As an employer, you may be required to report an employee who you suspect or know has a problem with substance use disorder. The employer must be familiar with the requirements of not only the board of nursing, the board of pharmacy, and the office of the attorney general but also the Indiana Professionals Recovery Program (IPRP). We are here to help you. 


If you question whether or not your employee may be addicted, abusing, diverting, or practicing impaired, we encourage you to familiarize yourself with these possible indicators of an impaired provider. This list is not meant to diagnose but may serve as preliminary warning sings that there is a problem with substance use disorder or an impaired provider:

  • Sudden change in attitude, mood, or personality
  • Change in work habit; late to work, unprepared for shifts, hurried
  • Coming in early, staying late, offering to give breaks often
  • Change in medication use
  • Patients report increasing pain/discomfort on nurse's shift
  • Weight loss/gain/changes
  • Increased isolations
  • Pupillary changes (constriction or dilations)
  • Physical illness such as nausea, vomiting, diaphoresis or anxiety (possible signs of withdrawal)
A careful plan of action needs to be constructed to avoid a negative reaction and allow you to keep your thoughts on track as you communicate with the individual. We can help.

Next Steps

A collection of objective documentation or “evidence” is imperative. A careful plan of action needs to be constructed to avoid a negative reaction and allow you to keep your thoughts on track as you and your team communicate with the individual. Ideally there should be a variety of staff members present during the intervention, representing human resources, security, EAP, nursing, pharmacy, etc. Contacting IPRP before attempting an intervention is suggested to garner support and expertise.

As IPRP, we are required to work directly with all agencies as well as with you, their employer, to ensure transparency and promote a successful completion of the program. Not only are you providing your employee with the chance to live their best life, but you are also keeping the public, your institution, and your patients safe.

Once the employee meets criteria and demonstrates program compliance, we will assist you and the employee in implementation of a professional re-entry plan. This plan will help ensure the provider remains compliant with the program while practicing in your healthcare profession safely.

It makes a difference

A study published in Nursing Research concluded that alternative-to-discipline programs for healthcare professionals potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more professionals with substance use disorders, thereby initially removing more nurses with active substance use problems from direct patient care.

Contact us if you suspect a healthcare professional of abusing drugs.

Know The Signs:

American Nurse Today published the below considerations when determining if a healthcare professional has a substance use disorder:


  • Brief, unexplained absences from the nursing unit
  • Rounding at odd hours
  • Medication errors 
  • Isolation from peers
  • Mood changes after meals or breaks
  • Frequent reports of lack of pain relief from assigned patients
  • Narcotic or Pyxis obsession, offering to medicate co-workers patients
  • Wasted narcotics attributed to a single nurse 
  • Increased narcotic sign-outs
  • Discrepancies with the narcotic record and/or the patient record
  • Altered verbal or telephone medication orders
  • Decreased quality care, documentation arriving late to work and requesting to leave early

Physical Signs

  • Shakiness and/or tremors
  • Fatigue
  • Slurred speech
  • Frequent use of mouthwash or breath mints
  • Watery eyes
  • Constricted/dilated pupils
  • Diaphoresis
  • Unsteady gait
  • Frequent runny nose
  • Frequent nausea, vomiting and diarrhea
  • Weight gain or loss
  • Change in grooming

Behavior Changes

  • Frequent mood changes
  • Outbursts of anger
  • Defensiveness
  • Inappropriate laughter
  • Hyperactivity or hypoactivity
  • Lack of concentration
  • Blackout periods
  • Justify with the need to "relax" 
  • The need to escape reality
  • Cold weather clothing in warm weather to hide track marks
  • Frequent accidents or emergencies 
  • Personal relationship issues
  • Insomnia
  • Frequent complaints of pain
  • Denial of problem
  • Frequent lying
  • Poor judgement in work
Indiana Professionals Recovery Program
If you suspect a co-worker is impaired, or you are struggling
with substance use disorder, reach out today.