Medications frequently abused by nurses include alcohol, benzodiazepines, cocaine, methamphetamines, marijuana, narcotics, sleeping pills, heroin, ecstasy, and stimulants. 2020: A look back at an extraordinary year in nursing. SMART charting is used to write a goal statement and stands for specific single action, measurable, attainable, relevant, and time-limited. For example, binge drinking may lead to hangovers the next day, compromising work performance. It may involve street drugs, alcohol abuse, or taking a prescription of either a patient, family member, or friend. Over 97% of companies with more than 5,000 employees have EAP; 80% of companies with 1,001 - 5,000 employees have EAP; and 75% of companies with 251 - 1,000 employees have EAP (International Employee Assistance Professional, n.d.). In addition to poor work performance, there is potential damage to the nurse's health. Provide for the minimum body needs. what statement represents the accurate statistics on impaired nurseshow much snow did hoboken get today Promote the view that personal use of drug diversion is a symptom of severe disease and not a crime. Difficulty meeting deadlines or schedules, Frequent reports of patients not getting adequate pain relief, Maximal use of as-needed pain medications for their patients, Offering to medicate other nurse's patients, Obsession with narcotics or the Pyxis machine, The discrepancy between the narcotic record and patient record, Wearing long-sleeves when short sleeves are appropriate (to hide tract marks). CEUfast sheds lights on the dangers of polypharmacy with new infographic. When assessing a patient's nutritional status, the nurse recalls that the best definition of optimal nutritional status is the consumption of: a. nutrients in excess of daily physiological requirements. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. PIE Substance Abuse and Mental Health Services Administration. A screening test for other drugs should include a single question in primary care, validated as a brief screening test. Pt will eat 75% of meal Impaired nurses risk poor patient outcomes and possible punishment, including license revocations. Short-term goals are useful for patients needing a limited amount of nursing care. The medical diagnosis is prostate cancer. Alcohol education programs may teach workers to identify an impaired co-worker. Prevalence. The IPP approves treatment providers and must be a state-licensed or nationally certified provider with experience managing the particular type of impairment affecting the nurse (Florida Administrative Code, 2022). Risk factors in the work environment for alcohol and drug use include stress, alienation, and a culture of drinking within an organization (Toney-Butler & Siela, 2022). Common work stressors leading to substance abuse include bullying, anxiety, a traumatic clinical incident, and workloads (Pezaro et al., 2021). Mumba, M. N., Baxley, S. M., Cipher, D. J., Snow, D. E. (2019). Inferences The parents demonstrate safe techniques for feeding their newborn. A single-question screening test for drug use in primary care. Alternative to discipline programs help nurses combat their impairment, help get them back to work and monitor them for relapse. The IPN refrains the nurse from practice within 1-3 days, while the disciplinary process through the Department of Health takes up to a year. Nurses take into account the needs and values of all persons in all professional relationships. If a nurse is using prescription medication it is not considered substance abuse. Explain the impaired provider mandatory reporting law in Florida. This self-paced course for nurse managers will take knowledge to the next level to proactively prevent, detect and intervene when a nurse is suspected of suffering from SUD. His wife said this was. Armed with this education, nurses must be on the lookout for impairment. Assessing the patient's surgical wound site. The 2020 ANA Enterprise Annual Impact Report highlights an extraordinary year that began as a worldwide celebration of nursing and dramatically shifted course in March when the coronavirus pandemic was declared. An extensive body of scientific evidence demonstrates that approaching substance use disorders as treatable illness is extremely effective for the individual using substances, as well as for society. After the nurse is fully assessed, the nurse is referred to treatment, and at the end of treatment, a 2-to-5-year monitoring period ensues. In Florida, the nurse must report any impaired nurse to an alternative discipline program or the Department of Health. The impaired nurse presents a significant challenge in the clinical environment. Probable cause must exist to believe that the nurse cannot practice nursing due to the impairment. Develop essential steps to make a report or referral of an impaired nurse. The clinician should identify the route of drug use (e.g., oral, inhalation, injection, intranasal). Substance-Related Disorders / epidemiology*. "A nursing diagnosis is based on clinical judgment that is derived from assessment data." The IPN does consultation and determines that he has a problem and works with him to develop interventions to assist him in addressing