Magazine article Addiction Professional

A Non-Punitive Approach for Impaired Nurses: Calif. Program Balances Treatment, Monitoring

Magazine article Addiction Professional

A Non-Punitive Approach for Impaired Nurses: Calif. Program Balances Treatment, Monitoring

Article excerpt

Susan, an experienced orthopedic RN, began to dread her patient assignment when she assumed care of Mary Ellen's patients at change of shift.


Mary Ellen was recognized for nursing excellence at her hospital, but for some reason, her patients seemed to be complaining of pain at start of shift, even though her charting indicated pain medications had been given. The charting had been a little vague recently, though, and once or twice there hadn't been any charting at all on some patients.

During change of shift, Susan casually commented to Mary Ellen that some patients seemed to be experiencing a lot of pain. Mary Ellen, known for her even disposition, snapped at Susan and said she had no idea what she was talking about. The orthopedic department nurse manager had also noticed changes in Mary Ellen's patient care and behavior.

Meanwhile, John arrived late to his 7 a.m. shift in the ER of another hospital. This wasn't the first time he'd been late, but he always had a good reason. Today he'd misplaced his car keys, and said his hands were shaking because he'd been so worried and upset. He washed down several acetaminophen pills for his headache with large gulps of coffee, and followed that with some breath mints. Later, staff noticed he was a little unsteady on his feet. When John seemed unaware that he'd contaminated a sterile field and put a patient at risk, his team leader admitted her concern that John might be impaired.

Although hesitant to voice suspicion about employees and coworkers, doing so may save a life. An equal-opportunity disease, addiction cuts across all professional, economic, educational, social, political, racial and religious barriers. In fact, the American Journal of Nursing estimates that 3 to 6 percent of registered nurses are impaired at work on any given day. Although the most commonly used drug in the general population is alcohol, among health professionals the drug of choice is narcotics.

Historically, employers and boards of registered nursing permanently revoked the licenses of impaired nurses. In 1982, the forward-thinking American Nurses Association (ANA) House of Delegates passed a resolution encouraging the State Boards of Registered Nursing to establish non-disciplinary peer-assistance programs in the individual states. In 2002, the ANA House of Delegates again passed a resolution supporting rehabilitation of impaired nurses rather than punishment, and concurrently supported efforts to increase awareness among nurses and the general public regarding addiction and psychiatric issues through education.

In response to the 1982 ANA resolution, the California Board of Registered Nursing developed the Health Professionals Diversion Program, more commonly known as Nurse Diversion, which began assisting impaired nurses in 1985. Nurse Diversion protects and preserves the nurse's license while offering a non-punitive, confidential alternative to discipline; recommends a sound recovery program for the impaired nurse; and protects the public.

Almost one-quarter of states still discipline chemically impaired nurses without regard to the nature of addiction, defined as a chronic medical illness by the Joint Committee of the National Council on Alcoholism and Drug Dependence (NCADD) and American Society of Addiction Medicine (ASAM). More than half of the states do not have a non-disciplinary program for nurses with psychiatric/mental health problems.

California's Nurse Diversion Program points to the success of nearly 1,000 nurses who have successfully rehabilitated their lives from alcohol, drugs and/or mental health issues, and returned to their professional nursing practice with the guidance of Nurse Diversion. A well-designed rehabilitation program for nurses will have a success rate of greater than 80 percent, according to the American Association of Nurse Anesthetists.

Registered nurses have a particular susceptibility to abuse and addiction: With increasingly high acuities and ever-present staffing shortages, the work of RNs is often stressful and exhausting. …

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