Impaired Nurses Working After a Treatment Program free essay sample

Impaired Nurses Working After a Treatment Program The nursing profession has an honorable position in society (Harris Poll, 2005). Nurses are responsible for the lives and health of others, to which they provide intimate care. However, nurses are not immune to the disorders that affect their patients. As a result, some are unable to practice due to some type of impairment, which is defined as a situation in which an individual is rendered unable to perform their professional duties and responsibilities in a reasonable manner because of a variety of health problems, including physical disease, psychiatric problems, substance abuse, and chemical dependence (Lectric Law Library, 2010). In fact, the American Journal of Nursing(2010) estimates that 3-6 % of registered nurses are impaired at work on any given day. These impairments not only put their patients at risk, but they also threaten their own health, and jeopardize their careers as well as their nursing licenses. We will write a custom essay sample on Impaired Nurses Working After a Treatment Program or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The American Nurses Association’s position on this issue is based on the ethical principle in its Code of Ethics for Nurses: Provision 3-The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001). Nurses who are challenged with any type of impairment not only pose a potential threat to those they care about, but have neglected, above all, to care for themselves. There is no question to these actions being wrong and for the need of immediate intervention to the same. The dilemma is if impaired nurses should keep practicing after completing a treatment program; this issue is controversial due to nurses being responsible for the lives of others, there are pros and cons that must be understood before making any judgments. To illustrate, there are six nurses in the surgical unit, three of which are experiencing some type of impairment. Marc has been an RN for over 25 years, last year he hurt his back, but never followed up  on medical care. At times he has a difficult time getting out of bed and up from a chair. On the job, Marc struggles to assist his patients so he is always asking for help, he prefers not to work overtime, and he barely makes it through the 12-hour shifts. He cannot afford to lose his job because he pays for his son’s college tuition. At work his co-workers are getting annoyed by his constant behavior and are starting to complain to the supervisor. Nurse Sarah was a new graduate and was feeling stressed all the time. She was trying to adjust to the new environment and the responsibilities of being a nurse. One day, she had a XANAX pill from a patient that refused to take it. She was going through a lot that day, so she took the pill. It made her feel much better. From then on, she would steal medication from her patients whenever possible. Most of her patients complain of pain within minutes of being â€Å"medicated†. Finally, Nurse Jackie got divorced a couple of months ago. She felt depressed most of the time, she was constantly late to work, making mistakes often, and her appearance was not appropriate for the health care setting. Her supervisor talked to her about the situation, and Jackie agreed to get help. She completed a treatment program last month and was able to spare her license and her job. She has more energy and is one of the best nurses in the unit. These three scenarios are examples of the reality that thousands of nurses experience on a daily basis. It is estimated that one out of five to seven nurses (Indiana State Nurses Association, 2007) suffer from some type of impairment. The ANA has adopted a resolution that seeks ways to assist impaired nurses to recover and reclaim their careers. This is the reason why the ANA supports â€Å"alternative to discipline† and â€Å"peer assistance programs† offered by most states, including the state of Texas. It is called the Texas Peer Assistance Program (TPAP), â€Å"it offers comprehensive monitoring and support services to reasonably assure the safe rehabilitation and return of the nurse to her or his professional community† (ANA, 2002). In addition to the ANA ethical principles, the Americans with Disabilities Act (1996) protects qualified individuals against discrimination in job application procedures, hiring, advancement, discharge, compensation, training, and other aspects of employment. Mental illnesses and serious physical impairments, including chemical dependence, are likely to be covered under this law. However, the ADA does not protect a nurse who is  unable to perform the essential functions of the job because of the specific disability and does not offer protection from illegal drug use (ADA, 2000). According to the last survey by the National Council of State Boards of Nursing, 37 states have some type of program to assist impaired nurses into treatment and rehab, monitor their return to work, and spare their licenses (National Council of State Boards of Nursing, 2010). The first reason given is that a punitive system creates barriers to reporting and keeps impaired nurses from getting help. Nurse colleagues or co-workers may hesitate to report something that could cost the nurse her job and license, which creates an unsafe environment for the patients and for the impaired nurse. The states that have a treatment program have a higher number of impairment reports, including voluntary ones and the ability to work during treatment is an important incentive to keep participants compliant (NCSBN, 2010). Another reason is that most of these nurses are â€Å"apt nurses†. They possess the appropriate skills and knowledge to care for the patients. The health care industry is experiencing a nursing shortage, and getting rid of these qualified nurses will make this situation worse. People that support this issue believe that there is a solution that can be done, where both affected sides benefit, i.e., the patients are taken care of appropriately, and the impaired nurses get help and keep their jobs and licenses. Some job modifications have to be made in order for the work