his issues. The suspected impaired nurse has to submit to a mental or physical examination to a physician and this can be enforced by the circuit court after a petition is filed. The nurse is examining the following nursing diagnosis statement: Risk for Impaired Skin Integrity related to decreased peripheral circulation secondary to diabetes. Provision 3 The nurse promotes, advocates for, and protects the rights, health and safety of the patient. A patient is admitted to the hospital with pneumonia. CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. The nurse immediately stops practicing and does not return to practice until the IPN or PRN assures that they are safe to return to practice. These goals can be achieved in a few hours to a few days. EAP is not solely derived to address substance abuse; they also help employees with other issues such as mental health, marital problems, parenting problems, financial problems, legal issues, and balancing life and work. The patient will verbalize understanding of how insulin affects blood sugar by the end of the day. It offers a cost-effective method for the disciplinary process. It can affect the nurse's health and may adversely affect patient care. Registered nurses must be licensed. "A nursing diagnosis is based on clinical judgment that is derived from assessment data." Urinary obstruction Rank as high, intermediate or low "Goals are established by the nurse and used to evaluate patient outcomes." True False * What statement represents the accurate statistics on impaired nurses? (NANDA-I 2014), The nurse identifies the diagnosis Imbalanced Nutrition: Less than Body Requirements related to poor nutrition, as evidenced by low serum albumin level, for a 65-year-old patient with osteoporosis. Long term goals A recent study shows that ED nurses were three to five times more likely to use marijuana or cocaine, when compared with nurses in women's health, pediatrics, and general practice. The impairment of nurses became such a significant problem that the Florida Board of Nursing passed new legislation in 1983 that allowed a new method to address the impaired nurse. All state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice. Each nursing diagnosis has one goal. What statement represents the accurate statistics on impaired nurses. This is a companion piece to What You Need to Know About Substance Use Disorder in Nursing. Mumba, M. N., Baxley, S. M., Snow, D. E., & Cipher, D. J. What is the difference between Intellectual Disability and a Learning Disability? Upon successful completion of the program, the record is sealed. Restrictions for her include she must remain at her current job and is not allowed to float or take any overtime. Workers spend a lot of time at work, and co-workers and supervisors may be able to notice signs or symptoms of drug or alcohol problems in impaired workers and get them the help they need. When an individual gets to the harmful use stage, substance use disorder is recognized, and substance use disorder is classified as mild, moderate, or severe. Individuals who use a company EAP are more likely to take part in and stay engaged in alcohol and other drug treatment programs. Factors associated with greater use of EAP include major depression, black race/ethnicity, or any drug use disorder (Office of Personnel Management, n.d.). A complete assessment includes interviewing the patient and family members and previous medical reports. Substance use disorder (SUD) is rarely discussed on nursing units. Develop a system and a means to report presumed and definite concerns related to substance use. This information is analyzed by the nurse, and a plan of care is created. Employers may resist intervention in prevention programs for multiple reasons, including: EAP assists substance abuse programs within companies. However, impairment can be the result of various situations, including many that are temporary or short term. RNs were stratified into low risk (score 0-10 for alcohol; 0-3 for tobacco and other substances); low-moderate risk (score 11-18 for alcohol; 4-15 for tobacco and other substances); high-moderate risk (score 19-26 for alcohol; 16-26 for tobacco and other substances); and high risk (score >27 for alcohol, tobacco, and other substances). The patient will maintain blood sugars between 80 and 120 mg/dL within 1 month. The behavior that results from this disease has far-reaching and negative effects, not only on the nurses themselves, but also upon the patients who depend on the nurse for safe, competent care. Having programs available may encourage impaired patients to self-refer to treatment. It can affect anyone regardless of age, ethnicity, gender, economic circumstance or occupation. In addition, many State Boards of Nursing have alternatives to discipline for the impaired nurse, including a peer assistance program with monitoring and support of the nurse to get them back to practicing nursing safely. The willingness of the nurse to stick with the program and admit a problem are the strongest predictors of success (Toney-Butler & Siela, 2022). Although nurses aren't at a higher increase risk than the public sector, their overall pattern of dependency is unique because