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Thread: Drug addiction among nurses: Confronting a quiet epidemic

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    Super Moderator cougarnurse's Avatar
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    Drug addiction among nurses: Confronting a quiet epidemic

    Quite a while ago, a member asked you all to aid her in a story she was planning to write. Thanks for the help you gave her. Here is the link and story: Drug addiction among nurses: Confronting a quiet epidemic - Many RNs fall prey to this hidden, potentially deadly disease. - RNweb

    Some nursing specialties, such as anesthesia, critical care, oncology, and psychiatry, are believed to have higher levels of substance abuse because of intense emotional and physical demands, and the availability of controlled substances in these areas, according to "Substance Use Among Nurses: Differences Between Specialties," a landmark study in the April 1998 American Journal of Public Health.

    ADDICTION TRIGGERS

    Most RNs, regardless of their practice areas, experience the stresses of long shifts, mandatory overtime, and shift rotation, which are physically taxing and tough on family life and friendships. Added to that are emotional demands. Nurses often need to internalize their feelings to stay in control and make split-second, life-and-death decisions. "Nurses go from one emotionally and physically demanding situation to another, with little time to decompress," Holloran said.

    As the backbone of the U.S. healthcare system, nurses are essential to the quality of care and well-being of patients. Nurses with untreated addiction can jeopardize patient safety because of impaired judgment, slower reaction time, diverting drugs from patients, neglecting patients, and making mistakes, wrote Debra Dunn, RN, in an often-cited study, "Substance abuse among nurses—Defining the issue," in the October 2005 edition of the AORN Journal, which serves the Association of periOperative Registered Nurses.

    The availability of medications at work and the acceptance that drugs have the power to help you feel and perform better increases healthcare professionals' risk of drug abuse. "Nurses have seen for themselves that medications can solve problems," said Holloran. Because of their access to and familiarity with drugs, nurses may feel comfortable using them on their own. "We have the erroneous belief that, because of our skills and knowledge, we can self-medicate without becoming addicted," Holloran added.

    DRUGS OF CHOICE

    While nurses' abuse of drugs and alcohol is roughly equivalent to the general population's, Dunn's study said, dependence on prescription-type medication use is higher for nurses, and addiction to street drugs, such as cocaine and marijuana, is much lower than the population. The most frequently abused substance is alcohol, followed by amphetamines, opiates (such as fentanyl), sedatives, tranquilizers, and inhalants, according to the ANA.

    A study on monitoring the diversion of controlled substances in the March 2007 Hospital Pharmacy details the typical ways that nurses obtain drugs in a healthcare setting. Nurses may ask doctors to write a prescription for them, or steal a script and forge prescriptions themselves, the study said.

    They also may divert drugs by administering a partial dose to a patient and saving the rest for themselves, or by asking a colleague to cosign a narcotics record saying a drug was wasted without witnessing the drug's disposal. Some nurses have signed out medications for patients who have been transferred to another unit or obtained as-needed medications for patients who have refused or not requested them.

    REPORTING AN IMPAIRED COLLEAGUE

    Substance abuse usually is noted first by fellow staff members. Some nurses may be reluctant to report a colleague. However, those who remain quiet about a colleague's drug abuse risk patient care and safety, the facility's reputation, and even their colleague's life.

    The New York State Nurses Association'smodel drug policy states: "Employers have an ethical obligation and most have a legal mandate to report an impaired nurse to the appropriate legal and regulatory authorities in order to safeguard consumers." The policy adds that nurses also "have an ethical obligation to address impairment of a colleague."

    While patient safety is the primary reason to report a nurse suspected of abusing drugs, a second reason is to help that nurse. Holloran said, "As bad as that day was when I was confronted for diverting drugs, it most likely saved my life."

    ADDICTION A TREATABLE DISEASE

    The ANA regards addiction as a "chronic, progressive, and treatable" disease. Addiction only gets worse if left untreated, and can be fatal due to overdoses, accidents, or the chronic effects of the disease over time.

    The ANA strongly advocates that medical facilities establish educational programs that teach nurses how to recognize colleagues who may be abusing drugs, and ensure that they know the facility and state board of nursing (BON) policies. Nursing staffs, the ANA said, also should know how to support colleagues who participate in rehabilitation programs. This provides recovering nurses with support and supervision while they regain full nursing practice.

    "Many nurses are not educated about how to recognize or intervene with a colleague who is abusing drugs or alcohol," Stem said. Too many healthcare facilities choose to fire employees with addiction problems rather than deal with the issue directly, leaving the addicted individual free to apply for employment elsewhere and put other patients at risk, he added.

