1. Maher-Brisen, Patricia MSN, APRN, BC

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Help is available.


Whether the rate of addiction among nurses is greater than that among the general population is unknown.1,2 But however many nurses may develop an addiction, it's an illness that requires treatment, not punishment.


Nurses are especially vulnerable to addiction to prescription drugs because of work-related stress and easy access to drugs.3 Work-related factors that might be associated with nurses' use and abuse of drugs include


* working a night shift or rotating shifts.


* critical care work.


* excessive overtime.


* musculoskeletal injuries and pain.


* knowledge of medications.



Trinkoff and Storr found that ED nurses were 3.5 times as likely to use cocaine or marijuana as nurses in other specialties.4 During my 10 years with New York's Statewide Peer Assistance for Nurses (SPAN) program, I too have noticed that the largest group with addiction problems is ED nurses. Some ED nurses have told me that they are "adrenaline junkies" who enjoy the rush they get from their fast-paced, exciting work. This may be a form of the sensation-seeking behavior that West found to be an early risk indicator among nurses.5


Nurses have reported a higher rate of a family history of alcoholism than other groups of health care professionals.6 Mynatt identified a triad of risks for addiction in women: a chaotic family of origin, victimization, and low self-esteem; comorbid depression is also often a factor.7



With little attention being paid to addiction in schools of nursing and continuing education programs, stereotypes and stigma persist. When education stresses that addiction is an illness, it will be easier for addicted nurses to seek help voluntarily. All nurses, including addicted nurses themselves, have an ethical duty to address addiction in health care and to take care of themselves, which in turn protects patients' safety.8


Staff nurses and nurse managers who understand that addiction is a progressive, treatable illness are likely to show compassion without enabling the addiction. Ideally administrators will offer to help the addicted nurse, rather than respond with termination.


The addicted nurse needs to realize that she or he is not alone. Help is available through state nurses' associations and elsewhere, and professional disciplinary action may be avoidable. But before nurses can ask for and accept help, they must understand that they have an illness that affects their ability to practice safely and can put their license in jeopardy.



Diversion is the "redirecting of drugs from legitimate use into illicit channels."9 The many signs of drug diversion by a nurse in the workplace include10


* arriving early, staying late, and coming to work on scheduled days off.


* excessive wasting of drugs.


* regularly signing out large quantities of controlled drugs.


* volunteering often to give medication to other nurses' patients.


* taking frequent bathroom breaks.


* patients reporting unrelieved pain despite adequate prescription of pain medication.


* discrepancies in the documentation of controlled substance administration.


* medications being signed out for patients who have been discharged or transferred or who are off the unit for procedures or tests.



A nurse who is diverting medications for personal use may attempt to minimize the seriousness of this theft. Nurses in the SPAN program have excused their diversion of drugs by claiming that the medication "would be wasted anyway."


Diversion is a crime, and when it occurs the police may be called in to investigate and make an arrest. Nurses have been arrested for falsifying records and forging prescriptions.


Practicing nursing while impaired by alcohol or other drugs is a form of professional misconduct. Nurses who practice while impaired report that they live in fear of being caught.11 It's often just a matter of time before a patient, colleague, or manager reports the problem to the administration.


Employers tend to look more favorably on a nurse who admits to an addiction than on a nurse who is reported. Nurses who voluntarily admit to the problem may be permitted to enter treatment with income and insurance benefits intact. But suspension or termination because of addiction can make treatment expensive.



Workplace resources include employee-assistance programs, employee health services, and human resources departments. Union representatives and nurse managers can also support nurses recovering from addiction. Legal consultation, behavioral treatment, peer support groups, and the meetings of 12-step programs such as Alcoholics Anonymous, Narcotics Anonymous, and Caduceus (open only to health care professionals) are also often necessary. Calls made to confidential peer assistance hotlines cannot be reported to disciplinary boards.


Approximately 40 states have alternatives to disciplinary action, including peer assistance and recovery monitoring programs. There is no national policy in this area; nurses should check with their state nursing board and association. Health care professionals who participate in assistance programs have a higher rate of long-term recovery than other addicted people. For example, Griffith reported that in Florida's alternative-to-discipline program, the oldest in the country, more than 80% of impaired nurses returned to practice, and fewer than 25% experienced a relapse.12, 13


Patricia Maher-Brisen, MSN, APRN, BC


outreach nurse, Statewide Peer Assistance for Nurses, New York State Nurses Association




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