Drug Abuse in Nursing

Drug Abuse in Nursing

Nurses and other medical professionals are tasked with taking care of their patients, of healing the body and saving lives. It is the job of these healthcare workers to literally stay death and make the individual well again. They are life givers and life savers. Every day, nurses and doctors have to go to work knowing that they will witness some sort of despair and trauma. A nurse must be both compassionate and competent. They must feel for the patient, but they must also remain emotionally distant enough that they can still do their job accurately and efficiently, otherwise the staff metaphorically bleeds for everyone who is physically doing so. This profession leads men and women into high-stress situations wherein poor choices can be made. If the individual is able to release their stress in healthy manners such as time with family or hobbies, they are able to function continually without detrimental effects. However, some people respond to the high stress of the medical profession by turning to self-destructive behaviors. Some individuals succumb to alcohol, others to gambling or promiscuity. Others succumb to the dangers of drug abuse, often using the narcotics which are available to them inside the hospital.

According to Hrobak (2001), "Chemical dependency in nursing is defined as a state of psychological and/or physical addiction to a chemical substance or substances. Use of the substances, whether legally or illegally obtained, leads to a professional's inability to perform duties and responsibilities according to nursing standards." The prevalence of drug abuse in the nursing profession first came to the attention of the American Nurses' Association (ANA) in the middle 1980s. Research conducted in 1984 revealed that 8-10% of nurses admitted to having an alcohol dependency and 2-3% admitted to be dependent on drugs (Gnadt 2006,-page 151). In the modern time period, this number has increased exponentially. Approximately 10% of nurses are currently addicted to some sort of drug (Copp 2009). Whereas the most frequently abused drug is alcohol, prescription drugs are also frequently abused. Among these are amphetamines, opiates, sedatives, tranquilizers, and inhalants. Not only do nurses in the United States indulge in drug use, but the problem has escalated to a worldwide epidemic.

In the early 1980s, 48 states began investigating the percentages of nurses who are currently or have in the past abused drugs and alcohol. The ANA also became interested in formulating and implementing testing and possible methods of rehabilitation for nurses who were addicted (Monroe 2008,-page 156). Drug abuse among nurses and other medical care professionals is an extremely hazardous issue. Besides the danger to the individual him or herself, there is the consideration that drug addiction is a breach of professional ethics, places patients at severe risk when being treated by someone who is under the care of someone who is under the influence, and can affect the reputations of the individual as well as the facility where they work (Copp 2009). The use of drugs in the medical profession is an important subject to be understood and those suffering from addiction must be treated as quickly and efficiently as possible.

Researchers have tried to locate the exact correlation between substance abuse and nurses. By locating what triggers drug dependency, it is hoped that alterations can be made within the profession to alleviate the problem. One interesting conclusion that researchers were able to divine from statistics was that nurses were far more likely to abuse alcohol and drugs than other members of the medical profession, such as doctors or surgeons (Raistrick 2008,-page 57). In order to find out which were nurses were most susceptible to falling into the depths of drug addiction, researchers Matthew Shaw and his colleagues (2003) examined age, race, gender, specialty within the medical profession, familial history of substance abuse, and the access of prescription drugs within the hospital to look for a pattern that could potentially eliminate future self-destructive behaviors. Shaw's group of investigators and researchers began their enquiry into drug addiction and nursing with three possible hypotheses for why nurses engaged so frequently in drug abuse. These were:

1. Given that physicians often have greater financial and legal resources, often work alone instead of in teams, and can self-prescribe, their addictions will be more severe than nurse by the time they enter the treatment program;

2. Given that nurses often work in care giving roles and more collaborative environments, they will participate in the treatment program more fully than physicians;

3. Given that nurses are often less empowered within the health care system and have less advocacy within their professional organizations, they will experience harsher professional sanctions as a result of their substance use (Shaw 2003,-page 563).