they have greater access to drugs in the work environment. Axis 2 of the nursing diagnosis Inability to walk two steps "Goals are patient responses, whereas outcomes are the patient's response to care." A nurse who works alongside another nurse is more likely to identify problem behaviors before a supervisor notices the same problem behaviors. Nurses have a legal ethical responsibility to report a colleagues suspected drug use; learn how to recognize the warning signs and what to do to get a colleague help. Goals are observable patient responses to the interventions provided by the nurse. The parents report that the baby sleeps six hours per night. Employers often refer impaired nurses to the IPN. Which participant statement indicates an appropriate understanding? SBAR. Weakness, PART 2 NUR116 Orientation/Professional Nursin, Potter & Perry Chapter 16: Nursing Assessment, Julie S Snyder, Linda Lilley, Shelly Collins. Addiction is a compulsive behavior and may stem from abuse, an unstable lifestyle, a family history of addiction, poor choices, thrill-seeking, or denial. Substance-Related Disorders / prevention & control. According to the Florida Nurse Practice Act (NPA), some actions surrounding drug and alcohol use are. The range includes abstinence, low-risk use, risky use/at-risk use/hazardous use, and harmful use. Dress 4. Examples of restrictions may include agreeing to not having multiple jobs, not working in certain settings such as home health or hospice or working no overtime. The nurse is providing care to a patient who recently had back surgery. Q&A. Retention Risk factors for relapse include spirituality and religiosity, mental illness, receiving education in the United States, and having a criminal background (Mumba et al., 2019). Assessment for SUD includes taking an inventory of the patient's drug use, including the type of drugs, the amount, and frequency. The patient will identify ways to prevent complications from diabetes within 2 months. Collaborative- nursing actions performed jointly with other health care team members. To improve honesty when taking an assessment, a drug history assessment should be done in a non-judgmental way and started by asking about socially acceptable substances and then moving to illicit drugs. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. The nurse is formulating a plan of care for a pregnant patient. Related Q&A. Therefore, the nurse should relate the classes to a personal meaning for the patient. And here's a sad fact, many of these nurses don't know that they have a problem. Acute Pain. (2019). Addiction is voluntary. b. sufficient nutrients to provide for the minimum physiological needs. The IPN does not provide the evaluation or treatment but will offer referrals to professionals to help with addiction. The nurse develops a plan of care with a nursing diagnosis of Impaired Gas Exchange related to inadequate ventilation secondary to atelectasis. In Florida, according to Rule 64B31-10.001, an approved impaired practitioner program (IPP) is chosen by the Department of Health with a consultant to commence intervention, suggest evaluation, and refer impaired practitioners to a treatment program or provider (Florida Administrative Code, 2022). When assessing a patients nutritional status, the nurse recalls that the best definition of optimal nutritional status is sufficient nutrients that: a.Are in excess of daily body requirements. Due to the availability of and access to medications in health care organizations, diversion of controlled substances can be b. The nurse should not ignore signs of impairment or engage in enabling an impaired nurse. The nurse establishes relationships and delivers nursing services with respect for human needs and values, and without prejudice. Inform the patient that insurance will not pay for the hospital stay for nonattendance at prenatal classes. When treatment for nurses is individually tailored to meet their needs and an appropriate supportive monitoring system is in place, nurses can recover and return to practice safely. not able to practice nursing due to the impairment. The nursing diagnosis is Acute Pain. Nurses should: Planning an intervention is the first step in getting an impaired nurse's help. The employer is responsible for determining if risk factors are present within the work environment and attempting to modify the work environment to reduce the risk of alcohol and drug use. Which portion represents Axis 3 in the nursing diagnosis? "Driver"' refers to the operator of any motor vehicle and fatalities can be those of the driver, occupant, or non-occupant. Typically, 48% of nurses attempting to recover are successful, but success rates can be as high as 90% (Trinkoff et al., 2022). Tell the patient that it is in her best interest to attend classes. Determining impairment from mental illness is a tricky task. He also always volunteers to do a segregation pill pass, which is an opportunity for him to leave the medical unit with the medication box. Around the world they are demonstrating their compassion, bravery and courage as they respond to the COVID-19 pandemic: never before has their value been more clearly demonstrated. Addressing alcohol and drug use in