House of Delegates adopted a resolution, “The Profession’s Response to the Problems of Addictions and Psychiatric Disorders in Nursing” calling attention to the prevalence of impaired practice. The resolution seeks ways to assist those nurses with substance addictions or psychiatric disorders to pursue recovery and reclaim their careers.

While focusing chiefly on substance abuse and addictions, the resolution recognized implicitly that psychiatric disorders often manifest in similar threats to the safety of a nurse’s patients, colleagues and self. The Code of Ethics for Nurses does not distinguish the cause from the effect. “In a situation where a nurse suspects another’s practice may be impaired, the nurse’s duty is to take action designed both to protect patients and to assure that the impaired individual receives assistance in regaining optimal function.” (Provision 3.6 Addressing impaired practice)

This advocacy role clearly does not stop once the impairment is identified. “Nurses in all roles should advocate for colleagues whose job performance may be impaired to assure that they receive appropriate assistance, treatment and access to fair institutional and legal processes. This includes supporting the return to practice of the individual who has sought assistance and is ready to resume professional duties.” (Provision 3.6 Addressing impaired practice)

Nursing’s ethical responsibility is the foundation for ANA’s strong support for “alternative to discipline” or “peer assistance” programs offered by most – but not all – of the state boards of nursing. These programs offer comprehensive monitoring and support services to reasonably assure the safe rehabilitation and return of the nurse to her or his professional community. Generally organized by state regulatory boards, in collaboration with nursing organizations or schools of nursing, these programs offer a non-punitive approach in which an impaired nurse typically signs an agreement to be monitored for several years while completing a treatment and rehabilitation plan.

A minority of states have not yet adopted the “alternative to discipline” approach, citing concerns for public safety. While certainly understandable, these concerns appear to be misplaced, in that alternative approaches have been demonstrated to be at least as effective in protecting the public safety as more antiquated punitive methods. ANA has resolved to work with these few states to pursue the legislative and regulatory modifications necessary to implement an “alternative to discipline” model for impaired nurses. To determine whether your state has adopted the “alternative to discipline” model, check with your specific state's Board of Nursing.