While all employers struggle with navigating the ever-changing landscape of drug and alcohol issues in the workplace, healthcare employers should pay particularly close attention.

According to the annual Quest Diagnostics Drug Testing Index, illicit drug use among U.S. employees continues to rise, resulting in the highest drug test positivity rates in the last 12 years. While the statistics on whether healthcare workers are more or less likely to abuse drugs or alcohol are unclear, the American Nurses Association estimates that 1 in 10 nurses experience drug or alcohol addiction. These figures and medical professional’s ready access to narcotics, demands healthcare employers’ attention.

Some unique issues facing healthcare employers are as follows.

• Healthcare professionals with knowledge of narcotics and its side effects are often more adept at hiding substance abuse at work. Without a policy and program to appropriately identify and test for drug or alcohol use at work, many instances of substance abuse go unnoticed or unaddressed.
• When a healthcare practitioner is suspected of drug or alcohol use at work, there are serious potential ramifications–not just for the practitioner’s employment, but his or her licensure or medical privileges as well.
• Drug and alcohol abuse amongst healthcare workers can significantly contribute to increased risk management concerns. Unlike liability issues facing non-healthcare employers, those in the industry have to consider the impact and liability vis-à-vis patient care.
• The line between workplace drug and alcohol issues is often blurred with the employer’s regular patient care practice. Meaning, when a supervisor (who happens to be a practitioner) identifies potential drug or alcohol abuse, that supervisor often views the situation through his or her medical practitioner lens and not that of a manager. This blurring of roles can lead to “diagnosing an employee” as opposed to merely identifying potential grounds for an employee drug or alcohol test.
• Similarly, even when there are grounds to require an employee to submit to a drug or alcohol test, the drug testing is often done on-site, as opposed to having a third party vendor involved. Outside of the industry, drug test results remain confidential in the hands of the vendor and human resources. Within the industry, often times, colleagues (especially those conducting the testing) gain access to this otherwise confidential information.

To combat these unique challenges, healthcare employers should get ahead of the issues and consider the following:

• Review policies and programs to identify what type of drug and alcohol testing makes sense for your operations. A healthcare employer focused on addiction treatment may take a very different approach to addressing drug and alcohol issues in the workplace than a skilled nursing facility.
• Think about whether merely conducting pre-employment testing is sufficient and implement programs to identify and address drug and alcohol abuse in the workplace, keeping in mind that each state has unique requirements that may limit when you can test an employee.
• Proactively implement internal measures to limit the potential for “employee diagnosis.” One way to accomplish this is to train supervisors and human resource professionals on the difference between diagnosing individuals with drug or alcohol issues versus merely identifying factors that may be grounds for employee drug and alcohol testing.
• Consider whether proper confidentiality measures, in addition to those under HIPAA, are in place when employee drug testing is conducted in-house. There may be occasions where having a third party vendor conduct the testing makes more sense.
• Ensure appropriate resources are available to employees who self-disclose substance abuse issues. While self-disclosure is not an automatic excuse from discipline, employees who proactively disclose substance abuse problems may be entitled to additional protections under the Americans with Disabilities Act and should be directed to appropriate resources. In many cases, states have physician and nurse health programs specifically designed to address these types of issues whereby practitioners who voluntarily identify a problem and participate in the program may avoid certain formal complaints or disciplinary measures from the state’s medical and nursing boards.