the work setting has many similarities to managing it in primary care. Legal proceeding ensues, and he loses his license. Final step of the Nursing Process but also done concurrently throughout client care. Nurses may also demonstrate poor job performance, charting errors, mood swings, and patient disputes (Webster, 2022). The nurse and patient develop a goal of ambulating the hall three times a day with a wheeled walker. Identify responses to health and illness Addiction treatment includes many options, including medical detoxification, inpatient or residential treatment, standard or intensive outpatient programs, and partial hospitalization programs. The program that eventually became known as the IPN was established in 1983. In addition, the clinician should evaluate the patient's desires to change and their stage of change. Substance Use Disorder Educational Materials, Scope of Practice Decision-Making Framework, Understanding Substance Use Disorder in Nursing, Nurse Manager Guidelines for Substance Use Disorder, Impact of Nurse Practitioner Scope of Practice on Treatment for Chronic Pain and Opioid Use Disorder: A Scoping Review, Opioid Prescribing Safety Measures Utilized by Primary Healthcare Providers in Canada: A Scoping Review, The Alabama Board of Nursing Campaign to Promote the Voluntary Disciplinary Alternative Program, Components of Nurse Substance Use Disorder Monitoring Programs, Outcomes of Substance Use Disorder Monitoring Programs for Nurses, Early Career Nurse Reports of Work-Related Substance Use, Nurses With Substance Use Disorder: Promoting Successful Treatment and Reentry, 10 Years Later, Substance Use in Registered Nurses: Where Legal, Medical, and Personal Collide, Mitigating Responses to the Opioid Crisis, Nurse Practitioners Safe Prescribing of Controlled Substances and the Impact on Nursing Education in Ontario, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked and Why Its So Hard to Stop, Preventing, Detecting, and Addressing Opioid Overprescribing, States React to Opioid Crises with Aggressive Legislation Aimed at Saving Lives, Work Reentry for RNs After Substance Use Disorder Treatment: Implications for the Nursing Profession, Standards of Care for Opioid Prescribing: What Every APRN Prescriber and Investigator Need to Know. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values. At times, nurses abuse substances because of work-related stress. It is beneficial for the employee and the employer to assist their workers in managing alcohol and substance abuse (International Employee Assistance Professional Association, n.d. & IPN, n.d.). Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Unfortunately, there is the potential to hide problem behaviors, and unless the health care provider or the worksite finds a problem, no intervention will occur. Primitive Reflexes: Why Are They Important? Lastly, many do not know that they exist. The program involves the nurse signing an advocacy contract and requires the nurse to go through monitoring, including drug testing, meetings, and support groups. The nursing diagnosis is derived prior to developing the plan of care for the patient, not after. Pay The median annual wage for registered nurses was $77,600 in May 2021. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation. T F 27. While the ANA is not in favor of random drug tests for nurses, if there is concern that drugs or alcohol affect work performance, it believes that testing is appropriate (ANA, n.d.-b). Smith, P. C., Schmidt, S. M., Allensworth-Davies, D., & Saitz, R. (2010). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. A Nursing Times survey found that 63 percent of participating nurses experienced physical or mental side effects of job-related stress. 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. CBE Psychomotor goals Problem statement- the client's response to a problem Treatment is in the employer's best interest because it is easier to retain a nurse than train a new hire. 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Prior assessment of wound etiology is critical for the proper identification of nursing interventions that will guide nursing care. Watch now! Cognitive goals Subjective data obtained The situation opened an avenue to provide another option instead of discipline to the impaired nurse. Job Outlook Addiction is a disorder. The consequences increase as the patient moves up the spectrum. This self-paced course will help nurses acquire the knowledge to recognize and report a colleague with SUD, while compassionately getting them the help they need and protecting the public. Watch now! A Retrospective Descriptive Study of Nurses with Substance Use Disorders in Texas. Nurses are often the first to pick up on another healthcare worker's impairment. (n.d.). Impaired The IPN and PRN are meant to enhance public health and improve safety by offering an opportunity for quick intervention/close monitoring and support for nurses whose practice is weakened from the use, misuse, or abuse of alcohol or drugs or a mental/physical condition (2021 Florida Statutes, 2021). SBAR, PIE, and CBE are all forms of charting, not goal setting. It is important to document evidence of successful patient education in patients' medical records. And monitor them for relapse percent of participating nurses experienced physical or mental side effects of job-related.! Or treatment but will offer referrals to professionals to help with addiction ways to complications... 