Peer Reviewed Nursing Articles Fir Substance Abuse Treatment
J Nurs Adm. Author manuscript; bachelor in PMC 2019 Apr 18.
Published in final edited form equally:
PMCID: PMC6472925
NIHMSID: NIHMS1010586
Nurses Recovering From Substance Use Disorders
A Review of Policies and Position Statements
Dr Todd Monroe
School of Nursing, Vanderbilt University, Nashville, Tennessee
Mr Michael Vandoren
Texas Peer Help Program for Nurses, Austin
Ms Linda Smith
Florida Intervention Project for Nurses, Jacksonville Beach
Ms Joanne Cole
New Jersey Recovery and Monitoring Plan, Trenton
Dr Heidi Kenaga
Section of English, Oakland University, Rochester, Michigan
Abstract
The authors review policy initiatives and professional organization position statements that hospital and nursing administrators should be familiar with to answer finer to public and policymaker concerns about substance employ in healthcare settings. Detecting and addressing substance utilize disorders proactively and systematically are essential for 2 reasons: to protect patient safety and to enable healthcare professionals to recognize problems early and intervene swiftly. The authors place central points and gaps in existing policy statements.
Infirmary and nursing administrators must address the consequence of substance corruption disorders (SUDs) among staff and students practicing in clinical settings. For the purposes of this article, nosotros define SUDs as the abuse of, misuse of, or dependency on alcohol or drugs. Electric current estimates are that the percentage of nurses with dependency ranges from 2% to 10%, and estimates of misuse and abuse may exceed fourteen% to 20%.1–11 Considering the broad variation in the incidence of SUDs reported among nurses in the literature, nosotros caution against using whatever one number. Moreover, the verbal numbers of nurses with an SUD is difficult to estimate.12 To appreciate the severity of this issue, one needs to await no farther than the state level. The Alabama Land Board of Nursing identifies an boilerplate of 300 nurses per year for alcohol/substance abuse bug.xiii The National Quango of Land Boards of Nursing (NCSBN) has 59 member boards, most of them in states with a greater population than Alabama.14 Generally one-half of nurses who attempt recovery succeed, with many state monitoring programs reporting success rates from 48%fifteen to ninety%.xvi A conservative estimate is that 750 nurses per month, or 9,000 per yr, are reentering the workforce while in recovery from an SUD, equaling nearly the unabridged combined nursing workforce of Alaska and Wyoming.17,18 Considering the monitoring and rehabilitation of recovering nurses accept been in identify showtime in the early 1980s,19 over the last 3 decades more than 250,000 may have returned to work.
The impact on the workforce and therefore patient care if nurses in recovery were removed from exercise can be illustrated in a calculation of direct hours of patient care. For example, 9,000 nurses employed at 2,000 hours a year (l weeks) would provide 18 million hours of straight patient intendance in single twelvemonth. The current and predicted shortage of nurses is well documented. The US Department of Labor's "Occupational Employment Projections for 2010"20 indicates that the nation will need to train 1.1 meg new nurses past 2012 and that the number of nurses needed volition grow by 27% that aforementioned yr.21 Monitoring programs that assist nurses reenter the workforce while recovering from an SUD will play a vital role in ensuring sufficient numbers of healthcare providers in the United States.
This commodity provides healthcare administrators with information about the handling of nurses with SUDs past providing an overview of position statements and policy recommendations from key nursing organizations in the United States and away. This information should facilitate give-and-take of this daunting issue with the public, besides as all those who have a stake in protecting patient rubber and retaining skilled nursing professionals.
Background
Recently, media stories have described instances of nurses impaired by drugs or booze who may steal drugs from the workplace. For case, Lindsay Peterson22 of the Tampa Tribune reported that neither the local constabulary nor the Florida State Lath of Nursing was notified about an incident involving a nurse who diverted (stole) medication. The implication was that the nurse was not subject to sanction for this behavior. However, in Florida, nurses with an SUD are usually referred to a confidential alternative-to-subject area (ATD) drug program and may or may not serve prison time, depending on the disciplinary approach taken by the employer.22 Peterson22 notes that addiction professionals believe handling results in amend outcomes, which is confirmed by research. The Function of National Drug Command Policy (ONDCP) recommends that rather than imprison irenic substance abusers, drug courts exist available to divert such individuals into treatment.23 By increasing direct supervision of offenders, analogous public resources, and expediting instance processing, drug courts can aid break the cycle of criminal behavior, booze and drug use, and incarceration.23 The ONDCP has demonstrated that drug courts reduce criminal offense by lowering rearrest and confidence rates, improve substance abuse treatment outcomes, and reunite families, thus producing measurable cost benefits.23 Alternative-to-subject area programs and drug court programs both offer rehabilitative justice in lieu of incarceration.24
In addition, many laypersons do non empathise that the nursing profession is subject to rigorous internal regulation. Policy makers from key nursing organizations in the United states of america and abroad challenge media portrayals of drug and/or alcohol monitoring programs as convenient places for healthcare providers with SUDs to hibernate and avert disciplinary activity.22 Most programs enforce rigorous standards that participants must run across in society to reenter practice (Figure 1).25 In those situations where a nurse cannot or will not maintain sobriety, many programs help him/her transition out of the profession. Furthermore, formal disciplinary activity by a state nursing board may be warranted, upward to and including revocation of licensure.