environment to be conducive to recovery, but the end result is productive for the public and the facilities (Winokur, 1992). In addition, this provides a safer environment for the patients because the impaired nurse is being treated, instead of getting fired and working somewhere else, where she/he continues practicing while under the impairment (Corinth, 1997). This reduces the risk for patients, and eligibility requirements serve as a public safety net. An impaired nurse is usually not allowed to work for multiple employers, to be self-employed, to do agency nursing, to take on private-duty assignments for a nursing registry, to work in home health, or to be floated to other units (NCSBN, 2010). This is an advantage for the public because the impaired nurse will be under supervision to prevent a relapse, to which many programs have a zero tolerance. In most cases they are only given a one time opportunity to recover. On the other hand, the people against this issue state that it is too much of a hazard for the  patients. The way they see it is that regardless of the nurse completing the treatment progr am, she is still at risk of relapsing. They do not believe that a previous impaired nurse should be allowed to handle the care of patients. The argument is simple, â€Å"they had a duty to the patient, and they chose to break that duty† (Rogers, 1970. By giving them another opportunity, they are providing the impaired nurses with another chance to do harm, and an innocent life could be lost. They want the public to have a safe environment during hospitalization. They are not willing to take any chances because it is not safe for the patients and it is unfair for the rest of the employees (Dunn, 2005). Consequently, giving an impaired nurse the opportunity to work after the treatment will put a strain on the co-workers. The affected nurse will have many restrictions to her usual activities, which in return will require the assistance of others (Hendrix, 1997). A basic task such as administering medications has to be supervised or monitored. The other nurses have their own patients, and these types of activities will only increase their workload. A nurse that suffers from a physical impairment will need to have adjustments to their daily routines. This will mean that others have to either help the nurse or finish the assignments for the nurse. Regardless of the type of impairment, once the nurse comes back to work, changes have to be made to promote a safety environment, and others around the affected nurse would also have to adjust and work with these changes (Dunn, 2005). The final opposing argument is that by allowing recovering impaired nurses to work, it creates a major impact on the economy (Daniel, 1994). Participation in the monitoring program itself is usually free, or at minimal cost to the nurse, which means the hospital or private insurance has to pay for it (American Journal of Nursing, 2009). People against this issue argue that it should be the nurse’s responsibility to pay for the treatment and whatever costs that come with it. When the nurse is allowed back to the job, other extra accommodations have t o be implemented to monitor the nurse. This entails the facility to provide for overtime of other nurses due to the restrictions of the affected nurse. This creates a decline in productivity and lack of effort on the impaired nurse and the rest of the staff. Ultimately, the facility and tax payers suffer the consequences of having to pay for these treatment programs (Berens, 2000). In conclusion, this issue is extremely  controversial due to nurse’s duty and responsibility to care for their patients. Nurses are expected to provide appropriate care and a safe environment to the public. When an impaired nurse is in charge of these tasks, it violates the basic philosophy in which nursing stands. Patients deserve to receive adequate care from a competent nurse; there is no doubt about this. It is the nurse’s responsibility to comply with the patient’s needs; therefore, when an impaired nurse chooses to provide care for another person, this nurse is jeopardizing the safety of the patient. If the nurse has the option to get treatment, while maintaining the job, this nurse will be more than likely to voluntarily ente r a treatment program. In fact, other co-workers that become aware of the impairment will be more willing to report the nurse as long as they know they will not cause her/him to lose the job. Consequently, the impaired nurse will be removed from the care of the patients until she is stable. If the nurse needs special accommodations to keep working, these will be provided and this will enhance not only the nurse’s performance, but the care of the patient. Imagine, if the nurse knows that she will lose her/his job, she will deny having a problem, and the only option for the employer until this resolves will be to fire the nurse. What is the nurse going to do? Find another job, and put others at risk? In the meantime, the litigation is in process, and not only is the facility losing more money than if the nurse was under treatment, now they are short one more person. This will increase the nursing shortage, and others nurses will be working over-time, which will cost more money to the facility. If the nurse maintains the job, and is willing to get help, most of the co-workers will be glad to help the nurse with the recovery. Regardless of the special accommodations being made, the bottom line is that most of these nurses are competent and knowledgeable; they just need help to overcome their problem. Nursing is based on caring for others. How can we not care for our own? Nurses are just as humans as the rest of us, capable of making mistakes and not immune to mental and physical illnesses, that require the same care and treatment of the patients they care for. If the nurse admits to the problem and has finished a treatment program, this nurse deserves to get a second chance because this experience will allow her/him  to show compassion to the patients, and these will be the ones to benefit the most. Impaired nurses are in need of care and compas sion. This is what nursing is all about†¦helping those in need.

