Signs and Behaviors of Impaired Colleagues

Although it is difficult to recognize impairment in a colleague, knowledge of the signs and behaviors is imperative for every anesthesia professional.  As Ira P. Gunn, 
CRNA, MSL, FAAN said in a 1986 editorial, "until there are better methods for preventing, controlling, and treating chemical dependency, we must remember that
we all are our colleagues' keepers and, as such, are in the best position to protect
the patients we all serve."  

If signs and behaviors are identified, or if you have any questions, see Getting Help, or call the helpline (800) 654-5167 for assistance.  

Identifying Impaired Colleagues

One or more of the following patterns of behavior and consequences may indicate substance abuse or chemical dependency in an anesthesia professional: 

  • Comes to work during scheduled time off and loiters around departmental drug supply
  • Isolated and withdrawn from peers
  • Frequent bathroom breaks or disappears on duty
  • Desire to take extra call
  • Increased or unexplained tardiness or absenteeism
  • Gradual decline in work performance
  • Consistently signs out more narcotics than peers
  • Patterns of inappropriate drug choices and dosages
  • Increased labile mood with frequent, unexplained anger and overreaction to criticism
  • Increased difficulty with authority
  • Forgetful, unpredictable, confused, and lacks concentration
  • Frequent illnesses or physical complaints
  • Dishonesty, often over trivial or unimportant matters
  • Elaborate excuses
  • Tremors or "Monday morning shakes"
  • Evidence of alcohol or drug use, such as odor of alcohol on breath, heavy perfume or mouthwash, wearing long sleeves
  • Intoxicated at social functions
  • Discovered comatose or dead

 Reporting Impaired Colleagues


Anesthetists often enable colleagues to continue bad behavior or poor performance by making excuses, accepting inadequate work, or covering up mistakes.  Coworkers may have certain legal responsibilities in identifying and reporting the chemically dependent CRNA. Many states have mandatory reporting laws which may hold colleagues responsible for harm to patients if they fail to report a coworker in whom abuse is suspected.  In those states with alternative programs, confidential reporting to the programs absolves the colleague from reporting to the nursing regulatory board. 

Call your State Peer Advisor with state specific questions regarding reporting and assistance with Getting Help for yourself or others. 


 Health & Wellness Contacts


Peer Assistance in Your State 

Peer Assistance Helpline
(800) 654-5167 
American Foundation for Suicide Prevention Hotline
1 (800) 273-TALK
Anesthetists in Recovery (AIR)
AANA Peer Assistance Advisors

AANA Staff:
Julie Rice, Wellness Specialist
(847) 655-1114 or