By Jennifer Larson, contributor
Dianna Phares, Ph.D., FNP, remembers a time when she didn’t know much about nurses and addiction. That all changed a few years ago when the Missouri Nurses Association asked Phares, then a state director for the association, to chair a peer assistance committee.
Suddenly, Phares found herself asking questions like, “Why are nurses with substance problems being fired and being made to feel ashamed and scared with nowhere to go?”
The Emergency Nurses Association (ENA) reports that the rate of chemical impairment among nurses ranges between 7 and 24 percent.
She set up a hotline through the association and worked with Dr. David Ohlms to establish an inpatient program for medical professionals at CenterPointe, a psychiatric hospital in St. Charles, Missouri. Then she started a free support group for nurses recovering from addiction.
Why might nurses—people whose job is to promote health—find themselves abusing alcohol or using a banned substance or diverting medications from patients? Why would they risk their licenses and livelihoods for a “high?”
Addiction is not a character flaw but a disease, as Phares learned from Ohlms—one that some people may have genetic tendencies toward. Some experts speculate that the stress that accompanies the nursing profession may also be a factor, but there are no conclusive studies proving that point.
Regardless of why it happens, there is no doubt that a substantial percentage of the nursing population, like the general population, struggles with drug or alcohol addiction.
A 1998 study published in the American Journal of Public Health estimated that approximately 40,000 nurses in the United States suffered from alcoholism. The study also noted that drug abuse often varied widely by nursing specialty, although the overall statistics did not widely vary from those of the general population.
The Emergency Nurses Association (ENA) reported that the incidence rate of chemical impairment among nurses ranges between 7 and 24 percent, with emergency nurses three times more likely to use drugs such as marijuana and cocaine. In a 1997 study, the American Nurses Association estimated that as many as 20 percent of nurses may have some substance abuse issues.
The good news? Help is available.
Several major nursing associations have dedicated considerable attention to impaired nurses. The American Association of Nurse Anesthetists has a peer assistance program, while the ENA has codified its support for impaired nurse programs with an official statement.
A number of states have also developed programs to help nurses recover from substance abuse without losing their license to practice. The National Council of State Boards of Nursing developed guidelines for such “alternative to discipline” programs a decade ago.
Typically, the programs allow a nurse to keep his or her license after meeting certain criteria for rehabilitation, which is sometimes referred to as “in lieu of discipline.”
“We don’t punish people for having a disease,” Phares said. “Without having ‘in lieu of discipline,’ you are punishing people. And they would have a terrible time finding a job because it stays on their record.”
Massachusetts was one of the first states to create a substance abuse rehabilitation program, or SARP, about 20 years ago. “We think it’s been very successful,” said Gino Chisari, MSN, RN, deputy executive director for the Massachusetts Board of Nursing.
The program is overseen by three trained coordinators, including two nurses and a mental health coordinator. "The coordinators are very devoted to the nurses and the success of the program," Chisari said. "But always with the focus that the board's mission is to protect the public."
The Massachusetts program is voluntary but nurses who agree to participate in it are monitored for five years as they gradually move through recovery and learn how to cope in the future. Among other requirements, they undergo a comprehensive assessment, they must agree to random drug testing and they must attend support groups. As they progress, they are given the opportunity to request greater privileges so they can adjust to the stress of the job with their new skills.
“Most of the time, nurses say it was a difficult program to get through but it’s the kind of structure that lends itself to successful rehabilitation,” Chisari said. “You need to be very disciplined to be fully engaged in recovery and it has to be very conscious. And this program, in a lot of ways, gives you those kinds of skills.”
Approximately 230 nurses are currently participating in the state program.
Phares said she hopes that more and more nurses will step forward to get help from programs in their areas. Some may not realize that addiction does not have to mean the end of their nursing careers.
"There are nurses working at grocery stores and here we are in a nursing shortage," she said. "We want to keep them at work."
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