Louvenia Ringuette BSN RN
Substance abuse in Healthcare Professionals
It is estimated that 1 in 10 health care providers have an alcohol or drug addiction disorder.
In my 30 years of nursing I have known several nurses and physicians that have had addiction issues. As with most substance abusers their addiction did not affect just them. It affected their loved ones, their jobs, their self-esteem, and the very patients they promised to protect and to care for.
What makes a healthcare profession turn to substances? Providing healthcare to others is physically and emotionally demanding, especially as a nurse. High stress positions coupled with the access to high potency medications make nurses, and other healthcare providers more susceptible to become chemically addicted.
Nursing is a challenging profession, and the severity of the challenges varies depending on the setting they work. Besides stress it is estimate that just above 40% of nurses have used prescription medication to treat chronic pain, and others take these for emotional problems. Of course most of us know that stress decreases your immune systems ability to protect you. Stress whether emotional or physical, affects your immune system, and can cause an increase in the chances you will develop an autoimmune disorder, or it can cause a progression of the symptoms of an already existing autoimmune disorder, among other disorder.
The nurses I knew fell into the two of the most common categories for healthcare workers. One, they fell pray to the prescription medication they were prescribed or two; they diverted medications from patients for their own use. Some were in denial about their addiction or that it was affecting their patient care or, they were very aware and felt bad about their addiction. Some were ready to face their fears, while others had to be made face this addiction.
How do we know if a healthcare provider has a substance problem? It is a lot like those with addiction problems in the general population in many cases, but healthcare providers are also very high functioning and can hide this addiction for a long time. However, chemical dependence can jeopardize patient care, by impairing a nurse’s judgment, and reaction time. It can also cause your patient increased emotional and physical pain. So we must all stay alert for the subtle signs.
What should you look for if you suspect a healthcare worker has a chemical dependence issue? Be sure to watch the video above. It is a wonderful and informative video. Some things you may see in a co-worker is that they are calling in sick more often, especially with short notice. They are increasingly arriving to work late, and look tired or ill. They are having increased personal problems. They offer to work shifts with the least amount of people around. You may also notice mood swings and a lot of excuses for why they act the way they are acting or why their could not complete their work. They may smell of alcohol and tell you it was from the night before. Remember though, there may not be any glaringoutward signs or symptoms, especially if they are diverting drugs from a patient to use later, or steal to sell the drugs to support their habit.
One way to spot someone diverting drugs is that you might notice they are the only nurse that ever gives a certain patient with a high potency for addiction drug, their pain medication. Their documentation is always off. Or maybe they are always the one to volunteer to medicate your patients for other nurses. These are just a few examples. Healthcare providers can be very good at covering themselves. One way to assess whether your suspicion is accurate is listen to the patients. Are they getting any pain relieve when they receive their medication? If you see that the patient hardly ever reports relief from pain after that nurse providers their medication this can be a big red flag.
If you suspect someone is diverting or has a substance abuse problem you need to notify their supervisor right away. You do not need to have proof. Healthcare workers are mandatory reporters. We have a duty to report our suspicions. The supervisor can then do their investigation to look into this further. Luckily facilities, regulatory agencies and healthcare workers are doing more to combat substance abuse in healthcare workers. Regulatory agencies have developed and continually develop regulations regarding drug screening, limiting the amount of medication that can be ordered at a time, and requiring non-pharmacological interventions be tried prior to resorting to pain medication to help combat these issues. Facilities are getting better with having policies and procedures regarding destroying medications in a more timely manner, and regarding how these medications are stored, accounted for and for limiting a staff members unsupervised access to highly addictive medications.
There this a lot of support for health care professional with substance abuse disorders. Each state department of health and nursing board, help to determine the support and action that is needed to protect the healthcare professional, and the public. In fact most states now help programs to help healthcare professionals continue work while they recover versus automatically revoke their nursing license. Of course each case is different, and whether a healthcare professional can continue to work as a licensed healthcare worker depends on many factors, one is whether legal issues have developed from the professionals substance abuse problem, or where they are at in the recovery process.
Washington State has many programs to help healthcare workers with substance abuse disorders. The goal is early recognition, assessment and recovery. Washington Recovery and Monitoring Program(WRAMP) is a referral basis program for healthcare providers not covered by the below programs. Washington Healthcare Professional Services(WHPS) which is a confidential self - referral program chemically impaired nursing professional. It ensures early entry into recovery for the impaired practitioner while providing maximal protection for public safety. They identify, assess and monitor these healthcare professionals. Washington Physicians Health Program (WPHP) is for physicians, physicians assistants, podiatrists, dentists, and veterinarians, and the Washington Recovery Assistance Program for Pharmacy (WRAPP) is for pharmacy professionals.
Many of the nurses I have worked with over the years with substance abuse disorders were nurses prior to the development of such programs. One took her life, some left the profession. I was fortunate recently to work with a nurse enrolled in the WHPS program. Even though the nurse had many restrictions on what they could do in the workplace, the nurse was still a valuable member of our nursing team. I was impressed by the contract between the nurse and the program. It outlined exactly what the nurse could and could not do the hours they could or couldn’t work and what type of supervision had to be present. I was impressed by my employer’s commitment to the employee but I was most impressed with the commitment this nurse had for the program, their recovery, in protecting their nursing license and of course for protecting the patients. Even thorough the high stress periods this nurse showed their commitment to their recovery. What a blessing these programs are. These programs preserve many professional lives, and keep our most knowledgeable workers at the bedside while increasing the safety of the care our public receives.