Substance abuse among nursing professionals

Nursing

Chemically Impaired Nurses

This is a paper on chemically impaired nurses. There are four references used

Health care workers face a number of challenges every day. Some have to work with nurses who are chemically impaired, while others are the ones dealing with the impairment. It is important to examine this growing problem in order to gain a better insight into those who are affected.

A Long History

The problem of chemically impaired nurses is not a new issue. In fact, "substance abuse among nurses has existed for at least 150 years. Historical research has shown that intoxication on the job existed even during the mid-19th century when Florence Nightingale began her work (West)."

Defining Impairment

In 1984, the American Nurses' Association (ANA) "defined an impaired nurse as one who 'has impaired functioning which results from alcohol or drug misuse and which interferes with professional judgment and the delivery of safe, high quality care' (West)."

Increased Awareness

The first time the ANA addressed "the issue of nurses with substance-related disorders was in the 1980s (West)," which was responsible for creating increased awareness of this dilemma.

Impairment research "increased during the 1980s but was focused on identification, attitudes about, effects, and consequences of impairment. Little attention was given to the previous circumstances leading to impairment or interventions to prevent nurses from becoming impaired (West)."

Alarming Statistics

It is estimated by the ANA that "approximately 6%-8% or nurses may have a problem with substance abuse, and those working night shift or on rotating shift have the higher degree of addiction (nursing.about.com/library/2000/blchem2.htm)."

Reports show that approximately 32% of nurses smoke, drink or use drugs. Even more alarming is the fact that "many nurses start using the substance they are addicted to before the graduate from nursing school. This makes preventing substance abuse more important than predicting it (www.nurseweek.com/news/98-5/25e.html)."

Impairment Causes

While there is not a particular theory available to explain why some nurses become chemically impaired, there have been "theoretical explanations which have focused on the unique relationship of people to their environment. Substance-related disorders are complex and no one identified set of risk factors account for them (West)."

Nurses who are chemically impaired must deal with certain matters that "add complexity to their recovery. Nurses are two to three times more likely to be impaired by chemical dependency than the general population, as they are used to prescribing or administering pills to cure anything. A high rate of nurses are children of addicted family systems, and their personal issues and experiences may make them susceptible to chemical dependency (Anderson)."

Denial

Impaired nurses deny they have a problem with substance abuse due to a number of reasons, such as "fear of job loss, confronting guilt and shame, specialized knowledge which contributes to the illusion that their drug use is under control, and the development of skills which enable them to postpone or avoid their feelings of pressure on the job (Anderson)."

Since the 1980s, there have been a number of advances made which are aimed to warn and instruct nurses about the problems associated with chemical addiction in their field. Despite these efforts, in 1994 "one in seven nurses in Georgia was or became impaired with chemical dependency, translating into 4,100 of Georgia's 59,000 RNs who were at risk (Anderson)."

Dependency in the Workplace

Studies show that the "workplace is often the last place chemical dependency is detected. A nurse's home life may be falling apart, but he/she still manages to get to work (Anderson)."

Since the main objective of a nurse is to make sure patients are cared for, other nurses will make sure patients do not suffer if the impaired nurse is not performing his/her job. While taking up the slack of the impaired nurse may ensure the safety of the patient, co-workers may actually be enabling the impaired nurse.

Enabling "within the profession can be attributed to many factors:

The conspiracy of silence: Everyone smells the odor of alcohol; no one says anything.

Fear of wrongful accusation.

Fear of reprisal.

Fear of personal vulnerability.

Fear of litigation.

Fear that the nurse will lose his/her license.

Unidentified codependency issues.

Unidentified alcoholism experiences (Anderson)."

Addiction Per Specialty

Studies have shown that nurses in certain fields are more likely to become chemically impaired due to the amount of stress they are under. "Emergency and critical care nurses are more than three times as likely to use marijuana or cocaine as nurses in other specialties. Oncology and administration nurses are twice as likely to engage in binge drinking, while psychiatric nurses are most likely to smoke cigarettes. Besides facing stress, and having easy access to medications, critical care and emergency nurses may use recreational drugs more often because they are more likely to have a sensation-seeking personality trait (www.nurseweek.com/news/98-5/25e.html)."

Treatment Implications

Getting treatment for chemical dependency will help the nurse get back to his or her daily life, however the nurse will have to address concerns and/or consequences related to the addiction. He or she faces a "multitude of traumatic experiences both potential and real, such as arrest, license suspension/revocation; negative publicity; reactions of family, friends and co-workers; fines; board and legal hearings; inability to secure work other than nursing; physical illness; and possible lack of health insurance. In the treatment setting, issues such as these add complexity to the nurse's recovery (Anderson)."

There are other complications which must be addressed during treatment of the impaired nurses. These issues include being considered a role model by everyone, having trouble becoming a patient instead of a caregiver, thinking instead of feeling, guilt over taking a patient's medication and possibly endangering the patient, and denial about the addiction due to taking prescription medications instead of street drugs. Since a nurse's work environment provides greater access to drugs, there may be concerns of a relapse upon returning to work.

Recovery Process

In order for the impaired nurse to recover properly, it is imperative that the addiction be treated with a lot of effort and patience. It takes time for the nurse to completely resume his or her career, and will only happen after the "nurse's feelings, beliefs, values, and behaviors become integrated and harmonious (Anderson)."

Researchers believe the chemically impaired nurses should not be subjected to "demoralizing punitive action, but instead have work places sponsor treatment for the nurse (www.nurseweek.com/news/98-5/25e.html)." Studies indicate nurses who receive proper treatment have a "very good rate of recovery and ability to return to work (www.nurseweek.com/news/98-5/25e.html)."

Returning to Work

When a nurse returns to work after receiving treatment for chemical addiction, the Board of Nursing will impose certain requirements which must be adhered to during a set probationary period. These rules may "include:

The nurse's license is limited. There is no access to controlled substances for a set period of time.