Review the below Case Study for a better understanding of potential examples of impaired nursing in the clinical environment. Answer the following questions.
CASE REPORT: The Supernurse
Monthly reports from the controlled substances vault showed that a registered nurse on one of the patient care units had a 3+ SD use of controlled substances compared with fellow nurses in the same time frame. Further investigation revealed that this nurse was the only one who gave several patients acetaminophen with oxycodone after charting their pain scales. Review of the charts showed that the highest doses were always removed, and no doses were wasted. The unit’s nurse manager vouched for the nurse in question, saying she was one of the most well-respected and reputable nurses in the department. She insisted that this nurse was beyond reproach—never taking vacation, always volunteering to work overtime, and available whenever someone called in sick.
The decision was made to interview this nurse and ask for an explanation for why her utilization patterns were notably different than her peers. For confidentiality, she was interviewed in a conference room outside the unit. The nurse denied any wrongdoing. She again was asked to explain the high volume of use and the unusual usage pattern. She emphasized how concerned she was for her patients and that she did not want to see them suffer, unlike some of her colleagues who encouraged patients not to use narcotic pain medication.
When the nurse manager questioned the nurse’s judgment in always offering patients the highest dose, the nurse said that she always removed the highest dose, and if all tablets were not used she would save them for later. The team then inquired why she did not follow policy and waste the medication per protocol, and the nurse replied that she did not want to waste other nurses’ time and throw away viable medication. The next question was whether or not she sometimes forgot she had the drugs and accidentally took them home after her shift. She strongly denied this. As she became increasingly upset, she was asked how long had she been taking medications from the unit and why she was taking them. At this time, the nurse finally confessed to diverting the drugs. She said she had received prescription pain medications several years ago for a work-related back injury, but that her doctor had refused to prescribe additional narcotics when she would not take time off from work for physical therapy. One day a patient only wanted one of the two tablets offered, so she took the other tablet. Because no one seemed to notice, this became her usual pattern. She apologized profusely, but explained that using the pain medication was the only way she could get through a shift. As her addiction increased, she volunteered to work more often. She rationalized that her ability to keep working was in the best interest of the hospital. This nurse was placed in a rehabilitation program.
- Identify at least 3 risk factors for impaired nursing that were seen in this case study.
- Identify at least 3 behavioral and/or physical signs of impairment in the workplace that were seen in this case study.
- Identify at least 3 behavioral and/or work-related signs of diversion seen in this case study.
- Discuss the elements of Virginia’s mandatory reporting laws in the case of impaired nursing. Outline the essential steps to making a report or referral.
- Describe the elements of an Intervention Program for Nurses (IPN).
- Research potential employer programs and initiatives to promote safety and provide assistance. Discuss impairment treatment options available for nurses in your area (VA, DC, or MD).
he Yugoslav transition to democracy is perhaps the most complex of all of the Eastern European cases. The level of parallel mobilization of ordinary people in Yugoslavia, namely of industrial workers and Kosovo Serbs, various groups during the antibureaucratic revolution and Kosovo Albanians, surpassed those in most other East European states, if judged by the numbers of participants, the variety of groups involved and the temporal and geographical extension of mobilization. Ranging from small and orderly events to large and highly disruptive protest marches and demonstrations, popular protests led to considerable changes in the composition of policies of Yugoslavia’s political elites, and more importantly, in the structure of its authoritarian regime. However, this narrative of mobilization that tends to dominate published accounts sharply contrast with those of the people associated with political struggles in other Eastern European states and the dark forces of nationalism in the region. In Yugoslavia, nationalism, which did not correspond perfectly to the various republics, dominated all other issues, including democratization. Unlike some of the other federal states in Eastern Europe, such as Czechoslovakia and the Soviet Union (USSR), Valerie Bruce has pointed out that Yugoslavia lacked a strong central bureaucracy, consisting in the final diagnosis of little more than the Yugoslavia National Army (JNA). While officially a federation, Bunce goes as far as to call Yugoslavia a “confederation” because unlike the Czechoslovak and Soviet “actual” federations, which were “characterized by the existence of shared power based on territorial-administrative divisions,” Yugoslavia was defined by the “domination of the republics over the center.” Despite his best efforts, Josip Broz Tito, the first President of Yugoslavia, had only been able to unite the six republics by offering each state significant degrees of autonomy in a highly decentralized federal government. For example, each republic was, following the USSR’s invasion of Czechoslovakia in 1968, allowed its own territorial defense force, and the Yugoslav market, including its banking system, was segmented along republican lines. Furthermore, it can be argued that Tito’s break with Joseph Stalin (1878-1953), head of the Soviet state, in 1948 absolved republican leaders of the intense presence of Moscow, and that regional politicians therefore felt less bound to the policies of the central government, especially after the death of President Tito in 1980. Some of Yugoslavia’s constituent republics were historically opposed, most notably the Catholic Croats and the Orthodox Serbs. For example, during the Second World War, the Utasha, the Croatian fascists, fought alongside the Axis powers, and more importantly, against the Serbian Chetniks. Following the war, President Tito’s solution to the long-lasting animosities was to prohibit any discussion regarding the topic. While initially, Tito’s solution created a sense of unity under the guise of socialism, ingrained nationalist grievances exploded among the republics as communism in the East fell. As a result of the fall of the Soviet Union, and as a consequence communism, ideas of democratization became less and less of a priority. Thus, in order to properly lead an effort of democratization, Yugoslavia’s historical record had to be resolved, in which each republic utilized different ideas in order to do. Periodization The periodization of the Yugoslav democratization process is a complex matter for several reasons. First, and most obviously, the period of liberalization of the Soviet Union and its satellite communist states during the 1980s could not contain the Yugoslav state and its successor states. States that followed a path of democratization similar to Hungary included only Slovenia. Other states, like Croatia and Serbia, respectively, took longer to complete their journey to democratization as Western-funded opposition groups imposed their will on the process. However, in 2000, Croatia left authoritarianism through an organized election while Serbia experienced the first “color revolution,” where hundreds of thousands engaged in protests against Slobodan Milosevic’s effort to capture the presidency. Lastly, the remaining republics of Macedonia, Bosnia, and Herzegovina fell victim to deep ethnic divisions, in addition to lagging economic development, resulting in a much slower path to democracy. By 2007, all of the former Yugoslav state, with the exceptions of Bosnia and>GET ANSWER