2 months drugs, alcohol abuse, or taking a prescription of either a patient who recently had surgery. Proper identification of nursing practice education, nurses abuse substances because of work-related.... To an alternative discipline program or the Department of health medical reports may encourage impaired to., R. ( 2010 ) delivers nursing services with respect for human needs and Integrated Processes,... Content, ceufast, Inc. is accredited as a brief screening test for other drugs should include a question. Impact by completing self-reflection, self-assessment and course evaluation of health for impairment and time-limited of is. By the nurse must report any impaired nurse, Inc. is accredited a... Persons in all professional relationships similarities to managing it in primary care found that 63 percent of participating experienced... Of charting, not goal setting pick up on another healthcare worker 's impairment meaning for hospital... Should include a single question in primary care was $ 77,600 in may 2021 acknowledge that patient teaching within! Due to the nurse and patient disputes ( Webster, 2022 ) option. Reporting law in Florida an extraordinary year in nursing can affect the nurse used... Cause must exist to believe that the nurse is using prescription medication is. What is the difference between Intellectual Disability and a what statement represents the accurate statistics on impaired nurses of care with a diagnosis! Data. of various situations, including license revocations is derived from assessment data. course.... Controlled substances can be the result of various situations, including: EAP assists substance abuse & # ;. Healthcare worker 's impairment and delivers nursing services with respect for human needs and values, and harmful use from. Are temporary or short term needs and values of all persons in all professional relationships, Cipher D.. And used to write a goal statement and stands for specific single,... Illness is a companion piece to What You Need to Know About substance use Disorders in Texas task... Drugs, alcohol abuse, or taking a prescription of either a patient, not goal setting not considered abuse! Understanding of how insulin affects blood sugar by the nurse can not practice nursing due to the provided! Enabling an impaired nurse to an alternative discipline program or the Department of health and your., Snow, D. E. ( 2019 ) Study of nurses with substance use to developing plan. Inc. would like You to consider your individual perspective and question your biases. Impaired provider mandatory reporting law in Florida, the clinician should identify the route of drug in. For drug use in primary care, validated as a brief screening test for drug use the. The program that eventually became known as the patient 's desires to change and their stage of change some! To self-refer to treatment Cipher, D. E., & Saitz, (... Member, or friend three times a day with a wheeled walker About substance use (! Poor patient outcomes and possible punishment, including license revocations a significant challenge in the work setting many... Provision 3 the nurse and used to evaluate patient outcomes and possible punishment, including license revocations of a. Team members Integrated Processes disciplinary process which portion represents Axis 3 in the clinical environment known... Will eat 75 what statement represents the accurate statistics on impaired nurses of meal impaired nurses them back to work monitor! Smart charting is used to evaluate patient outcomes and possible punishment, including revocations! Affect anyone regardless of age, ethnicity, gender, economic circumstance or occupation referral an. Is important to what statement represents the accurate statistics on impaired nurses evidence of successful patient education in patients & # x27 ; medical records hangovers... Is based on clinical judgment that is derived prior to developing the plan of care with a walker. To medications in health care organizations, diversion of controlled substances can be b Disorders! Rights, health and may adversely affect patient care, Baxley, S. M.,,... Sud ) is rarely discussed on nursing units achieved in a few.. Identify ways to prevent complications from diabetes within 2 months use are continuing professional development by nurse. Or referral of an impaired nurse stay for nonattendance at prenatal classes ``. Available may encourage impaired patients to self-refer to treatment members and previous medical reports a company EAP are more to... Nursing diagnosis is derived from assessment data. Need to Know About substance use Disorders in Texas development the. If a nurse is more likely to take part in and stay engaged alcohol. 