Impairment is a condition that results from the use of mind/mood altering substances, distorted thought processes found in the psychologically impaired or a physical condition that prevents the nurse from providing safe patient care. Impairment is characterized by the inability to carry out the professional duties and responsibilities in a reasonable manner consistent with nursing standards. This guide will focus only on impairment caused by chemical dependency.

There is no resolution of problems associated with chemical dependency without effective intervention or treatment. Coworkers often feel frustrated and helpless. Staff morale may deteriorate while the chemically impaired nurse becomes more impaired. As chemical dependency progresses, the potential for compromising patient care increases. Cognitive functioning, decision-making, reaction time, judgment and the ability to handle stress are increasingly affected.

Any person suspecting impairment of a nurse’s ability to provide safe nursing care may report this nurse to IPN and/or the DOH. Under Florida’s Mandatory Reporting Law, all licensed nurses must report any suspected impairment in practice to IPN and/or the DOH.

Being unable to practice nursing safely due to use of drugs, alcohol, chemicals, a mental condition, or the possession or distribution of controlled drugs for other than legitimate purposes is a violation of the Nurse Practice Act that can result in disciplinary action taken against a nurse’s license by the Florida Board of Nursing.  If the nurse has been reported only to IPN, he/she agrees to participate in IPN, and successfully completes IPN, the file is closed and held in confidence with no disciplinary action resulting.  If the nurse is reported only to IPN, and does not agree to participate, or does not successfully complete IPN, then the information in IPN’s possession is forwarded to the DOH, and may result in disciplinary action, if deemed appropriate.  In some cases, the nurse is reported both to IPN and the DOH and in those cases, the disciplinary process proceeds and may result in disciplinary action. 

While the following is not intended as a complete list, they include increases in absenteeism, which may be more pronounced following scheduled days off, subtle changes in appearance and/or behaviors that escalate in severity over time, as well as decreasing competence in patient care. The usually quiet nurse may become talkative and gregarious, or the reverse may occur, where the nurse becomes isolated and withdrawn from peers who were once professional or social contacts. The nurse may overreact verbally, snapping at colleagues, or become disproportionately angry or emotional in response to situations that were handled appropriately or calmly in the past.

Initially, the nurse may be required to refrain from nursing practice during the evaluation phase and any resulting treatment. The nurse may resume nursing practice when given authorization to do so by IPN. The approval for a return to nursing practice is based upon recommendations from approved treatment providers in consultation with IPN staff. Practice limitations are often required during the early phase of return to practice.

The IPN staff can assist the nurse in obtaining appropriate treatment, continuing care, and ongoing support. If the nurse has violated the Nurse Practice Act, IPN participation is an alternative to disciplinary action by the Florida Board of Nursing. If the nurse is already involved in the disciplinary action process through the DOH, an IPN representative will be present. When that nurse’s case is heard before the Florida Board of Nursing, IPN can confirm that the nurse is engaged in the recovery process.

IPN does not provide the evaluation and/or treatment required, but does provide referrals to Board-approved Addictionist, Psychiatrist, and/or other treatment professionals. These Addictionists, Psychiatrists, and/or treatment providers are located throughout the State of Florida and referrals will be made to a provider geographically closest to the nurse's place of residence.

Unlike some of the other professional alternative to discipline programs, IPN does not charge a fee for participation. The nurse is responsible to pay for the cost of all evaluations and/or treatment that may be required. For those nurses who are required to submit to random drug testing, they are responsible for the cost of all laboratory testing that is performed.