Reviewed Aug 2001, Feb 2002, March & Aug 2003, Jan Mar & Nov 2004, Mar 2005 , Apr Sep & Oct 2006, Aug 2007, Aug 2008
Selected inhalation anesthetic agents are thought to be hepatotoxic and on occasion an anesthetist may develop a sensitivity to agents which is reflected in abnormal liver function studies. In addition, studies performed in the past have suggested an association between sustained exposure to an anesthetic environment and an increased incidence in abortions, birth defects, and certain types of malignancies for both male and female personnel. While no cause and effect relationship has been established, consideration should be given to these findings in choosing anesthesia as a specialty.
Most hospitals have installed anesthetic gas exhaust systems for minimizing risk to operating room personnel. All of the clinical affiliates have scavenging systems for waste gases. It has not been established whether the risks to personnel are eliminated by these exhaust systems.
Anesthesia caregivers are frequently exposed to blood products, body secretions and used syringes and needles. All students are expected to strictly adhere to universal precautions whenever involved in patient care that involves potential for contact with mucous membranes, secretions or open wounds. Gloves, protective eye wear and masks are available at each anesthetizing site and must be worn. Proper regard for and performance of aseptic technique is mandatory to protect both patients and anesthesia caregivers. All students must be vaccinated against Hepatitis B.
Anesthesia personnel are also frequently exposed to x-rays during operative procedures. Lead aprons and thyroid shields are available at each anesthetizing site and must be worn during fluoroscopy or x-ray procedures. Radiology dosimeters to monitor the level of x-ray exposure are also available.
Responsibility for accepting risks associated with this specialty rests with the individual who chooses to work within this environment, rather than with the institutions which take reasonable precautions to minimize potential hazards.
The educational program for nurse anesthetists has a vital interest in maintaining a safe, healthy and efficient environment for its students and patients, an environment free from the misuse of drugs and alcohol. Recognizing that chemical dependency is both a disease and a professional hazard, the purpose of this policy is to provide guidelines for the prevention and management of substance abuse within the nurse anesthesia educational program.
The policy is intended to provide a safe, fair working environment for all anesthesia practitioners and their patients. Generally, nurse anesthesia students are expected to comply with the hospital policies at each clinical site. Students, like employees, are required to comply with all hospital policies regarding preemployment drug and health screening. Nurse anesthesia students shall be required to submit to drug testing as a condition of enrollment. Failure of the drug test, or refusal to cooperate with any aspect of this policy, or any hospital policy on substance abuse, will result in disciplinary action up to and including dismissal, refusal of enrollment, and the reporting of use to the appropriate authorities. Because of the paramount concern for patient safety, these disciplinary actions may be imposed without the customary mechanisms of academic warning, and probation period.
The Chair may, for cause, ask a student for a list of all prescription medications, including the name, address and phone number of the licensed practitioner prescribing the medication, the nature of the illness or medical condition, the type, strength, dosage, specific directions for the use of the medication and the expected duration of therapy.
A person currently involved in substance abuse cannot safely learn or practice as a nurse anesthetist. If this process is not interrupted it may result in the death of the student. Students are therefore encouraged to self-report to the faculty, and seek help from Peer Assistance and the state diversion into treatment program (see below). Such disclosure to the faculty, or the presence on a drug test of any intoxicant, non-prescribed narcotic, hallucinogen, marijuana or other prescribed or non-prescribed controlled substance in blood or urine will result in immediate placement of the student on leave of absence status from the clinical and classroom areas. The faculty may also invoke an involuntary leave of absence if they have reasonable cause to suspect 1) diversion; 2) inappropriate or excessive use of controlled substances, illegal drugs, prescribed drugs, or alcohol, or 3) any other condition which may threaten patient or student safety; particularly if any of these are resulting, or may potentially result in impairment. The initiation of voluntary or involuntary leave of absence status initiation shall be accompanied by a report to the Michigan Health Professional Recovery Program.
This leave will last twelve months. At the end of this time the student must bring 1) evidence (such as a signed contract) that they have sought diversion into treatment with the Michigan Health Professional Recovery Program (HPRP), and 2) an evaluation from a medical professional board-certified in the substance abuse area, detailing the degree of impairment, prognosis for return to sobriety and study, type of treatment needed, and any monitoring behavior that will be required. If these requirements are not produced, the student will be withdrawn from the educational program, and the program Chair may refer their situation to the Michigan Health Professional Recovery Program at any time if student health or public safety is at risk. The leave of absence may be shorter than twelve months leave of absence for good cause, for example, their voluntary resignation.
At the end of the leave, the program Chair will make a decision as to the student's capability for further study. This recommendation will be based on
In making this decision, the Chair may seek consultation from the nurse anesthesia faculty, the Dean of the College of Health Professions, University of Detroit Mercy, or others who can provide information. The Chair will use the utmost discretion to guard the student's confidentiality. The decision will include one of the following courses of action depending on the facts and prognosis:
Students may be counseled that voluntary redirection of their career choice may be in the best interest of their own health, considering the stresses and the access to controlled substances inherent to the nurse anesthesia educational program and career. Should the student wish to appeal the decision, they shall follow the procedure listed in this Handbook in Section 13. Committees; Grievance and Appeals
Drug testing is done at the student's expense. A student may be required to undergo a blood test or urinalysis under any of the following circumstances:
Confidentiality - Testing and test results will be handled confidentially with disclosure of results provided only to appropriate faculty, management, and program administration.
Prescription drugs - Students who have been taking legally prescribed drugs or over-the-counter medications should disclose this use prior to testing. They will be required to bring prescription or OTC medications to the pre-enrollment health screening.
A student's refusal to submit to drug testing shall be considered as equivalent to a failed drug test, and will subject the student to disciplinary and/or academic sanctions accordingly.
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