    SELF-REPORTING RARE

    Holloran and Stem agree that addicts rarely self-report for fear of losing their jobs, licenses, and livelihoods. Another major factor, they said, is that addiction causes chemical and physical changes in the brain that lead many addicts to think they are in control—until they hit rock bottom or overdose and die.

    In most instances, intervention creates an "artificial rock bottom," when the nurse can be offered treatment and rehabilitation in lieu of discipline, such as losing their licenses. "Most nurses will agree to undergo treatment and monitoring—if only to save their licenses—until they get to the point where they want to stay clean and drug-free," Stem said.

    WHAT TO DO IF YOU SELF-REPORT OR ARE CONFRONTED

    Whether they self-report or are confronted, nurses should enter an intervention program in lieu of discipline, said Marilyn Clark Pellett, RN, an attorney who has represented nurses in disciplinary hearings before the Connecticut Board of Nursing for many years. All but a handful of states have them. Through an intervention program, nurses sign contracts that specify they will undergo rehabilitation, therapy, and frequent drug testing, and attend 12-step programs.

    If nurses have been involved in diverting drugs, Pellett said, their employers have an obligation to report this to drug control authorities and the state BON. Nurses should seriously consider legal representation if formal action is being brought against them, especially in cases of serious diversion or drug dilution.

    A nurse's license may be temporarily suspended until he or she demonstrates progress in recovery, Pellett said. A number of medical facilities have supervisory programs that allow recovering nurses to return to duty. Recovering nurses, however, will not have access to narcotics and must be constantly supervised by other nurses until their licenses are fully restored, which can take months or years depending on the nurse's situation and the state BON's procedures.

    While nurses can retain or recover their licenses, Pellett observed that most nurses underestimate the amount of time that the rehabilitation and supervision process requires.

    Pellett and others in the drug addiction field view substance abuse as an occupational hazard for licensed healthcare workers. The general population doesn't have constant access to drugs as nurses, doctors, pharmacists, and others do.

    "When healthcare professionals deal with other hazardous substances, such as biohazards, radioactive materials, or toxic waste, we find ways to protect these people," Pellett said. "We should view drugs in the same way."

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    Super Moderator cougarnurse's Avatar
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    It's been nearly a year. I wonder if there might be an update?

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    Super Moderator cougarnurse's Avatar
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    Here is another article re: the story: http://www.modernmedicine.com/modern...date=&pageID=4

    What are nurses' attitudes about addiction in their ranks?
    Ultimatenurse.com, an information and discussion forum for nurses, invited RN to conduct an online survey of its registered members to find out. The 10-question survey, posted Feb. 18-20, 2009, netted 313 responses. Here are the questions and a summary of answers:

    1) HAVE YOU EVER WORKED WITH NURSES YOU FELT WERE ADDICTED TO DRUGS?

    Fifty-nine respondents said they had worked or are working with nurses impaired by drug addiction. Several nursessaid they had supervised other nurses who had returned to work following treatment for addiction. Eighty-eight said they were certain they never worked with drug or alcohol-addicted nurses. Others were not certain, given the strict privacy policies at their facilities. Some commented that keeping addiction problems private was challenging when nurses would return from a leave of absence, were supervised by others, and no longer had access to narcotics. "Once that happened, entire shifts would know," one respondent said.

    2) HAS PATIENT CARE BEEN AFFECTED BY NURSES WITH DRUG-ADDICTION PROBLEMS AT YOUR FACILITY?

    A total of 76 said drug-addicted nurses had hurt patient care at their facilities by diverting pain medications, failing to recognize changes in patient assessments, and making medication errors.

    3) HOW GOOD ARE EMPLOYEE-ASSISTANCE PROGRAMS (EAPS), PEER-SUPPORT, AND REHABILITATION SYSTEMS AT YOUR FACILITY TO HELP DRUG-ADDICTED NURSES RECOVER?

    Most said they had no personal knowledge of these support systems. However, 39 reported good-to-excellent EAPs, peer-counseling, and rehabilitation resources. One remarked, "If the nurse realizes there is a problem and goes to the nursing supervisor, there is a lot of support." A total of 56 rated their programs and support of drug-addicted nurses as fair, poor, or nonexistent. "I had to look for help and support outside the facility," said one respondent. Nurses in such facilities tended to report that nurses with addiction problems were fired. One commented, "My employer at the time of my active addiction chose to fire me, thus saying it was no longer their problem." Some said that because of the stigma of drug abuse and fear of losing their licenses, they left their jobs before employers found out about their addiction. One noted, "I quit before I found out about the EAP and peer-support program. I was so scared. I went into rehabilitation on my own."

