The impaired nurse Alcohol and drug dependence affects all segments of the population and nurses are not an exception to the rule. There is a concern that is a growing number of nurses use substances for different reasons. There is not enough data and research on the exact count, statistically speaking. However, recent statistics in state Boards of Nursing clearly define an upward trend. The American Nurses Association estimates that six to eight percent of nurse’s abuse drugs or alcohol. The two most common issues nurses have are access and availability. There are many reasons, nurses struggle with addictions. For the same reasons others do. It might be anxiety, depression or unintentional — caused from taking a prescription medication.
However, unlike everyone else, nurses and other healthcare professionals are at higher risk for substance abuse due to the nature of their jobs. Nurses may be at complex risk for substance use disorders given their risk for physical injury on the job, familiarity with comfort medications, and the overwhelming compassion of weakness on a regular basis given the stress of the work. What happened? Nurses have a higher vulnerability to substance abuse because their jobs are stressful and intense. They work long hours with little recovery time to get fully rested. And, many work in services that are understaffed.
Not to mention, they’re expected to be happy, friendly and compassionate all of the time. As a result, many nurses cope with the stress by self-medicating. Nurses are often handling powerful opioids and other prescription drugs, which can cause intensifications of temptation to use. Sometimes being the only caregiver to their patient, nurses grow attached to them causing emotional stress. While many patients recover and go home, some do not survive.
Nurses turn to drugs and alcohol to help deal with feelings of loss and grief. Suspicion on an impaired nurse Nurses must educate themselves on the signs, symptoms, behaviors, myths, and truths that represent substance abuse. While it may be very difficult to suspect a co-worker of substance abuse, and the fear of reprisal may keep some nurses from action, it’s important to take the steps necessary to confront or notify the nurse manager of your suspicions. Substance abuse issues in nursing typically are first noted by staff members.
Whether a staff nurse acts on his or her knowledge or chooses to remain silent directly affects patient care and safety and the reputation of the institution. It also in the end affects the impaired colleague’s level of functioning. Nurses should recognize that if addicted nurses are not helped, they are in risk of harming patients, the facility’s reputation, the nursing profession, and themselves.
The consequences of not reporting concerns can be far worse than reporting these issues. Educate yourself on the organization’s policy and procedures for employee substance abuse and employee assistance programs. Careful documentation of any changes in the suspected impaired nurses’ behaviors is important. If you are willing, you may choose to urge the nurse to seek help. Avoid any desire to enable the impairment. What can be done? A disciplinary approach to impaired practice or drug diversion involves due process with a state board of nursing and suspension or revocation of a nurse’s professional license.
There is no offer of a recovery program and the nurse may be terminated and legal charges can be filed. Through an alternative-to-discipline program, a nurse does not practice for a specific time while undergoing treatment and establishing sobriety and recovery program. He or she may undergo psychiatric evaluations, specialized treatment like one-to-one therapy and support groups, and random drug screens. A return-to-work agreement is created and often involves a reduction in hours, limited shifts, and restrictions in assignments with continued treatment and monitoring for periods of up to three to five years.
Restrictions are lifted as the nurse demonstrates he or she is making progress. Recovery and Rehabilitation Although the focus on rehabilitation over discipline may be controversial, the rationale is to attain a higher rate of reporting and self-reporting of the impaired nurse in order to help the impaired nurse overcome the addiction. Without early intervention, nurses with substance abuse problems can simply “job hop” from one facility to the next before getting help. In 1992, only 13 state Boards of Nursing provided an alternative to a disciplinary approach. Legislation to establish such programs was pending in 18 other states.
Today, according to the last survey by the National Council of State Boards of Nursing, 37 states have some type of program to channel impaired practitioners into treatment and rehab, monitor their return to work, and spare their licenses. In addition to rehabilitating nurses with chemical dependence, most of these programs also serve nurses impaired by certain mental illnesses, such as anxiety, depression, bipolar disorder, and schizophrenia. Some cover nurses with physical disabilities as well.
Tennessee Board of Nursing for Impaired Nurse The Tennessee Professional Assistance Program is a voluntary program funded by nurses’ licensure fees through the Tennessee Board of Nursing. The program offers consultation, referral, and monitoring for nurses whose practice is impaired, or potentially impaired, due to the use of drugs or alcohol, or psychological or physiological condition. The Peer Assistance Program (PAP) was established by the Tennessee Nurses Association in 1981 and subsequently placed under the Tennessee Nurses Foundation (TNF) in 1982 to assist in the rehabilitation of nurses who were impaired from the abuse of drugs or alcohol. From 1981 to 1994, the program was staffed with nurse volunteers who contacted the chemically dependent nurses and urged him/her to acknowledge the problem and seek treatment.
In 1994, the Tennessee Board of Nursing contracted with the Tennessee Nurses Foundation to provide advocacy, referral, and monitoring services for their licensees as an alternative to licensure discipline. Returning to the workplace and regaining trust Recognizing that substance abuse is a medical illness that requires treatment is the first step in removing the stigma associated with it.
Current philosophies of the ANA and boards of nursing support helping addicted nurses seek treatment and rehabilitation to become productive members of society and nurses again. Certainly, communication and information sharing are paramount for this process to be effective. With education about chemical dependence and compassion for each other, nurses can provide support and understanding for chemically dependent colleagues from intervention to their reentry into the profession.
