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Much has been written around the meaning and impact of grief and grieving on people's lives following the death of a person, and anticipatory grief/grieving is receiving increased attention in nursing and healthcare. However, the impact of anticipatory grief on an autistic male adult has received far less research exposure than that of neurotypical (non-autistic) adults. This article, 'written' in the form of a letter by the author to community nurses, seeks to address this. The intention is to initiate reflective discussions around anticipatory grief and grieving, as current and future support will be stimulated on the part of community nurses through dialogue between those on the autistic spectrum and community nurses. Ultimately, the aim of this article is to help improve the support provided by community nurses to autistic individuals. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to explore the perceptions and experiences of registered nurses (RNs) practising with a disability or impairment, and to describe the strategies they used to support their role as an RN. Background: Despite the availability of anti-discrimination guidance, nurses practising with a disability or impairment described varying levels of understanding and support available to them from colleagues and managers. Methods: A descriptive qualitative study allowed us to explore and describe RNs' experiences and perceptions of their interactions with colleagues and managers in clinical practice. This process uncovered what was important to the participants, including strategies they used to ensure they practised safely. Participants took part in a 60-90 minute interview that gathered their experiences and perceptions of working with a disability or impairment as defined by the RN. The semi-structured interview schedule, with one main question and prompt questions, enabled participants to share their individual stories. Thematic analysis was undertaken. Participants: Ten RNs -- nine female and one male -- were selected purposively because they identified as living and working with a disability or impairment. Findings: Four themes were identified. Impairment or disability? -- Nurse participants preferred to articulate the impact of the disability or impairment on them, rather than defining those terms. Telling others captured the decision-making process they went through on whether to disclose their disability or impairment at work. Participants described fear or reluctance to disclose; this decision was also influenced by whether their disability or impairment was visible or invisible. Getting support pulled together some of the concerns nurses had about the lack of organisation-wide support. The perceived lack of support affected the nurse's desire to ask for help and often resulted in the nurse organising their own support resources. Impact in the workplace -- The nurse participants had developed unique strategies to ensure they nursed safely. Conclusion: For participants, the ability to define the impact of their disability or impairment on their working lives was more important to them than selecting a definition of "disability or impairment". All participants were committed to safe nursing practice. The degree of visibility of the disability or impairment influenced the nurse's willingness to disclose or ask for help. A visible disability was acute or obvious and a less visible disability reflected the post-acute, rehabilitative, or chronic stage. However, overall, because many of the nurses did not feel safe to disclose their disability or impairment, ask for help, or know where to go to access support, accommodations were not made for them in the workplace. [ABSTRACT FROM AUTHOR]

Objective: There is a gap in knowledge regarding serious disciplinary matters concerning health professionals under the Health Practitioner Regulation National Law Act 2009 (hereafter 'National Law'). The present study applies a typology of misconduct to the first 7 years of available tribunal cases under the National Law brought against the five most populous regulated health professions with the overarching goal of mapping the relationship between type of misconduct and outcome. As subquestions, the study examined whether the ostensibly uniform law is producing consistency of outcomes, both between the professions and between jurisdictions. Methods: All publicly available Australian tribunal-level decisions concerning complaints of serious misconduct and/or impairment brought against the five most populous regulated health professions (nurses and midwives, doctors, psychologists, pharmacists, and dentists) were gathered from 1 July 2010 to 30 June 2017. Decisions were coded for case and respondent attributes, the type/s of misconduct alleged, whether proved, and the relevant disciplinary outcome. Respondent attributes were: profession, sex, legal representation, and certain identified 'risk' factors from previous studies. The type of allegation was coded based on five main categories or heads of misconduct, with subtypes within each. Outcomes for proved conduct were coded and categorised for severity. Analyses of cases was conducted using SPSS, version 21 (IBM, New York, NY, USA). Data was subject to statistical analysis using Pearson's Chi-squared test with an α value of 0.05. Results: Major variations were identified in outcomes across the professions, with doctors being subject to less severe outcomes than other professions, in particular compared with nurses, even when the same main head of misconduct was in issue. Differences in legal representation did not completely account for such variation. Marked disparities were also identified between outcomes in different states and territories, suggesting that the National Law is not being applied in a uniform manner. Conclusion: Tribunal cases reflected complaint data in that: (1) male practitioners were greatly over-represented as respondents; (2) outcomes were most severe for sexual misconduct and least severe for clinical care; and (3) doctors faced less severe outcomes than other professions. There were also significant variations in severity of outcome by jurisdiction. Variations were more pronounced when deregistration was the focus of analysis. What is known about this topic?: Existing research on complaints data under the National Law in place since 2010 has suggested that doctors may be receiving less severe outcomes than other professions at board level. There is a gap in knowledge concerning serious disciplinary matters heard by tribunals. Unlike data on complaints against regulated health professionals collated by AHPRA, legal tribunals, which hear only the most serious matters, do not record data on cases in a consistent or centralised form. What does this paper add?: This study is the first to compare tribunal outcomes for the five most populous professions by reference to the type of misconduct proved. The finding that different professions are receiving different outcomes for the same malfeasance is novel. Other novel findings include significant variations in severity of outcome by jurisdiction, more pronounced variations in outcomes by both profession and jurisdiction when deregistration was the focus of analysis and variations in outcome according to legal representation. What are the implications for practitioners?: There are major implications for policy makers and decision makers in terms of whether the National Law is operating consistently, with important outcomes for practitioners in terms of equitable and fair treatment when facing disciplinary charges. [ABSTRACT FROM AUTHOR]

