By Christina Orlovsky, senior staff writer
Nurses are so accustomed to caring for others that they often
neglect to care for themselves. Nurses who are challenged with substance abuse
problems are no exception. In an effort to assist addicted nurses with the care
they need to conquer their addiction and keep their job, many states are
offering alternative-to-discipline programs for health care providers.
It has been estimated that 10 to 15 percent of all nurses in
the United States are addicted to some type of illegal or controlled substance,
explained Art Zwerling, MS, MSN, CRNA, FAAN, a nurse anesthetist educator and
member of the peer assistance program at the American Association of Nurse
Anesthetists (AANA). While the risk of addiction is not limited to any one
specialty, the specialties with the highest prevalence of substance abuse issues
are ICU, ER, OR and anesthesia.
Zwerling added that alternative-to-discipline programs have
evolved over the past few decades as recovering nurses and physicians began to
seek out groups where they could share their addiction issues related to their
profession without alienating or frightening non-medical professionals.
“Physicians were far more progressive than nurses,” Zwerling
added. “They would get referred to an alternative-to-discipline program and
enter into a three-to-five-year monitoring contract, which says in lieu of
suspension, you will do ‘x, y and z’.”
As more light has been shone on the issue, more nurses are
seeking similar programs.
“There was a lot of shame-based isolation, and part of the
process is finding out that you’re not alone and that you’re not the only nurse
that made some pretty egregious behaviors around patient care,” he added.
The Philadelphia Recovering Nurses Association is one
organization that evolved from the need for nurses to share their stories and
eliminate some of the stigma associated with chemical dependency. Additionally,
the state of Pennsylvania has a Voluntary Recovery Program, in which nurses
enter into an agreement with the state’s Board of Nursing to be monitored for
three years and complete a treatment and rehabilitation plan. Nurses who have
diverted drugs from patients to sell or distribute or who have failed a similar
program in another state are ineligible for the volunteer program, but the state
is also working toward developing other alternative-to-discipline and peer
While not all states have designated alternative-to-discipline
programs that are affiliated with their state boards of nursing, the majority
have established some sort of diversionary program to assist nurses in seeking
treatment and keeping their licenses.
One such state program is the New Jersey Recovery and
Monitoring Program (RAMP), which, according to the organization’s Web site, is
“designed to encourage health professionals to seek a recovery program before
their impairment harms a patient or damages their career through a disciplinary
action.” While it is not guaranteed that nurses involved in RAMP will keep their
jobs, the program, which is administered by the Trenton, New Jersey-based
Institute for Nursing, offers advocacy for nurses in talks with their employers,
assistance dealing with licensing boards, drug screening, treatment resources
and other services. Nurses can voluntarily involve themselves with RAMP, or they
can be recommended for the program by a coworker, family member or even the
state Board of Nursing.
Zwerling pointed out that data that comes out of alternative
programs reports a high success rate that should encourage more such programs to
be developed and assist in the re-entry of recovering nurses into the
workplace—although not always in the unit where they were initially working.
“We know from these alternative programs that once nurses are
identified, treated and monitored in an appropriate monitoring program, their
outcomes are good, but often there are units they can’t re-enter,” he said.
“You have to look at the unit and the nurse manager and do a
lot of education on the unit. Some are wonderful and will bend over backwards
because they know up to the time the person was intervened upon and went for
treatment, they were a wonderful provider,” he added. “But there are some that
are so toxic that re-entry just is not going to happen. The culture of the unit
wins out every time.”
The American Nurses Association addresses the issue of
chemical dependency in the impaired practice section of its Code of Ethics,
as well as the issue of nurses’ return to work after completing treatment. The
organization puts the responsibility on nursing professionals to, first and
foremost, protect the patient, and second, to advocate for the assistance of
their fellow nurse.
“In a situation where a nurse suspects another’s practice may
be impaired, the nurse’s duty is to take action designed both to protect
patients and to assure that the impaired individual receives assistance in
regaining optimal function,” the Code reads. “Nurses in all roles should
advocate for colleagues whose job performance may be impaired to ensure that
they receive appropriate assistance, treatment and access to fair institutional
and legal processes. This includes supporting the return to practice of the
individual who has sought assistance and is ready to resume professional
© 2006. AMN Healthcare, Inc. All Rights Reserved.