    4) HAVE YOU EVER BEEN ADDICTED TO DRUGS?

    Twenty survey participants reported problems with addiction. Most of these said they have been in recovery for years and successfully returned to full practice. One chose to practice nursing in areas where narcotics are not administered. Another works in a drug-rehabilitation facility. However, one respondent gave up nursing for fear of relapse.

    5) DO YOU HAVE RECOVERED NURSES AT YOUR FACILITY?

    Most respondents said they didn't know of any. Others have worked with several nurses who were supervised during their recovery and are now "doing fine." A few reported that they worked with nurses in recovery who relapsed and ultimately lost their licenses. One nurse said she worked with a colleague almost a decade ago who was heavily supervised and restricted from dispensing narcotics: "Some nurses were supportive, but others were rude and agitated at the prospect of having to pass controlled substances for that nurse. The verbalization was 'She shouldn't be here if she can't do her full job.'"

    6) WHAT CAUSES NURSES TO BECOME ADDICTED TO DRUGS, IN YOUR VIEW?

    The overwhelming response was "stress"—from work and family responsibilities, coupled with a predisposition toward addiction and availability of drugs at work. One nurse commented that many nurses are the "big breadwinners, adding stress to an already stressful career." Another said some nurses have come back to work following injury or surgery, still in pain and on medication. That plus working in a high-stress environment with the controlled substances available "sets nurses up for addiction." A third felt that every profession, not just nursing, comes with its own set of stressors: "Drug use provides an 'escape' from reality," and is easier than doing the "difficult internal work of developing safer and more appropriate coping skills."

    7) DO YOU FEEL THAT OTHER STAFF MEMBERS—SUCH AS PHYSICIANS, FOR INSTANCE—WHO ARE ADDICTED TO DRUGS GET TREATED DIFFERENTLY FROM NURSES?

    This question got a spirited response, with many nurses reflecting a comment from one participant who said, "Doctors generate a lot of money for hospitals. Indeed, they are treated differently." Some nurses felt that doctors tended to cover for one another and have the financial resources to obtain better treatment for addiction. Other nurses said they did not know or felt that treatment was fairly equal among all hospital staff.

    8) WHAT KEEPS NURSES FROM SELF-REPORTING IF THEY ARE ADDICTED TO DRUGS?

    The overwhelming response was "fear": of job loss, losing one's license and livelihood, losing respect of peers, family, and friends, and lifelong stigma. A few others cited "denial." They said the addiction process prevents nurses from knowing they have a problem. One commented, "Nurses are human. Most individuals don't self-report drug addiction until they reach rock bottom or are caught."

    9) DO YOU BELIEVE THE INCIDENCE OF DRUG ADDICTION AMONG NURSES IS GROWING?

    Responses were mixed. One participant who has been a nurse since the 1960s said, "I work with the same percentage of addicted nurses now that I have always worked with." Another nurse felt that addiction problems will continue to grow: "There is a reason there is a nursing shortage. It's a very, very difficult and taxing job. You need a lot of personal resources and support to do it well and to remain whole." A few nurses said the advent of automated medication and supply-management systems has helped to reduce the incidence of drug addiction.

    10) DO YOU BELIEVE THAT YOUR FACILITY IS TOO SOFT OR TOO HARD ON NURSES WITH DRUG PROBLEMS?

    One nurse responded that facilities in general are too soft. "I believe that healthcare professionals are in a unique and privileged position to have access to narcotics. We should be fiercely protecting patients from healthcare professionals who are high on drugs, as they are impaired and cannot provide a high level of care." Others felt that state boards of nursing have become too punitive, without a balance of consequences and support. "I would make professional nurse support groups more easily accessible and mandatory for the duration of the consent agreement. I would mandate 12-step recovery meetings during and after mandated treatment. There would be a committee within the board to do case management on nurses needing supervision. The contract I signed ... included all this and more, and kept me compliant until I wanted to be, until I got past the shame and fear." Several felt that facilities were tough on those who were caught but often take too long to investigate nurses who are suspected of substance abuse. Some nurses were frustrated when reporting suspected drug-abuse problems. One was made to feel like a "troublemaker." Another was told, "We're working on it. We need more proof." Three respondents recommended random drug screens for all nurses to detect problems at an earlier stage, rather than singling out a certain nurse who is suspected of drug abuse, or waiting until patient care is compromised. One commented that nurses with drug-abuse problems should be treated "like human beings with an illness rather than as criminals. A little compassion, my friends. ... We have all stumbled and fallen short."

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