Policy regarding Impaired Practice Involving Substance Abuse

Overview
The policy was developed based upon the recommendations and guidelines from American Association of Colleges of Nursing (AACN), and The Ohio State University Student Health Services. According to AACN, substance abuse is a universal health problem affecting all segments of society, including the profession of Nursing. Moreover, college students are one of the segments of the population at highest risk for substance use and abuse problems. Nursing students’ use and abuse of substances not only compromises their educational process but also their ability to provide patient care (http://www.aacn.nche.edu/publications/position/substance-abuse-policy-and-guidelines).

The College of Nursing has the responsibility to educate students who will be responsible professional, knowledgeable nurses who provide quality health care. Students with impaired practice involving substance abuse are incapable of providing this care. Therefore, it is imperative that students with impaired practice be identified and referred for evaluation and treatment of their substance use/abuse problems. Specific criteria for identification of a student with impaired practice are listed in the identification and documentation section of this policy. The purpose of this policy is to establish a process to facilitate the identification and management of nursing student substance abuse problems within the College of Nursing.

Identification and Documentation of Student with Impaired Practice

Faculty in the College of Nursing have a professional and ethical responsibility for the identification, documentation and referral of students who are suspected of having an impaired practice to the Professional Misconduct Committee. Confidentiality for every student is to be maintained throughout the entire process. Identification of a student with possible impaired practice is based on a pattern of observed and/or objective behaviors that may indicate substance use and/or abuse. This pattern of behaviors includes the violation of professional standards policy, alcohol on the breath, cognitive impairment, slurred speech, motor incapacity, absenteeism, tardiness, and inconsistent performance.

Specific information based on behaviors arising from impaired practice must be documented in the student’s academic and/or clinical record. Faculty involved in the identification of a possible substance use/abuse problem must initially meet with the student. A subsequent meeting will then occur between the student, faculty involved in the identification of the problem, and a member of the Professional Misconduct Committee. After this meeting, it is the responsibility of the Professional Misconduct Committee to review written materials regarding a student who is suspected and/or identified as having an impaired practice.

The committee is also responsible for any additional or continued action necessary for each student case. In addition, this committee has the responsibility for the referral of a student who is identified as having impaired practice to The Ohio State University Student Health Services for evaluation, intervention, and treatment of their substance use and/or abuse problems. Any student who is identified and verified as having a substance use/abuse problem will not be allowed in any clinical area as long as the use/abuse continues. Finally, this committee also has the responsibility to determine whether the re-entry of the student into clinical and/or academic settings can occur.

Procedure for a Student with a Positive Urine Drug Screen

Students in the College of Nursing are required to undergo urinary drug screen testing according to College and Agency guidelines in which students may be located for clinical and/or research experiences. Students will be responsible for incurring any costs associated with urine drug screen testing.

Laboratory results for urine drug screen will be sent to the Associate Dean for Academic Affairs. The Associate Dean for Academic Affairs will review the urinalysis test results to determine whether a legitimate medical explanation could account for any “confirmed positive” result reported by the laboratory. This is accomplished by an in-person interview with the specimen donor and by giving the donor an opportunity to provide evidence of legally prescribed medication use that may have caused the positive lab result. If the Associate Dean determines that a legitimate medical explanation exists, the results reported will be recorded as “negative.”

If there is no legitimate medical explanation, the protocol for a positive drug screen will be implemented. Any student testing positive will not be permitted in a clinical setting. A student who tests positive will be asked to make an appointment with the Counseling and Consultation Services (CCS) at The Ohio State University Younkin Success Center. CCS will ask the student to attend three one-hour assessment sessions. The student will be asked to sign a release notifying the Associate Dean for Academic Affairs of the disposition of the visits. The student will be asked to be tested again, at the student’s expense, prior to returning to a clinical course.
If the student tests positive the second time, the student will be asked to withdraw from the program and will need to petition to re-enter. Upon petition to re-enter the program, the student will provide the Associate Dean for Academic Affairs with documentation from a certified drug and alcohol counselor indicating readiness to return to the program and prognosis for full recovery.

After a student has completed the required counseling sessions at CCS, has a negative drug screen, and returns to the clinical setting, random drug testing will occur periodically until the student graduates from the program. The Associate Dean of Academic Affairs office will notify students of the required random drug screening which will be completed within five days of notification, at the student’s expense. If a positive drug screen occurs, the student will be asked to withdraw from the program and will need to petition to re-enter as indicated in previous paragraph.

Evaluation of Student Progress

A student may be granted re-entrance into the clinical area, one time only, upon completion of his or her treatment programs as defined in accordance with The Ohio State University Student Health Services. The Undergraduate Studies and/or Graduate Studies Committee is responsible for the review and maintenance of documentation of all materials regarding re-entry of any student into clinical and/or academic areas. Any student who is identified as having impaired practice more than once will be disenrolled from the College of Nursing. Re-admission to the College of Nursing will be determined using standard re-enrollment procedures.