Competitive Improv Theater Games for Improv Actors

Competitive Improv Theater Games for Improv Actors Most improvisational activities are guided by a very loose format. Actors might be given a location or a situation in which to create a scene. For the  most part, they have the freedom to make up their own characters, dialogue, and actions. Improv comedy groups play each scene in hopes of generating laughter. More serious acting troupes create realistic improvisational scenes. There are, however, many challenging improv games that are competitive in nature. They are judged usually by a moderator, host, or even the audience. These types of games generally put a lot of restrictions on the performers, resulting in a great deal of fun for the viewers. Some of the most entertaining competitive improvisation games are: The Question GameAlphabetWorld’s Worst Remember: Although these games are competitive by design, they are meant to be performed in the spirit of comedy and camaraderie. The Question Game In Tom Stoppard’s Rosencrantz and Guildenstern are Dead, the two bumbling protagonists wander through Hamlet’s rotten Denmark, amusing themselves with a combative â€Å"question game.† It’s a sort of verbal tennis match. Stoppard’s clever play demonstrates the basic idea of the Question Game: create a scene in which two characters speak only in questions. How to Play:  Ask the audience for a location. Once the setting is established, the two actors begin the scene. They must speak only in questions. (Normally one question at a time.) No sentences ending with a period – no fragments – just questions. Example: LOCATION: A popular theme park.Tourist: How do I get to the water ride?Ride Operator: First time at Disneyland?Tourist: How can you tell?Ride Operator: Which ride did you want?Tourist: Which one makes the biggest splash?Ride Operator: Are you ready to get soaking wet?Tourist: Why else would I be wearing this raincoat?Ride Operator: Do you see that big ugly mountain down yonder?Tourist: Which one? And so it continues. It might sound easy, but continually coming up with questions that progress the scene is quite challenging for most performers. If the actor says something that is not a question, or if they continually repeat questions (â€Å"What did you say?† â€Å"What did you say again?†), then the audience is encouraged to make a â€Å"buzzer† sound effect. The â€Å"loser† who failed to properly respond sits down. A new actor joins the competition. They can continue using the same location/situation or a new setting can be established. Alphabet This game is ideal for performers with a knack for alphabetization. The actors create a scene in which each line of dialogue begins with a certain letter of the alphabet. Traditionally, the game starts off with an â€Å"A† line. Example: Actor #1: All right, our first annual comic book club meeting is called to order.Actor #2: But I’m the only one wearing a costume.Actor #1: Cool.Actor #2: Does it make me look fat?Actor #1: Excuse me, but what’s the name of your character?Actor #2: Fat man.Actor #1: Good, then it suits you. And it continues all the way through the alphabet. If both actors make it to the end, then it’s usually considered a tie. However, if one of the actors flubs up, the audience members make their judgmental â€Å"buzzer† sound, and the actor at fault leaves the stage to be replaced by a new challenger. Normally, the audience supplies the location or the relationship of the characters. If you tire of always beginning with the letter â€Å"A† the audience can randomly select a letter for the performers to begin with. So, if they receive the letter â€Å"R† they would work their way through â€Å"Z,† go to â€Å"A† and end with â€Å"Q.† Ugh, it’s starting to sound like algebra! World’s Worst This is less an improv exercise and more of an â€Å"instant punch-line† game. Although it’s been around a long time, â€Å"World’s Worst† was made popular by the hit show, Whose Line Is It Anyway? In this version, 4 to 8 actors stand in a line facing the audience. A moderator gives random locations or situations. The performers come up with the world’s most inappropriate (and incredibly humorous) thing to say. Here are some examples from Whose Line Is It Anyway: World’s Worst thing to say on your first day in prison: Who here loves to crochet?World’s Worst thing to say on a romantic date: Let’s see. You had the Big Mac. That’s two dollars you owe me.World’s Worst thing to say at a Major Award Ceremony: Thank you. As I accept this major award, I’d like to thank everyone I’ve ever met. Jim. Sarah. Bob. Shirley. Tom, etc. If the audience responds positively, then the moderator can give the performer a point. If the joke generates boos or groans, then the moderator may want to good-naturedly take points away. Note: Veteran improv performers know that these activities are meant to entertain. There aren’t really winners or losers. The whole purpose is to have fun, make the audience laugh, and sharpen your improve skills. However, young performers might not understand this. If you are a drama teacher or a youth theater director, consider the maturity level of your actors before trying these activities.