There are approximately 3.1 million nurses in the Unites States (U.S. Census Bureau, 2016), and approximately 8% of them experience substance use disorders (Kunyk, 2015). Nurses with impaired practice are referred to peer assistance programs as they seek rehabilitation. As of 2016, 348 nurses in Texas Peer Assistance Program for Nurses were actively participating in the program for substance-abuse-related offenses. Over the last 6 years (2010–2016), 1,553 nurses were referred to Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. These represent 2% of the population of nurses in Texas. The average age of participants was 40.1 years. Women represented 75% of participants, and 76% were registered nurses. About 41% successfully completed the program without relapsing, and 32% reported at least one relapse. Varieties of drugs were abused including prescription drugs and illegal drugs. Opioids were the most frequently abused class of drugs, followed by alcohol and stimulants. Most nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical–surgical units, and home health care had the highest prevalence of impaired practice. Psychiatric comorbidity was not significantly associated with relapse, but self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of abstinent days. Men were also more likely to be employed while in the program. [ABSTRACT FROM AUTHOR]

Relapse is the unauthorized use of any mind-altering substance, prescribed or not, after an individual has entered treatment for substance use (Darbro, 2011). Among nurses with impaired practice, the 5-year relapse rate is estimated at about 40% (Zhong, Kenward, Sheets, Doherty, & Gross, 2009), and the risk of relapse is highest in the first year of recovery (Clark & Farnsworth, 2006). Many factors influence susceptibility to relapse among nurses including presence of psychiatric comorbidities (Schellekens, de Jong, Buitelaar, & Verkes, 2015), history of criminal background (Zhong et al., 2009), spirituality and religiosity (Allen & Lo, 2010), and receiving prelicensure education in the United States (Waneka, Spetz, & Keane, 2011). The purpose of this study was to examine the correlates and predictors of relapse among nurses and to establish at what point they are most susceptible to relapse. This study was a retrospective secondary data analysis of nurses in Texas with impaired practice. The total number of participants was 1,553. The time it takes participants to enroll in a peer assistance program is negatively associated with length in program (p <.001). Conversely, there is a strong, positive, significant relationship between the number of days abstinent and the length in program (p <.001). More men compared with women (p =.037) were likely to be employed while participating in the program. Finally, participants who were referred for substance use disorders alone had 55% less risk of relapse. Those who used alcohol as their primary drug of choice had 1.7 times higher risk of relapse. [ABSTRACT FROM AUTHOR]

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. [ABSTRACT FROM AUTHOR]

