Impairment defined

The ANA defines nurse impairment is defined as the inability or impending inability to provide safe, professional activities and duties. This inability may be due to a behavioral, mental, or physical disorder, fatigue, substance use or person circumstances (ANA, 2015).

The Joint Commission™ requires health care organizations to have in place a a culture of safety. The Commission is particularly concerned with impairments that lead to drug diversion by nurses and other health professionals. https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_drug_diversion_final2pdf.pdf

Salani et al (2022) state that the term substance use disorders (SUDs) is used to describe prolonged use or misuse of a substance such as alcohol or drugs that impairs a person's health or ability to meet personal, social, or occupational responsibilities. They identify substance use disorders as one of the most common reasons for disciplinary action against a nurse.

Substance Use Disorders

The DSM-5-TR recognizes substance-related disorders resulting from the use of these 10 separate classes of drugs:

• Alcohol
• Caffeine
• Cannabis
• Hallucinogens
• Inhalants
• Opioids
• Sedatives
• Hypnotics, or anxiolytics
• Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
• Tobacco

The DSM-5-TR Substance Use disorder can be grouped into these fours primary categories:

• Physical dependence
• Risky use
• Social problems
• Impaired control

State laws

The definition of "impairment" differs across professional nursing organizations and from state to state. Some states cite only substance abuse in their definition of nurse impairment. Other states list substance abuse and mental health issues. Still, others list substance abuse, mental health issues, and physical conditions.

State law is dynamic, and it is essential for the individual nurse to regularly review her/his Nurse Practice Act and Board of Nursing administrative rules, including impairment information.

Florida statute (2023) Title XXXII, Chapter 456.076 (e) “Impairment” means a potentially impairing health condition that is the result of the misuse or abuse of alcohol, drugs, or both, or a mental or physical condition that could affect a practitioner’s ability to practice with skill and safety. http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/Sections/0456.076.html

• Illinois statute defines impaired nurse as meaning a nurse licensed under this Act who is unable to practice with reasonable skill and safety because of a physical or mental disability as evidenced by a written determination or written consent based on clinical evidence, including loss of motor skills, abuse of drugs or alcohol, or a psychiatric disorder, of sufficient degree to diminish his or her ability to deliver competent patient care. 
  https://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24 
• The board of nursing in Ohio may impose sanctions, such as deny, revoke, suspend, or place restrictions on any nursing license for any of the following
  • (9) Habitual or excessive use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to the extent that impairs the individual's ability to provide safe nursing care or safe dialysis care;
  • (10) Impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care or safe dialysis care because of the use of drugs, alcohol, or other chemical substances;
  • (11) Impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care or safe dialysis care because of a physical or mental disability; https://codes.ohio.gov/ohio-revised-code/section-4723.28 

References

American Nurses Association (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

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