The Impaired Perfusionist
It is easy to change a failing oxygenator or fix a broken pump. But how do you fix a broken perfusionist? Even more importantly, how do you know when a perfusionist is broken? There is failure on the part of a chief perfusionist, on the impaired perfusionist and on suspecting co-workers in allowing a broken perfusionist to run the pump. Perfusionists have a responsibility to protect patients by recognizing their own impairment or by identifying impaired colleagues who are unable to practice with reasonable skill and safety. Perfusionists recognizing impairment in themselves or others should report concerns confidentially to an appropriate supervisor and seek guidance from Human Resources (HR) to comply with the many laws, regulations and corporate policies governing these situations.
One of the most difficult things to do is confront another perfusionist who is impaired. It is difficult to accuse a co-worker of substance abuse because of the fear of reprisal. Nonetheless, steps should be taken to confront a co-worker or notify the manager of the problem. That is why I think it is important for a Chief Perfusionist or other supervisor to maintain some level of aloofness with his/her staff. Leadership is not about making friends. This leadership aspect is about keeping patients safe, objectively assisting staffers when they need help or even terminating them when the situation warrants.
Self-identifying an impairment or accepting the recognition of an impairment from another is difficult because the manifestations vary and many professionals will typically suppress or deny any suggestion of a problem. Estimates are that about 10-15% of medical professionals will be impaired by alcohol or drugs at some point in their careers not to mention all of the other factors that can lead to impaired clinical performance (1). This is the same percentage as the general population. So perfusionists are not immune.
I have had several encounters with impaired staffers over the years. Most turned out well. Unfortunately, I had to terminate some. When I had to fire someone, I always felt that I wasn’t just terminating that individual, I was firing their spouse, their kids, their mortgage company, their health insurer, their college fund, etc. I hated to do that, and I resented the staffer when I was forced to do it.
Early intervention is the key in keeping patients safe and preventing an employee’s termination. So learn the symptoms well and maintain good situational awareness about someone’s behavior rather than just “letting it slide”. Impairment is most commonly manifested by physical illness, mental illness, emotional stress, loss of motor skills, loss of cognitive functioning, drug abuse and alcohol abuse. Two or more of these physical symptoms below should trigger an informal investigation by talking to the perfusionist and other staffers who may have also noticed problems developing.
Immediate physical symptoms (2):
- In ability to stand or walk normally
- Red or watery eyes
- Stuffy, draining nose or excessive sneezing
- Slow, slurred, garbled or rapid speech
- Excessive fidgetiness
- Discolored, pale or red face or skin
- Altered mental state or demeanor
- Loss of bowel or bladder control
- GI disturbances leading to vomiting.
- Smell of alcohol
- Overt intoxication
- Needle marks
Not all of the symptoms are physical. Many are work-related (3):
- Late to appointments; increased absences; unknown whereabouts
- Unusual pump set-up times, either very early or very late
- Increase in OR/surgical staff complaints
- Increase in secrecy
- Decrease in quality of care; careless decisions
- Incorrect or incomplete charting
- Decrease in productivity or efficiency
- Increase in conflicts with other perfusionists or OR/surgical staff personnel.
- Increase in irritability and aggression
- Failure to respond to “on call” situations
- Past erratic job history
Home related symptoms may develop before problems at work are noticed (3):
- Withdrawal from family, friends, and community
- Legal trouble (i.e, DUI, drug or domestic violence arrest)
- Increase in accidents
- Increase in medical problems and doctor’s visits
- Increase in aggression, agitation, and overt conflict with family and friends
- Financial difficulties
- Deterioration of personal hygiene
- Emotional disturbances noticed by family members; depression, anxiety, and moodiness.
Management in these situations can be difficult for the staffer as well as the chief perfusionist. Carefully document any changes in the suspected impaired perfusionist’s behaviors. Avoid any enabling behavior such as frequently covering call or completing work details for the impaired perfusionist. Confront the impaired perfusionist or notify the manager of suspicions. Any confrontation should include resources to aid the impaired perfusionist. Relieve an impaired perfusionist from duty if necessary. There are many laws and regulations pertaining to temporarily removing an employee from duty as a result of impairment. Resuming clinical duty may require an official fitness-for-duty certification. The assistance of Human Resources (HR) should always be sought in these situations.
Consider other issues the impaired perfusionist may encounter such as the loss of confidentiality, loss of trust and respect of manager, surgeon and other perfusionists, fear of losing job and license, the stigma of having a physical, mental, emotional or addictive impairment, and the reluctance of other perfusionists to get involved to help. The increased risk of suicide should be taken seriously. If after treatment and counseling, behavior is repeated and the situation warrants it, be prepared to terminate the impaired perfusionist’s employment by proper procedure under the direction of HR (2).