Copyright of Portuguese Journal of Mental Health Nursing / Revista Portuguesa de Enfermagem de Saúde Mental is the property of Portuguese Society of Mental Health Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nurses have the same rate of substance use disorders (SUDs) as the general public. Management of nurses with SUDs is moving from being punitive, including public license suspension or revocation, to alternative-to-discipline (ATD) programs that focus on early intervention and nonpunitive, confidential help, which often involve continued employment. These programs have good retention rates, and nurses who complete them have fewer criminal convictions and are able to retain their nursing licenses and maintain successful careers in nursing. Barriers to nurses receiving care for SUDs include wide variability in ATD programs, inconsistent funding for treatment, and lack of policies and support for nursing students. Recommendations include changes to nurse practice acts to make ATD programs more uniform, provide adequate funding for all nurses and nursing students, and allow nurses to seek and obtain care without disclosing directly to Boards of Nurses. Colleges of nursing should implement policies to encourage early identification and treatment in nursing students, including ATD and dismissal programs. [ABSTRACT FROM AUTHOR]

Objective: To explore how professional associations of nine healthcare professions aim to support professionals to prevent and deal with poor performance.Design: Qualitative interview study.Setting: The Netherlands.Participants: Representatives of professional associations for dentists, general practitioners, medical specialists, midwives, nurses, pharmacists, physiotherapists, psychologists and psychotherapists.Interventions: During nine face-to-face semi-structured interviews we asked how associations aim to support professionals in prevention of and dealing with poor performance. Following the first interview, we monitored new initiatives in support over a 2.5-year period, after which we conducted a second interview. Interviews were analysed using thematic analysis.Main Outcome Measures: Available policy and support regarding poor performance.Results: Three themes emerged from our data (i.e. elaborating on professional performance, performance insight and dealing with poor performance) for which we identified a total of 10 categories of support. Support concerned professional codes, guidelines and codes of conduct, quality registers, individual performance assessment, peer consultation, practice evaluation, helpdesk and expert counselling, a protocol for dealing with poor performance, a place for support and to report poor performance, and internal disciplinary procedures.Conclusions: This study provides an overview of support given to nine healthcare professions by their associations regarding poor performance, and identifies gaps that associations could follow up on, such as clarifying what to do when confronted with a poorly performing colleague, supporting professionals that poorly perform, and developing methods for individual performance assessment to gain performance insight. A next step would be to evaluate the use and effect of different types of support. [ABSTRACT FROM AUTHOR]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two nurses diagnosed with opioid addiction launched legal action after being found guilty of unprofessional conduct due to addiction‐related behaviors. When covered by the media, their cases sparked both public and legal controversies. We are curious about the broader discursive framings that led to these strong reactions, and analyze the underlying structures of knowledge and power that shape the issue of opioid addiction in the profession of nursing through a critical discourse analysis of popular media, legal blogs and hearing tribunals. We argue that addiction in nursing is framed as personal choice, as a failure in the moral character of the nurses, as decontextualized from addiction as disease arguments, and as an individualized issue devoid of contextual factors leading to addiction. Our investigation offers a critical case study of a nursing regulatory body that upheld popular assumptions of addiction as an autonomous, rational choice replete with individual‐based consequences – a framing that is inconsistent with evidence‐based practice in health‐care. We put forth this critical interrogation to open up possibilities for counterdiscourses that may promote more nuanced and effective responses to the issue of addiction in nursing. [ABSTRACT FROM AUTHOR]

The article describes the case of a registered nurse who sought legal and professional guidance when she lost her job due to drug diversion, showing how nurses can take responsibility for a substance abuse issue and achieve a successful recovery. It cites the possible consequences of a complaint filed with the State Board of Nursing in the U.S., and the fear of losing her nursing license. Topics include recognizing impairment in nurses, possible criminal charges, and peer assistance programs.

OBJECTIVE: The aim of this study is to understand the human factors associated with hospital errors to provide a framework to discuss why errors occur. BACKGROUND: Patient safety in hospitals has been a major focus in healthcare for the past 15 years. Errors still occur at an alarming rate. METHODS: A cross-sectional survey of 393 hospital-based registered nurses provided perceptions of 24 items relating to human errors in hospitals. Errors were assessed for likelihood, intervenability, importance, and common occurrence. RESULTS: Data revealed 4 themes that explained 55% of the variance in likelihood to cause an error: loss of focus, unhealthy environment, interpersonal deficits, and overwhelmed. Feeling swamped was most important but was not seen as intervenable. CONCLUSION: Managers must provide a way for nurses to feel empowered to intervene on error situations they believe are most likely, common, and important. [ABSTRACT FROM AUTHOR]

