Fitness for Duty Workplace Resources

Get Help in the Workplace

The AANA recommends all healthcare facilities create, improve, and enforce comprehensive and evidence-based policies and procedures to address at-risk substance use, drug diversion, impairment, and substance use disorder (SUD) in healthcare providers, including anesthesia professionals.   

 A 2019 safety notice issued by The Joint Commission encouraged all healthcare organizations to establish a policy to help detect and deter drug diversion. Leaders have the responsibility to institute processes for rapid response to drug diversion and to create a safety culture that supports staff with uniform and equitable management of providers with at-risk use.  

Establishing Workplace Policies 

This environment makes staff feel safe and empowered to speak up promptly with concerns, i.e., “see something, say something.”  The AANA recommends the following key elements in the development and implementation of workplace policy and procedures: 

• Apply a non-discriminatory and non-punitive fitness for duty policy equally across all facility personnel (e.g., employees, contracted providers, students in clinical training). 
• Incorporate promotion of and support for mental and physical well-being and fitness for duty including emotional support for grief and healing, e.g., experiencing a colleague’s death or following an adverse event, reporting another for drug diversion or impairment. 
• Implement drug diversion deterrence strategies. 
• Develop procedures to report and address a fitness for duty concern appropriately. 
• Respond rapidly to drug diversion or impairment observations. If action is required, follow established workplace policy and process. 
• Follow best practice guidelines for fair, safe, empathetic, and non-punitive interventions. 
  • Please call the AANA Helpline (800-654-5167) before and after conducting an intervention for instructions and guidance from our partner Parkdale Center for Professionals.
• Transition the individual to an addiction treatment provider experienced in treating healthcare professionals, where a comprehensive evaluation will be conducted to develop a plan for inpatient treatment and aftercare aimed at disease remission and continuity of care. For more information, see the accompanying Fitness for Duty Toolkit for recommendations specific to anesthesia professionals. 
• Establish a supportive workplace for individuals returning to work, including monitoring, return-to-use mitigation factors, and peer support from colleagues. 
• Educate personnel judgment-free during the onboarding process, provide annual ongoing education, and encourage open communication. Effective education includes: 
  • The definition of fitness for duty and the personal and professional responsibility to be mentally and physically well. 
  • Self-care strategies for resiliency and stress reduction. 
  • The facility fitness for duty policy and process. 
  • The disease of SUD for increased understanding and reduced stigma. 
  • The risk of SUD in a healthcare workplace. 
  • The signs and behaviors to identify impairment or drug diversion. 
  • The importance of early identification. 
  • The procedure to report a colleague anonymously or self-report. 
  • The components of safe intervention, including the risk of suicide when addressed poorly. 
  • The importance of a recovery-friendly environment for the return to clinical practice following SUD treatment. 

Well-conceived and well-executed policies and procedures can help healthcare professionals restore their health and retain their licensure, career, and identity. A pathway to return to a workplace is an incentive for sustained remission. This approach may help decrease the costs by reducing the need for staff dismissal, recruitment, and replacement.  

Resources to Support Workforce Policies 

Resources for nurse anesthetists and facilities to prevent, detect, and treat substance use disorder. 

• AANA Addressing Substance Use Disorder for Anesthesia Professionals 
• AANA Signs and Behaviors:  If You See Something, Do Something 
• SAMHSA Drug Testing 
• National Safety Council Workplace Drug Testing 
• NCSBN Course: Understanding Substance Use Disorder in Nursing 
• ONDCP Launches New Recovery Ready Workplace Toolkit
• AANA Helpline Resource: Signs & Behaviors, Intervention Essentials, Treatment Recommendations, and Re-entry Criteria for Anesthesia Professionals