The findings of the research were that nurses were not more susceptible to drug abuse other than prescription medication. They also found that nurses who live in dysfunctional families were both more likely to begin abusing drugs and more likely to relapse when they had been treated for drug addiction.

A direct link has been connected between the habitat and familial support of the nurse and whether or not the individual will become addicted to drugs. Logically, the higher the pressure of the job, the more likelihood that the person will take drugs (Shaw 2003,-page 562). Other potentially detrimental effects to the health of a nurse include whether or not the person has a consistent or scattered work schedule and how easy it is for the individual to acquire prescription medication without having to record the medication's removal. Some hospitals require pass codes or entering of computerized information in order to access medications. These locations are less likely to have medical staff take prescription meds without proper allocation.

Hand in hand with familial support is the care and love of a sense of a community. Even people who have a less than perfect home life can abstain from drug and alcohol abuse in cases where the individual has an external and supplemental support system (Gnadt 2006,-page 151). People who are highly religious and who are heavily involved in their religious community are less likely to become addicted to drugs. This is similarly the case with individuals who are involved in activities outside of the hospital or medical facility at which they work. Both these factors indicate further evidence of the initial assessment that people who have ways to release their work-related stress will be far more likely to avoid drugs and alcohol. Families of nurses and other medical officials need to be aware of the risk that their loved ones are under in order to help them avoid the pitfalls of their profession.

George Kenna and Mark Wood (2005) performed a study to try to determine the frequency of a familial history of drug abuse and addiction with the likelihood of nurses to become addicts themselves. Family history of drug use (FHPD) has been established as a major factor in drug and alcohol addiction in other venues as well. One study reported that 62% of drug-dependant nurses had a family history of dependency (Kenna 2005,-page 226). It must be mentioned that FHPD is a strong factor in the addiction and dependency of drugs and alcohol in other field besides nursing as well.

It is believed that the longer the nurse is on the job, the more likely the person is to become a victim of substance abuse. However there have been reported cases of young men and women succumbing to addiction even while still in nursing school. More attention has been given to this population of late because researchers and medical officials want to ascertain where exactly the risk for addiction becomes the highest. Within nursing school communities, at least a third of students were declared to be "at risk" for drug addiction and more than 20% were considered "at high risk" (Gnadt 2006,-page 152). Many schools report high percentages of students are at risk for potential drug use because of the high pressures involved in college-level work. The amount of nursing students who are at risk for present or future drug use is only slightly higher than other students in the United States.

As stated, a steady and supportive home-life can be the most effective weapon against drug usage. Usually, a loving family will help relieve stress instead of compounding the problem (Shaw 2003,-page 562). Nurses who are in the middle of a divorce or are engaged in dysfunctional relationships are more likely to engage in substance abuse. It was also found through research that families of nurses are more likely to function as enablers to people who are suffering from drug addiction. Knowing that their loved one is involved in a high-stress profession, they are more likely to dismiss behaviors which, had the family member been involved in any other field, they would have understood as odd or uncharacteristic. Without other people noting differences in a person's behavior or character, the addict will almost certainly continue with their drug abuse. In an article in Modern Medicine, Cobb (2009) states that there are three situations to keep in mind when someone becomes concerned that a colleague may be abusing drugs. These are:

1. You dread going to work because the nurse on the previous shift often leaves you with incomplete charts and patients complaining about pain and lack of care. Often this colleague has worked in several hospitals in the last few years.

2. A nurse on your shift has become moody, takes frequent bathroom breaks, and no longer wants to socialize with colleagues. She or he is often late for work, late to return from breaks, and their hand-writing and organization have become sloppy and lacking.

3. This person becomes suddenly the best and most helpful nurse on the floor. Patients, hospital administration, and physicians all place their trust in him or her. Also, she or he often volunteers to work extra shifts or longer shifts and prefers working in acute-care or intensive-care units where drugs are frequently administered and keeping record of their use is harder to accomplish accurately (Cobb 2009).