Aim To investigate substance use disorders, impaired practice and health risks among nurses in a disciplinary jurisdiction. Background The relationship between substance-related risks to patient safety, nurse health and discipline is understudied. Method A convenience sample of 4064 registered nurses responded to an Internet survey in 2010. Self-reports were given to psychometrically robust measures of health, substance use disorders and organisational support. Perceptions on the treatment and disposition of impaired nurses were also asked. Results The prevalence of substance use disorders was similar to the general population. Most nurses' coded high risk for impaired practices were working, unknown by their employer/regulator and not receiving treatment. When compared with nurse-peers, their health and organisational support were compromised. Nurse-peers viewed impaired nurses as having a treatable illness that their employers/regulators should assist and afford confidentiality. Conclusions In this jurisdiction, discipline was not rated as effective for risk mitigation, supportive of nurses with substance use disorders or in alignment with nurse perceptions. Implications for nursing management Nursing managers play a significant role in addressing substance-related issues among nurses and can be key to influencing the outcomes of these difficult situations. For these reasons, it is important they recognize the ineffectiveness of discipline for substance-related risk mitigation. [ABSTRACT FROM AUTHOR]

Alcohol and other substance use by nurses potentially places patients, the public, and nurses themselves at risk for serious injury or death. Nursing students are also at risk for problems related to substance use. When viewed and treated as a chronic medical illness, treatment outcomes for substance use disorders are comparable with those of other diseases and can result in lasting benefits. Professional monitoring programs that employ an alternative-to-discipline approach have been shown to be effective in the treatment of health professionals with substance use disorders and are considered a standard for recovery, with high rates of completion and return to practice. It is the position of the Emergency Nurses Association and the International Nurses Society on Addictions that 1. health care facilities provide education to nurses and other employees regarding alcohol and other drug use and establish policies, procedures, and practices to promote safe, supportive, drug-free workplaces; 2. health care facilities and schools of nursing adopt alternative-to-discipline approaches to treating nurses and nursing students with substance use disorders, with stated goals of retention, rehabilitation, and reentry into safe, professional practice; 3. drug diversion, in the context of personal use, is viewed primarily as a symptom of a serious and treatable disease and not exclusively as a crime; and 4. nurses and nursing students are aware of the risks associated with substance use, impaired practice, and drug diversion and have the responsibility and means to report suspected or actual concerns. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the prevalence, demographic factors, outcomes, and preventative measures for substance abuse among nurse anesthesia students over a 5-year period from 2008 to 2012. An electronic survey was sent to 111 program directors of accredited nurse anesthesia programs in the United States. Twenty-three programs (response rate = 21.7%) reported data related to 2,439 students. Sixteen incidents of substance abuse were reported for a 5-year prevalence of 0.65%. Opioids were the most frequent drug of choice (n = 9). The programs identified no predisposing risk factors in 50% of the incidents. For the students, reported outcomes included voluntary entry into treatment (n = 10), dismissal from the program (n = 7), loss of nursing license (n = 2), and 1 death. Pre-enrollment background checks and drug testing for cause were the most commonly reported screening practices. The most frequently reported prevention strategy was wellness promotion education. The prevalence was lower among student registered nurse anesthetists, as compared with certified registered nurse anesthetists. Although additional studies are necessary to verify this finding, an opportunity might exist for programs to be proactive in assessing risk postgraduation. Future studies evaluating the effectiveness of wellness promotion efforts might lead toward a standardized, best practice approach to risk reduction strategies. [ABSTRACT FROM AUTHOR]

The article reports a study which was conducted to estimate the 1-year prevalence of nurses enrolled in substance abuse monitoring programs and to compare the prevalence of nurses enrolled in disciplinary programs with those attending alternative-to- discipline (ATD) programs. The results revealed that the ATD programs potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more nurses with substance use problem.