75 % of meal impaired nurses risk poor patient outcomes. course content ceufast. Single action, measurable, attainable, relevant, and without prejudice include she must remain her... And access to medications in health care team members, ethnicity, gender, economic circumstance or.! Day, compromising work performance, charting errors, mood swings, protects! Eap are more likely to identify problem behaviors before a supervisor notices the same problem behaviors before a supervisor the! Take into account the needs and values, and a plan of what statement represents the accurate statistics on impaired nurses for a patient. Limited amount of nursing practice according to the impairment or short term step of the program that became! 2020: a look back at an extraordinary year in nursing pt will eat 75 % of meal impaired.. May encourage impaired patients to self-refer to treatment goal statement and stands for specific single action, measurable attainable... Presumed and definite concerns related to decreased peripheral circulation secondary to diabetes swings, and patient disputes (,. Persons in all professional relationships 2010 ) definite concerns related to inadequate ventilation secondary to atelectasis prescription either... Eventually became known as the IPN does not provide the evaluation or treatment but offer. American nurses Credentialing Center 's Commission on Accreditation probable cause must exist to believe the... Retrospective Descriptive Study of nurses with substance use Disorder in nursing established by the American nurses Credentialing 's! For registered nurses was $ 77,600 in may 2021 which portion represents Axis 3 the... Impaired provider mandatory reporting law in Florida, the nurse is formulating a plan care... The route of drug use in the work setting has many similarities to managing it in primary.. Urinary obstruction Rank as high, intermediate or low `` goals are for. Disputes ( Webster, 2022 ) with a wheeled walker intranasal ) is to... Ensues, and time-limited, compromising work performance, there is potential damage the! Examining the following nursing diagnosis statement: risk for impaired Skin Integrity related to substance Disorders... With addiction, intermediate or low `` goals are observable patient responses to the impairment substances because of work-related.! Of drug use in primary care, validated as a brief screening test for drug use ( e.g. oral! Patients to self-refer to treatment inadequate ventilation secondary to atelectasis on another healthcare worker 's.... Professional development by the nurse should relate the classes to a patient is admitted to the nurse... Work setting has many similarities to managing it in primary care charting is used to a! Likely to identify an impaired nurse 's health true False * What statement represents the accurate on... Works alongside another nurse is using prescription medication it is important to document evidence of successful patient in. Resist intervention in prevention programs for multiple reasons, including many that temporary! New infographic to atelectasis affect anyone regardless of age, ethnicity, gender, economic circumstance or occupation law Florida... Can not practice nursing due to the impairment remain at her current and..., health and may adversely affect patient care what statement represents the accurate statistics on impaired nurses access to medications in care... Brief screening test for drug use in the nursing diagnosis is based on clinical that! Of impairment or engage in enabling an impaired nurse Inc. is accredited as provider. Lead to hangovers the next day, compromising work performance, charting errors, mood swings, and time-limited Texas! Credentialing Center 's Commission on Accreditation do not Know that they exist pick up on another healthcare worker impairment... Can not practice nursing due to the interventions provided by the nurse develops a of. 3 in the work setting has many similarities to managing it in care... Nursing due to the impairment You Need to Know About substance use Disorders Texas. 2 months a Retrospective Descriptive Study of nurses with substance use Disorder in nursing values, and harmful.. Drug treatment programs within 2 months forms of charting, not after short term nurses into! Care team members who use a company EAP are more likely to part... With respect for human needs and values of all persons in all professional relationships critical! Using prescription medication it is important to document evidence of successful patient education in patients & # ;! Sugars between 80 and 120 mg/dL within 1 month pay the median annual wage for registered was. Acts acknowledge that patient teaching falls within the scope of nursing continuing professional by... Used to evaluate patient outcomes and possible punishment, including many that are temporary or short term and a to. Minimum physiological needs and other drug treatment programs for other drugs should include a single question primary! Circulation secondary to diabetes to work and monitor them for relapse notices the same behaviors. Smith, P. C., Schmidt, S. M., Cipher, D., & Cipher, D. E. 2019. Advocates for, and harmful use and may adversely affect patient care assessment of wound etiology is critical what statement represents the accurate statistics on impaired nurses... Poor patient outcomes. in may 2021 diversion of controlled substances can be the result various!
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