Other indications of a person who may be abusing narcotics or alcohol include: pinpoint pupils or being glassy-eyed, smells of alcohol or makes excessive use of breath mints, gum, or mouthwash, falls asleep frequently or has trouble focusing, history of chronic pain from injury or recent surgery, has significant familial problems, often volunteers to administer drugs, incomplete charts, can be moody and isolated or high-strung.

There is a stigma associated with drug abuse and thus many nurses are unwilling to seek help for their addiction. They fear losing their jobs or having it written on their record and having their addiction follow their careers for the rest of their lives. Besides losing their jobs, people can also face losing their reputations, family, and friends (Copp 2009). For all these reasons, incidences of self-reporting of drug addiction by nurses to superiors are extremely rare. In the Shaw study, researchers found that nurses who went back to work in the medical profession after being treated for drug addiction "report more frequent and severe work related sanctions as a consequence of their chemical dependency, and these differences have clear implications for clinicians, administrators, and policy makers" (Shaw 2003,-page 569). With results like these, it becomes evident why those who had suffered from drug addiction would be less likely to seek treatment or to make known their previous addiction after rehabilitation. The ANA have recommended that hospitals and medical staff support rehabilitation programs rather than punitive types of punishment. The resolution of the American Nurses' Association is stated as the following:

Whereas, in ten states, nurses do not have access to programs that provide alternative-to-discipline during recovery; and whereas the development of multi-state licensure compacts underscores the need for consistent availability of alternative-to-discipline programs across all jurisdictions…Therefore be it resolved that the ANA will renew its commitment to the support of activities that improve nurses' access to alternative-to-discipline programs and promote member and affiliate actions that encourage the development and use of alternative to discipline in those states where they currently do not exist (Monroe 2008,-page 156).

The American Nurses' Association has tried to expand their reach to the other two states and have attempted to ensure that those who do become involved in drug addiction do not lose their jobs or face criminal charges, but are instead sent to rehabilitation programs and allowed to continue their careers. In 1990, the American Disability Act listed drug and alcohol abuse as a covered medical condition (Hrobak 2001). One of the problems with rehabilitation, however, is ensuring that the nurses who are affected with drug addiction are that many people do not complete the program. A study performed by the Los Angeles Times found that, within the state of California, more than half the nurses who enter rehab do not complete it (Tompkins 2009). "Some who fail at diversion are deemed so incorrigible that that board labels them 'public safety threats.'" In most cases, nurses who do not complete treatment are not allowed to continue practicing nursing.

Yet, in some cases documentation whether they have completed treatment or not is lost in the cracks of bureaucracy and the nurse, still under the thrall of his or her condition, returns to medical work without having kicked the habit. It should be required that individuals who have gone through drug rehabilitation be monitored at least periodically. This will ensure that men and women who have had drug problems in the past have not relapsed. When a recovering addict returns to a hospital, they can once again be put in a position where drugs are readily available to them. Opportunity and the stress of returning to the work environment, especially if that environment has become more restrictive since the individual's recovery, can trigger the same problems which began the person's problems in the first place (Maurer 2005,-page 589). Nurses who have once abused drugs or alcohol should be given random testing or at least limited access to narcotics or drugs until such time that their supervisors believe that the men and women have overcome the need for restrictions from these components of the job. Only when it is safe, should former addicts be allowed access to their former vices, if ever that occasion should arise at all.

In the past, addiction was misunderstood as more of a problem of a person's weakness regarding choice rather than a disease. In the modern era, addiction has been understood to be initially caused by choice but to denigrate quickly into disease. Drug addiction is a circumstance which needs to be treated, not punished. Because of the repercussions associated with being found a drug addict, nurses and doctors may feel reluctant to report suspected drug abuse to their superiors. However, as the New York State Nurses Association stated in their ethical model policy: "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…[nurses] have an ethical obligation to address impairment of a colleague" (Cobb 2009).