1. Douglas, Valerie MSN, RN, APRN, ANP-C

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"OH NO, IT'S A NURSE!" The words of my colleague, a new RN, resonated in my ears, but my mind wouldn't process them.

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Responding to the code blue at change of shift, I'd arrived at the code location with the rest of the team, including two new RNs. Directed to the bathroom, we assumed that a patient's family member had collapsed. We were wrong.


That's when the new RN's exclamation pierced the air. Looking down, I saw scrubs and sneakers protruding from the bathroom door. CPR was in progress. The monitor/defibrillator showed asystole during the compressor role change.


I heard my voice calling for supplies as I attempted to insert a large-bore peripheral I.V. catheter. When venous access couldn't be obtained, intraosseous access was established. Despite high-quality CPR, multiple doses of vasopressors, and a frantic search to identify and treat the underlying etiology of the cardiac arrest, the asystole persisted and she was pronounced deceased.


In shock, I heard my colleagues' voices:


"She was impaired."


"She's been using a lot of..."


"She disappeared and we were worried so we went looking for her."


We covered her body and lifted her, carefully, onto a stretcher and moved her into a patient room. I removed her cell phone from her pocket; someone would need that to call her family.


To me, she was a comrade in arms, even though I'd never met her. But to the new RNs, who'd worked with her and had spent the day with her in the unit, it was deeply personal. They'd both spent time with her when they began their training. She'd spoken openly with them about her personal and professional journey; they knew about her climb from patient-care technician to LVN to RN. They knew about her children, her life. I was sorry they were there. I was sorry that two novice nurses were looking at the deepest, darkest secret of nursing-substance abuse.


The image of her lying there lifeless and exposed was indelible. It haunted me, and revisited uninvited in the night. I learned secrets about her life that I was never supposed to know. The truth is, I hadn't wanted to know about them.


This is probably why so few nurses report a chemically dependent nurse colleague who they know is troubled and hurting. Our colleagues risk their lives right in front of us and we just watch or avert our eyes. It's too hard to confront, so we enable impaired nurses as we try to shrink their addiction into something understandable. "She's going through some tough personal stuff." "Her husband left her." "His mother just died."


The National Council of State Boards of Nursing estimates that 15% of nurses have a drug use disorder.1 We should speak frankly to our administrators and state board of nursing instead of whispering to each other. Are we so protective of the image of nurses that we stand by silently as impaired colleagues endanger themselves and their patients day after day? If they were patients, we'd try to protect them from themselves by any means necessary.


Are we afraid that exposing the shortcomings of a colleague would expose our own personal problems and how they boil over and spill into the workplace? I don't know the answer to that. I just know that the nurse I failed-we all failed-to help will never hug her children again. And somewhere, huddled together and bound by grief, a unit tries to make sense of a death that occurred much too soon to one of our own.




1. National Council of State Boards of Nursing. Breaking the habit: when your colleague is chemically dependent [video]. 2010. [Context Link]