Drug Testing for Health Care Workers

Summary: ANA opposes random drug tests for health care workers. It gives qualified consent to testing where there is reason to believe drugs or alcohol is affecting the work of the employee and proper restrictions are applied.

The Federal government has implemented mandatory drug testing of all federal employees through Executive Order 12564, September 1986. A presidential order required federal agencies to have a plan to achieve a "drug-free workplace." The Drug-Free Workplace Act has made government contractors establish drug testing programs for their workplaces. There has also been a significant increase in the number of private employers who have instituted drug testing programs for their employees. Nurses and other health care workers are subject to calls for drug testing because of their professional responsibilities, their contact with narcotics and other controlled substances and the recognized occupational hazard for nurses and other health care professional of substance abuse.

Drug testing for health care workers can arise in three different contexts and should be approached separately:

1. The American Nurses Association opposes random drug screening of health care workers, applicants, or incumbents. Random screening violates the constitutional principle of innocence until proven guilty and poses a grave threat to civil liberties. Health care workers should not be forced to forego their civil rights in exchange for employment in the absence of reasonable suspicions regarding drug and alcohol impaired job performances.
2. The American Nurses Association gives qualified support to drug and alcohol testing of employees when there is a reasonable suspicion and objective evidence that job performance is or has been impaired by alcohol or drug usage. Employers must provide managers and supervisors with specific and objective guidelines for establishing a reasonable suspicion of drug impaired job performance. These guidelines must be observed and applied uniformly and fairly. Once an objective and reasonable suspicion has been documented, the employee should be informed and asked to submit to testing in a manner that is consistent with the health care worker's personal dignity and legal rights as part of a total clinical evaluation process. The testing must be done by a reliable laboratory with procedures for ensuring the integrity of the specimen, the confidentiality of the results, and the opportunity for repeat testing if there is a dispute regarding the results. If drugs are detected in the specimen, the employee should be offered counseling and treatment prior to the institution of any discipline. Appropriate personnel policies addressing the insurance benefits for substance abuse treatment must be developed.
3. The American Nurses Association recognizes that random screening is sometimes incorporated into agreements between health care workers and state licensing agents allowing the health care worker to maintain his or her license when the health care worker is in treatment for an identified substance abuse problem. These agreements must incorporate principles of informed consent and due process to protect the health professional and the ability to legally enforce the agreements.

Substance abuse among health care workers is an unfortunate but real occupational hazard. Measures taken to deal with the problem must provide protection for the health care workers as well as to promote the safe delivery of health care.

THIS INFORMATION COPYRIGHT 1997 AMERICAN NURSES ASSOCIATION

Return to the position statement index list.

Return to the Reading Room.