When a Nurse Returns to Work after Substance Abuse Treatment

By Chris, O'Neill | American Nurse Today, July 2015 | Go to article overview

When a Nurse Returns to Work after Substance Abuse Treatment


Chris, O'Neill, American Nurse Today


A substance use disorder (SUD) that impairs a nurse's ability to practice poses a safety risk. So it's reasonable to ask: What are adequate safeguards to put in place when a team member returns to work after treatment for SUD? Ideally, nurse colleagues would know how to support a nurse in early recovery from SUD while simultaneously protecting patient safety. But more often, they feel uncertain about how to do both at once. In my role as an educator, I've found that nearly every nurse I ask has a story about a colleague with a substance abuse problem--yet has little confidence in addressing the issue and virtually no specialized training.

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SUD prevalence among nurses resembles that of the general population--about 10%. That's a large number, amounting to nearly 300,000 U.S. nurses. Apparently, our specialized knowledge of pathophysiology offers little protection from the risk of becoming addicted.

Most nurses diagnosed with SUD receive treatment and return to the workforce. Many become known to their nursing board and enroll in a program where their practice is monitored through a formal contract to ensure patient safety. Using 2009 data, researchers estimated about 12,000 nurses were enrolled in disciplinary monitoring (probation) programs or nondisciplinary (alternative) monitoring programs. Nearly half of nurses monitored in probation and about 75% of nurses who complete alternative monitoring programs return to work.

The nursing profession provides guidance in this area, in the form of the American Nurses Association's Code of Ethics for Nurses. The Code states that nurses must advocate for appropriate assistance (including treatment) for colleagues when indicated. Furthermore, advocacy includes supporting nurses in early recovery when they return to work. (See Nurses' ethical obligations when a colleague is in recovery.)

Stakeholder responsibilities

While every situation is unique, there are typical return-to-work challenges for which nurse supervisors and staff nurses can be prepared. The Nurse Assistance Network, a program of the Oregon Nurses Foundation, has developed a matrix identifying key stakeholders who play a role when a nurse in early recovery returns to work. The matrix describes stakeholder responsibilities related to basic issues to consider before the nurse can return to work.

Return to work: Practical questions

When a recovering nurse returns to work, administrators and colleagues should address these practical questions:

1. What is the organization's substance abuse policy and how has it been applied in the past?

2. What are the practice limitations or requirements of the nurse monitoring program? For instance, which shifts is the returning nurse permitted to work? What are the nurse's overtime restrictions? How frequently are worksite monitor reports required?

3. What reasonable accommodations does the Americans with Disabilities Act mandate for the returning nurse?

4. Who needs to know the nurse is being monitored? How will her confidentiality be protected?

5. Who will monitor the nurse in the practice setting? Has this person completed specialized education for this role and acknowledged the responsibility?

6. Will the nurse's practice limitations affect coworkers--for instance, in regard to care assignments that need to be adjusted for her temporary restrictions on administering opioids?

7. What general education on nurse addiction and recovery has the nursing care team received? Is it up-to-date?

8. How will assigned staff monitor the nurse to ensure her performance meets practice standards?

9. What types of organizational support will be devoted to ensuring that workplace supervision is equitable for all employees and that communication about performance is transparent?

These practical questions imply that return to work is a process rather than a single event and that it's all about the nurse who returns after treatment. …

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