This site contains no information directly related to the problem of substance abuse within the profession. The industry related information on the workplace environment is geared towards serving the nursing professional, and especially protecting their rights in the various nursing workplace settings. It begs the question of why, when substance abuse is a problem in the profession, the site offers no resources to the nursing professional as to where they might confidentially turn to for help with substance abuse problems, nor does it encourage the nursing professional who might be suffering such a condition to seek help. This might be as a result of the very public exposure that is inherent in its internet setting, and suggests that perhaps the industry considers substance abuse and guidance for the nursing professional who might seek help to be a condition or problem that is not best addressed on such a public forum level.

One of the professional journals which have published current and pertinent articles on the subject of substance abuse in the nursing profession is the Clinical Journal of Oncology Nursing. An article in this journal by JeanAnne Johnson Talbert (2009) boldly discusses a specific case of a nurse, Tammy, in a hospice setting who puts a patient at risk when she steals the medications of patients under her care (p. 17). In the case discussed, the nurse who follows Tammy notes the level of distress of one particular patient, and, upon examining the patient's chart and medication record, takes action to relieve the patient's distress and pain (p. 17). This action by the nurse who follows Tammy causes the patient to code, and even though the patient recovers, the nurse following Tammy becomes suspicious, and practices good nursing medicine by trying to understand what went wrong with her patient's care (p. 17). The follow-on nurse has actually had a suspicion about Tammy and the patients' medications for some time, but having now experienced a direct patient crisis as a result of what she believes is a case of a nurse stealing patients' pain medications, she reports Tammy (p. 17).

This very important case study, the only one its kind found in the literature, segues to a discussion by the author on substance abuse by nurses (p. 17). The article is well organized, and examines the nurses as substance abusers with criteria for recognizing signs and symptoms of the nurse substance abuser, underlying causes for substance abuse, and, most importantly, the issue of whether or not colleague, fellow nurses, should become involved if they suspect a nurse they work with is abusing substances (p. 17).

The flow of the article is logical, citing current sources in the literature, and even the Drug Enforcement Agency (DEA). It is important because it is the only article of 49 articles that specifically cites a case study involving a patient put at risk because of a nurse's substance abuse. It also demonstrates that while nurses are more likely to abuse prescription medicines, those medicines are not necessarily prescribed for the nurse by a physician, but actually come from the nurse's access to powerful narcotics intended for patient care. It is not only a case of drug abuse, but theft, and patient abuse, because the medications for patients experiencing end of life pain and distress from cancer are being deprived of a quality of life that can only be achieved by administering to their needs with pharmacological interventions. It brings up serious issues about nurses and substance abuse which warrant further studies.

An article found in the American Journal of Public Health, written by Carla L. Stor and Alison M. Trinkoff (1998). This article is one of two found through the search engine query that contains quantitative statistical data as a result of direct research. The statistics support the data cited in other reports as it pertains to the percentages of nurses who have substance abuse problems, and the percentage of nurses, six percent, whose impairment as a result of substance abuse is putting patients in harms way. This study is cited in other articles selected for inclusion here. The data yield is supported by the second article, by Margaret West (2002), which uses the same anonymous mailed survey approach. West, however, employs Donovan's multifactorial model of impairment and the Rogerian Theory of Unitary Human Beings. The Trinkoff and Stor article was available through the search engine only in its abstract form, although the abstract was succinct in the data results of the study. The West article was available as a full-text article.

The West article cites as its weakness the anonymous mailer approach, and we can ostensibly...

West used a descriptive and co relational and comparative methodology to examine patterns of abuse, and Trinkoff and Stor also looked for co relational patterns, but across nursing specialties. West says the anonymous mailer sample was "one of convenience," and, therefore, "the findings cannot have widespread generalization (p. 193)." Trinkoff and Stor are cited by another of the articles, Dunn (2005).
Summary

The articles selected for this essay have points that support conclusions from one to the next. Each article that addresses the issue of reporting substance abusing nurses who are putting patients at risk, however, that does not happen as often as we might hope. Nurses are trained to be sensitive to social, family, and other conditions which might adversely impact an individual's well being, and, in the face of overwhelming problems in any one of these areas, turns to substance abuse. As might be expected, the industry is protective of their working group, and nurses seldom report one another for substance abuse even when it puts patients at risk (Dunn, 2005, p. 578).

A nurse, such as the one cited in the case study, Tammy, is likely to be disciplined by the licensing board and would lose her license. More recently, however, the industry's protection of nurses and nursing jobs has been reflected by calls for nurses, like other people, to have an opportunity to receive substance abuse treatment and enter a program for support in pursuing and maintaining sobriety (Fletcher, 2004). The problem that arises is that patients are at risk, and as we saw from the case study, it can be life threatening if nurses do not report their colleagues.

Another problem that we find in the literature cited, is that one of the places that a nurse might turn to seek information on getting assistance, the ANAOJ, does not have any information or direction for nurses seeking that kind of help. A nurse with a substance abuse problem who recognizes his or her own need for help, but who is concerned about self-reporting because of the potential consequences, and whose decision making ability might be impaired because of his or her substance abuse, would not find recommendations on an important industry web site.

There are many considerations that must be made when considering the substance abusing nurse, but the nursing dictum, "First, do no harm," must always take precedence. The well being and quality of life of patients in the care of nurses should always be the first and foremost consideration.

Annotated Bibliography

American Nurses Association online Journal; Nursing world;

http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/environmentalhealth.aspx, 2009 -- retrieved October 20, 2009. A professional information web site that updates the nursing industry on news, events, continuing education credits, and other information useful and needed by the nursing profession, falls short in that it has no information whatsoever for the substance abusing nursing professional. This site provides valuable information to the profession, but does not acknowledge the problem in substance abuse in the profession. It is one of the places that a nurse might turn to for information if he or she recognizes that they have a substance abuse problem, and are worried about confidentiality, but they would not find assistance or direction at this site.

Beckstead, Jason W. (2005). Reporting peer wrongdoing in the healthcare profession: the role of incompetence and substance abuse information, International Journal of Nursing Studies, 42(3), 325-332, Gale, Full Text, retrieved October 21, 2009. This is an article that attempts to report and analyze from the nursing professional's perspective. It supports the notion that nurses, as a profession, view substance abuse as a serious condition of the nursing professional. The article, however, goes on to examine the complex ways in which nursing professionals view substance abuse. It contends that their training critical thinking skills acquired during their nursing training makes it a complex issue for them to consider.

Dunn, Deborah (2005). Substance abuse among nurses: Defining the issue, AORN Journal 80(4), 572-595, retrieved 21 October 2009, Gale, Full Text. This article is cited by other articles selected for this essay. It is an independent study focusing on the issues of substance abuse in the nursing profession. It discusses the prevalence of addiction in the nursing profession, signs and symptoms, the adverse effects of failing to report colleagues, and the role of the…