Substance Abuse in the Nursing Profession

Danielle Labitad

A career in nursing can be the most rewarding occupation most people can think of. It truly takes a unique person with a strong sense of discipline, diligence, responsibility, and a love for mankind to take on such a role. While nursing for most is very rewarding, it is also an occupation that can very easily overwhelm employees and requires most of the time more so then none, a great tolerance to stress. For some when the stress becomes overwhelming, it may lead to addiction, especially in the medical profession where prescription drugs are readily on hand. The addicted/under the influence nurse affects many people including their colleagues. Most importantly, under the influence nurses pose a serious risk to their patients. There is a major controversy in the medical field because not all states in the U.S. handle these matters in the same way. Some policies use a disciplinary method in regards to substance abuse others remove the nurse from practice and give them a chance at rehabilitation, a chance to save their licenses, and for their problem to remain confidential. Adopting a nationwide policy to address substance abuse among nurses will ease the role of the professional nurse dealing with this controversy. The sooner this situation can be addressed and reconciled in the most productive and effective way, the sooner nurses can achieve delivery of the best quality of care possible to their patients.

Approximately 10 to 15% of all nurses may be under the influence or recovering from alcohol or drug addiction. Nurses are not at a higher risk then other people but their pattern of dependency is like no other because they have greater access to narcotics in their work environment.(ISNAP 2012)

The decisions that nurses make are at times a matter of life and death, and it is imperative that nurse and healthcare providers are attentive and alert to what they are doing at all times with no exceptions. All the combined stressors that may often come with this profession, along with the other stresses of personal life may lead a person to feel as though they will do what they have to so they can make it. Sadly for some this can lead to disappear and addiction. In the healthcare setting where medication is widely accepted as a cure to ailments and is readily accessible, nurses are at high risk to develop substance issues. Although the incidence of addiction among nurses is about the same as the general population, there is a higher rate of prescription-type medication abuse as opposed to street drugs. Nurses may administer medications on a daily basis, thus may feel more comfortable self-medicating.

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One of the most important roles of a registered nurse is to assure the patient is getting the safest and most appropriate care possible. If a nurse is providing care while under the influence they are failing to fulfill this role. There is also a legal and moral responsibility of all nurses to report suspicions of abuse because the number one role of the nurse when dealing with an impaired colleague is to protect the patient. There may not be many signs or symptoms in the beginning, however as it progresses, it becomes more clear that something may not be right.(Bettinardi-Angres K,& Bologeorges 2011)

Impaired nurses become unable to provide safe and appropriate patient care. Today addiction is considered a disease, but the addicted nurse still remains responsible for actions when working. The most common substances abused by healthcare professionals are alcohol, cocaine/crack, Ritalin, marijuana, inhalants, ultram, methamphetamines, ecstasy, hallucinogens and stadol, sleeping pills, antidepressants, morphine, Demerol, Percodan, vicodin and codeine. However, coworkers should never underestimate the need or desire for drugs from a substance-abusing nurse. The nurse might use whatever drug is available to satisfy the addiction while at work.(Monroe & Kenaga, 2011)

Nurses must be aware and proactive on the signs and symptoms that represent substance abuse. It may be difficult to suspect a co-worker of substance abuse, and the fear of retaliation may keep some nurses from taking action, it’s important to take the necessary steps to confront or notify the chain of command of your suspicions.

Educate yourself on the facility policy and procedures for employee substance abuse. Through documentation of any changes in the suspected impaired nurses’ behaviors is important. You may choose to urge the nurse to seek help and avoid any desire to enable the impairment.

The legal aspects to report an impaired nurse vary from state to state, but nurses have a moral and ethical duty to their patients, colleagues, the profession, and the community to take action. Documents such as the American Nurses Association Code of Ethics for Nurses provide a framework for patient safety.(Vernarec 2012)

Nurses who will have the courage to seek treatment have a good opportunity for a successful recovery. Treatment can be effective to improve health, social, and occupational well-being. Many organizations offer alternative treatment programs instead of termination. As of 2012 37 states offer some form of a substance abuse treatment program to direct nurses to treatment, they monitor the nurses’ re-entry to work, and continue their license according to the National Council of State Boards of Nursing.

Alternative programs monitor and support the recovering nurse for safe practice. Strong recovery programs offer a comprehensive individualized treatment plan. However, boards of nursing have a responsibility to safe guard the public, so they may suspend the nursing license of an identified impaired nurse if they suspect he or she may pose a danger to patients.(ISNAP 2012)

The American Nurses Association (ANA) is a strong supporter of alternative or peer assistance programs that monitor and support safe rehabilitation and the eventual return to the professional workforce. While relapse is high, the goals for the substance-abusing nurse is to seek treatment, reach recovery, and re-enter the workforce.(ISNAP 2012)

Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions.(Monroe & Kenaga, 2011).

The nursing profession is all about caring and educating not only for the patient, but also anyone who needs assistance and it is important for everyone to understand that those who are suffering with addiction have an illness, which requires treatment and evaluation.

References

Bettinardi-Angres K, Bologeorges S. Addressing chemically dependent colleagues. J Nurs Regulation. 2011;3(2):10-17.

ISNAP Indiana State Nurses Assistance Program. Retrieved July 7, 2012 from http://indiananurses.org/isnapsite/warning_signs.php.

Monroe, T., & Kenaga, H. (2011). Don’t ask don’t tell: substance abuse and addiction among nurses. Journal Of Clinical Nursing, 20(3/4), 504-509. doi:10.1111/j.1365-2702.2010.03518.x

Vernarec, E. Impaired nurses: Reclaiming careers. The Carter Center. Retrieved July 7, 2012 online from http://www.cartercenter.org/news/documents/doc591.html?printerFriendly=true 2001.