The definition of "impairment" differs across professional organizations and from state to state. Some states cite only substance abuse in their definition of nurse impairment. Other states list substance abuse and mental health issues. Still, others list substance abuse, mental health issues, and physical conditions.
State law is dynamic, and it is essential for the individual nurse to regularly review her/his Nurse Practice Act and Board of Nursing administrative rules. Here are some examples:
- American Nurses Association (ANA) definition of impairment: performance adversely affected by "mental or physical illness, fatigue, substance abuse or personal circumstances" (2015).
- The Joint Commission™ requires health care organizations to have in place a process of education and prevention of physical, psychiatric, and emotional illnesses as well as facilitation of confidential diagnosis, treatment, and rehabilitation of potential and actual impaired healthcare professionals.
- Florida statute (2020) Title XXXII, Chapter 456.076 (e) states impairment means a potentially impairing health condition that is the result of the misuse or abuse of alcohol, drugs, or both, or a mental or physical condition that could affect a practitioner’s ability to practice with skill and safety. http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/Sections/0456.076.html
- Illinois statute defines impaired nurse as meaning a nurse licensed under this Act who is unable to practice with reasonable skill and safety because of a physical or mental disability as evidenced by a written determination or written consent based on clinical evidence, including loss of motor skills, abuse of drugs or alcohol, or a psychiatric disorder, of sufficient degree to diminish his or her ability to deliver competent patient care. https://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24
- The board of nursing in Ohio may impose sanctions, such as deny, revoke, suspend, or place restrictions on any nursing license for any of the following:
(9) Habitual or excessive use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to the extent that impairs the individual's ability to provide safe nursing care or safe dialysis care;
(10) Impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care or safe dialysis care because of the use of drugs, alcohol, or other chemical substances;
(11) Impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care or safe dialysis care because of a physical or mental disability; https://codes.ohio.gov/ohio-revised-code/section-4723.28
Fatigue is considered a form of impairment by the American Nurses Association.
American Nurses Association (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association.