What should an occupational health nurse do when asked to deal with drug and
alcohol testing as part of a pre-employment health assessment in the absence of
a company policy? Readers provide the answer
Q Last month we asked what
readers would do when faced with the following problem: I am a newly appointed
nurse in a transport-related company. In my first induction week with my line
manager, I was advised that the pre-employment health assessment process includes
a urine drug and alcohol test. While I feel competent to perform the chain of
custody procedures, I am concerned that the employer does not have a drug and
alcohol policy. I have discussed this with my manager who has told me that the
previous nurse did not question the absence of a policy and that I should
perform the chain of custody procedure in accordance with the personnel
department’s request. What is my course of action?
A I am very much enjoying the new
feature on professional dilemmas and would like to offer an opinion on the
dilemma in the March edition.
While I believe it is extremely important to have both a drugs and alcohol
policy in place, in these circumstances it is not essential to have it already
in place. As long as the nurse is competent to carry out the chain of custody
procedure, and has the written consent of the patient that is all that is
A positive result would make the person unfit to be employed. The issue is
entirely different if the company were to decide to do random, or with-cause
testing on its employees, both of which are still quite controversial.
I would suggest that she/he advises the company to implement a drugs and
alcohol policy as soon as possible.
(Occupational Health Adviser working in industry)
The clear message should be that drug testing of a workforce should not be
undertaken without first implementing a company drug and alcohol policy that clearly
defines the purpose of the screening and its consequences. An employer may have
a number of reasons for wishing to introduce drug testing in the workplace
which may include public safety (as in the transport industry), employee safety
(reduction in workplace accidents), public relations and corporate image and
the achievement of a drug-free workplace.
Whatever the employer’s objectives, it should be mindful of its
responsibilities and statutory duties towards employees, the public and
employees of other organisations who may be working on its premises. Of
particular relevance would be the Health and Safety at Work Act 1974, the
Management of Health and Safety at Work Regulations 1999, the Misuse of Drugs
Act 1971 and the Transport and Works Act 1992.
Employers must bear in mind the consequences of the above legislation when
considering the introduction of a drug and alcohol policy and I think it is
fair to comment that it would be unacceptable to expect employees to agree to
drug and alcohol testing where no policy is in place. It is my understanding
that where a company is planning to introduce workplace drug testing, contracts
of employment must be changed and an appropriate period of notice given.
Good planning and the initiation of a clear and concise policy, are the
first steps to successfully implementing a workplace drug testing programme.
The most important stage in the introduction of the proposed policy is
communication to the workforce, who should understand what is expected of them
and the results of non-compliance. The policy should be explicit in its
objectives, state the expected code of conduct and the date from which it will
The reasons for the introduction of workplace drug testing should be clearly
stated, what drugs are likely to be detected, when employees will be tested and
what will happen in the event of a positive test result also need to be
precisely defined. It is also important that employees are aware of the appeals
procedure. In addition, the policy should state the organisation’s intentions
should an employee voluntarily seek help for a drug or alcohol problem.
While to my knowledge there are no legal restrictions on pre-employment drug
testing, it should be remembered that an employee may refuse to be tested. It
is therefore imperative when testing existing employees that a policy is in
place to give clear guidance on further action.
The advice given by the personnel department for the nurse to continue with
the procedure is worrying. What would happen if the test were performed and
found to be positive? It is likely that the employee would seek advice from the
nurse on an appeals procedure and again without a policy this is unclear.
It is important that when drug and alcohol testing is being carried out we,
as OH professionals ensure it is performed to an ethical standard with due
respect for human rights.
RGN BSc(Hons) Dip HE Cert Hlth Prom Occupational Health Practitioner MTL
Q Our February dilemma page featured
a question about whether an occupational health nurse should disclose
information from a health questionnaire to a manager who is concerned that a
new employee may have a pre-existing back problem that she has not disclosed.
A The straight answer to your
question is No! The employee is entitled to the assurance that the answers
provided to any medical questions are recognised as being confidential to
occupational health and it is not appropriate to disclose them to any other
In view of the fact that the employee has an established pattern of
ill-health-related to back pain after only five months in the job, the manager
should be contacted. My action would be to suggest that the manager review the
staff member’s sickness record and with her consent refer her for a routine
appointment with the occupational health physician. It will be the
responsibility of occupational health to advise on whether the employee is
suffering from work-related ill-health and to recommend an appropriate course
It is possible that the employee knowingly withheld the fact that she had an
existing health problem for fear of not getting the job. If it transpires that
this is preventing her from working to her present job description, management
may decide that, as a consequence of being untruthful about her fitness for
work, she should be liable to dismissal.
Occupational Health Nurse
Occupational Health Department, Llandough Hospital
Magic of Counselling
In Occupational Health October we featured a review of some videos entitled
The Magic of Counselling. Unfortunately we had some difficulty finding the
suppliers contact details. Here they are: The Quiet Associates, 35 Audley
Grove, Bath, BA1 3BT, tel 01225 463656, email: [email protected]. Apologies for the
This month’s dilemma
Senior managers within my organisation, (a local government department) are
becoming concerned by the amounts being awarded in settlement for
stress-related claims, and the evidence that stress related long-term abscence
within the company is on the increase.
As the occupational health adviser, I have been asked to assess the issue on
behalf of the company and devise a strategy for the company to adopt. In
particullar the company have asked me to devise a mental health risk assessment
tool. I am finding it difficult to write this "tool". Can anyone help
me before I too go down with stress!
What is my course of action?
Fax 020 8769 7892 or e-mail [email protected]
This month’s dilemma does not have a model answer – we are asking readers to
supply the answer themselves. We will publish a selection next month, the best
reply receives a bottle of champagne. This month’s champagne goes to Lynsey
Scott for her suggestions on how to deal with the problem on drugs testing
policy. Champagne is also on its way to the reader who supplied the real-life
professional dilemma featured above. Please
send your replies in to reach us by 12 April.