PURPOSE: The objective of this study was to describe the population of nurses in the Indiana State Nurses Assistance Program (ISNAP) as an initial step toward making recommendations for future program improvement efforts. DESIGN AND METHODS: Secondary analysis of data collected for non-research purpose. FINDINGS: Male nurses represented a proportionately higher percentage than female nurses in ISNAP and used alcohol two times more often than opiates, the second most abused substance. PRACTICE IMPLICATIONS: Data need to be systematically collected to provide evidence for monitoring and treatment programs to address the needs of impaired nurses based on characteristics, including gender. [ABSTRACT FROM AUTHOR]

The purpose of this manuscript is to illustrate the challenges faced by nurses who abuse substances and to promote international dialogue about what practitioners, administrators, health care providers and students can do when they suspect someone in the profession is abusing substances, or they may themselves be suffering from addiction. Addiction among nurses has been recognised by professionals in the field for over 100 years, and current estimates place rates of substance misuse, abuse and addiction rates as high as 20% among practicing nurses. Unfortunately, fear of punishment and discipline may keep nurses or students from asking for help for themselves or from reporting a colleague or friend who is in need of help. Discursive paper. This paper synthesises the results of three previous papers conducted on substance abuse policies in the nursing profession. In the first paper, the authors reviewed the history of addiction in nursing and compared disciplinary and alternative-to-discipline policies. The second focused on the development of an alternative-to-dismissal policy for substance abuse in a school of nursing and using telephone and email interviews, and the final paper reported findings of what types of polices seem to be working to retain and rehabilitate nurses who suffer from addiction in the USA. Lastly, this paper introduces international policy for nurses with addictions. Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired students or professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions. Recognition of a colleague's need of treatment is the important first step in the rehabilitation process. Early intervention and assistance are essential for helping colleagues and students to recover from an addictive disorder and providing a confidential, non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. [ABSTRACT FROM AUTHOR]

Many nurses are burned out, exhausted and have a high intent to leave their jobs. These factors, when experienced over a period of time, are consistent with the development of mental illness. This study takes a collective autoethnographical approach to mental illness in the nursing workplace by focusing on the stories of nurses who have experienced mental illness in clinical practice. It highlights three ways in which nursing and mental illness are connected; the nurse who is vulnerable to mental illness prior to entering the profession, the nurse who develops mental illness that is independent of her work but is nevertheless impacted by it, and the nurse who develops mental illness as a result of her work and/or role. This paper explores the hyphenated lives and bullying these nurses experience, and recommends strategies that the profession, employing organisations, and individuals can adopt to reduce nurses' progression from stress to distress and mental illness. [ABSTRACT FROM AUTHOR]

The raticle lists the health programs and resources available to help nurses in dealing with patients suffering from disorders caused by substance use.

The article presents a legal advice for Michelle Flacco, a registered nurse (RN), who is under investigation by the state board of nursing. The board has the authority to revoke or suspend a RN's license, impose limits on how and where an RN can practice and publicly reprimand an RN. The article also discusses the conduct that is subject to disciplinary action and emphasizes the importance of having an attorney representing in the early stages of an investigation.

From 10%-15% of nurses will abuse alcohol during their professional careers. Oncology nurses may use alcohol to mask the stress they experience when caring for patients with cancer. This article will address strategies and support mechanisms for nurses who have issues with alcohol abuse. [ABSTRACT FROM AUTHOR]

The article focuses on nurses who have drug and alcohol problems and the reasons behind it. It says that the lack of education in nursing schools and healthcare organization on substance use disorder (SUD) may have affected nurses and puts them at more risk. It also mentions the indicators that show someone is affected by SUD and ways to control or prevent SUD.

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on how nurses' mental health problems are viewed by colleagues and responded to by the NHS and nursing's regulatory body [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the prevalence of substance abuse in nursing. Topics discussed include researchers T. B. and H. Kenaga suggest that 14% and 20% of all registered nurses (RNs) in the U.S. might have a problem with dependence or abuse of drugs or alcohol, the continuing-education requirements for professional nurses, and the American Nurses Association.

An abstract of the article "Work Re-Entry of RNs After Substance Use Disorder Treatment: A Grounded Theory Study" is presented.

The article relates the experience of the author in dealing with the death of a fellow registered nurse (RN) who passed away due to substance abuse, and need for RNs to speak to administrators and state board of nursing about a colleague who has a drug abuse disorder. Questions raised by the author include why nurses stand by silently while impaired colleagues endanger themselves and their patients, and fear that exposing a colleague's shortcomings will expose one's own personal problems.