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Duty to Report - (CLICK HERE for Online Referral Form)

Couple in the sunsetHealth care professionals often avoid dealing with drug impairment (legal and/or illegal) in their colleagues. There is a natural reluctance to approach a co-worker suspected of impairment. There is the fear that speaking out could anger the co-worker resulting in retribution or could result in a colleague losing his/her job or even their license.

Many employers end up being “enablers” of individuals whose professional competence has been impaired by physical, mental or chemical impairment. Addicted colleagues are often given lighter work schedules, and excuses are made for their poor performance. Excessive absences from the work site are often overlooked. Impaired workers are protected from the consequences of their behavior. This allows them to rationalize their behavior or continue their denial that a problem even exists.


Under the Rules of the TN Board of Nursing (Rule 1000-1-.13, Unprofessional Conduct and Negligence, Habits or Other Causes) and other health related rules of ethical conduct, anyone with knowledge of a practice that is or could be below the acceptable standard of care must immediately notify the appropriate authorities. In Tennessee there are two recognized appropriate authorities:

  1. Tennessee Department of Health, Division of Health Related Boards, Office of Investigations, or
  2. Tennessee Professional Assistance Program.

Boards that collaborate with TnPAP are mainly concerned in rehabilitating the practitioner, not in discipline simply for the sake of punishment. An advantage to reporting to TnPAP is early intervention. Every effort is made to retain the professional skills of the individual for the sake of the community and the profession while ensuring that public safety is not compromised. Once notified, TnPAP will:

  • Attempt to contact the individual.
  • Refer the individual to an appropriate treatment facility or practitioner for evaluation.
  • Assist the individual with any pending Board disciplinary action or procedures when appropriate.
  • Monitor and verify treatment progress and compliance.
  • Advocacy once monitoring agreement has been signed.

Individuals who are referred and refuse TnPAP services may be passed on to the Tennessee Department of Health, Office of Investigation, if it appears that a practice act violation has occurred. The TN Department of Health will determine if a practice act violation has or has not occurred and will take the appropriate action.

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What to Report

Conducts that demonstrate poor judgment or skill resulting in violations of the Practice Act that are reportable include, but are not limited to:

  • Drug diversion suspected
  • Failing to account for wastage of control drugs/falsification of documents
  • Forgery
  • Giving medication without an authorized order
  • Inappropriate behavior or mental health impairment
  • Impairment due to prescribed medication, illegal drugs or alcohol
  • Positive workplace drug screen without a valid prescription
  • Positive workplace drug screen due to illegal drug or alcohol use
  • Serious medication errors or charting errors

You are encouraged to review your board's Practice Act and rules and regulations frequently.

Warning Signs of Alcohol or Drug Impairment

  • Increase in tolerance, amounts, frequency
  • Changes in personality and mood swings
  • Defensiveness when confronted about alcohol or drug use (prescribed or illegal)
  • Excuses, promises, lying, denying, blaming
  • Changes in lifestyle to one more centered on alcohol or drugs
  • Isolated and wants to work night shift
  • Appearing like a victim needing to be rescued
  • Decline in job performance (does minimum amount of work)
  • Depression, abuse, guilt, fear
  • Difficulty meeting schedules and deadlines
  • Overachiever or perfectionist

Professional Enabling

  • Lack of knowledge about chemical impairment and the dynamics of recovery
  • Mistaken belief that the dependent could eliminate problems associated with use if (s)he really wanted to
  • Feeling powerless to effectively confront the practitioner
  • Live and let live policy
  • Resentment at being manipulated leads to emotional withdrawal from the practitioner
  • Fear of professional inadequacy leads to avoidance reaction
  • Professional "no talk" rule associated with issues of confidentiality, politeness and personal uneasiness
  • Discomfort with own chemical use or that of a family member

Recognizing the Impaired Co-worker


TnPAP is a program of the Tennessee Nurses Foundation. This program is funded under an agreement with the Tennessee Department of Health.

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Tennessee Professional Assistance Program
545 Mainstream Drive, Suite 414
Nashville, TN  37228-1219
FAX 615-726-4003

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