Standards for reentry into practise from alternative to discipline programs. Source: Roche.25
Recovery
Because nurse administrators are likely to be working with nurses in various stages of recovery now and in the future, a cursory discussion of recovery, reentry, and recidivism is warranted. Best and colleagues26 conducted a comprehensive review of recovery literature and reported that stable recovery does not happen speedily. The authors establish that (a) using personal and social supports is the all-time predictor of developing effective recovery, (b) barriers to effective recovery include increased trouble burdens, poor mental and concrete health, and connected alcohol or drug use, and (c) structured drug and booze handling programs (with the highest percentage of recovery reported later on xc days of treatment) followed past connected community support are near effective in achieving and maintaining long-term recovery.27
All-time and colleagues defined recovery in 3 domains: (1) remission of substance use disorder, (ii) enhancement of global health (physical, emotional, spiritual, occupational, and relational), and (3) community inclusion.27 They identified three stages of recovery from an SUD as guidelines for nurse managers: early sobriety (first year), sustained sobriety (1–5 years), and stable sobriety (>v years).27 Some nursing specialties, such as anesthesia, recommend that nurse anesthetist achieve one year of recovery before reentry into clinical practice.28
Readiness for reentry should be determined through the collaboration of the monitoring program, a certified drug and booze counselor, and the nursing school27 or employer.29 Ideally, the event of recidivism requires nurse administrators and monitoring programs to communicate effectively in order to develop and enact exemplary policies, which ensure patient safety through swift confrontation and referral if necessary (Figure 2).
Determination of fitness for duty. Linda Smith, Florida Intervention Project for Nurses, personal communication, March 1, 2011.
Position Statements
Professional person groups in the United States have long advocated for monitoring programs and the render to work of nurses in recovery. In 1987, the NCSBN developed the outset model guidelines for such initiatives.28 Also called "culling-to-discipline" programs, these strategies were designed to protect the public, which is accomplished by closely profitable nurses in the recovery procedure and ensuring they are prophylactic to practice.15 In 2007, the NCSBN encouraged the early detection and treatment of nurses with the disease of chemical dependency.29 Many of the ATD programs are noncompulsory and confidential. The underlying philosophy is that nurses will voluntarily seek assistance to combat their SUD, and colleagues will more than readily written report any concerns if they know such reports volition not exist made public.
In 2001, the American Nurses Association (ANA) Lawmaking of Ethics for Nurses was revised to specifically address impaired practice: "Nurses must exist vigilant to protect the patient, the public, and the profession from potential harm when a colleague's practice, in any setting, appears to exist impaired."30
The lawmaking requires that nurses extend compassion and caring to colleagues in recovery. When a nurse suspects another's practice may be dumb, he/she should take action designed both to protect patients and assist the impaired nurse receive assistance in recovery. The lawmaking suggests a direct chat in the grade of a planned intervention may be one method for intervening in such situations. The code calls for a return to practice past impaired and recovering nurse colleagues who accept received treatment and are ready to resume professional duties.30 Monitoring programs for nurses with SUDs are in accordance with the philosophy of the lawmaking. In 2002, the ANA Firm of Delegates developed a position statement that supported the development of ATD programs and encouraged each state to prefer nonpunitive strategies to address chemical dependency among its membership.xxx Currently, 43 states31 have initiated programs that focus on patient protection and memory of recovering nurses.
SUD Among Nursing Students
In 2002, the National Student Nurses Clan passed a resolution to encourage schools of nursing to refer students with possible SUDs for assessment and treatment. The resolution called for states to expand the use of existing peer assistance programs to include students in grooming. This is an important footstep in identification and treatment, because nosotros know that substance abuse and dependency may begin prior to graduation. Considering of the general risk of SUDs among teens and young adults,20 clinical sites and schools of nursing will likely go on to be faced with students with positive drug tests or clinical behaviors that signal substance abuse.
The American Clan of Colleges of Nursing (AACN)32 adult a position statement that recommends that schools of nursing implement nonpunitive policies, including identification of the problem, initiation of an intervention, evaluation by a substance abuse professional, diagnosis of the condition, the beginning of treatment, and reentry into work or schoolhouse. The AACN guidelines include iv basic assumptions: (i) substance abuse compromises patient safety, (two) substance abusers may demand assistance in identifying their problem, (3) addiction is a disease that tin can exist treated, and (4) students should have an opportunity to receive treatment and continue with their training. Many schools of nursing have taken additional steps to provide assistance to students while protecting the public.27
Policies and Guidelines
Hospital and nursing administrators are charged with the task of formulating such practices and procedures in their healthcare institutions to maintain patient safety while supporting an individual nurse's recovery. To this end, the guidelines specified by professional groups such as the NCSBN and the ANA can serve as the foundation for a audio and rigorous protocol that addresses the transition of nurses with SUDs every bit they sally in the workplace. Protocols should country the upstanding obligation of administrators and other nurses to help intervene with a colleague with an SUD. Employers must increment awareness of SUDs through education and back up positive and timely action past acknowledging the risks of addiction to the profession—while recognizing that early on identification and referral volition improve the management of risk.
Policies should address regulatory obligations of the nursing administrator and nurse employee—concerning either the proper administration of controlled substances and/or reporting a nurse to the appropriate country entity, such every bit the licensing lath and/or the alternative program. Implementation of comprehensive policies and procedures helps ensure that the health and welfare of all involved—the afflicted nurse, the nurse's patients, and the nurse'southward coworkers—are addressed. Such protocols may serve to enhance workforce morale and positive perception of hospital administration. Proactive polices may help reduce the stigma attached to a disease that has too ofttimes been misunderstood, subconscious and not discussed, and infrequently acted upon by those most responsible for doing so.
International Professional Organizations'
Position Statements
Programs offer monitoring and peer assistance for nurses with an SUD are now recognized internationally equally the optimal evidence-based method for protecting the public and acting in the best interests of the profession. In its 1995 position newspaper,33 the International Nurses Social club on the Addictions (IntNSA) recognized that nurses are not immune to addictive disease; rather, the rates of SUDs among nurses are like to those in the general population—and in some specialties, such as disquisitional care and anesthesia, even greater. The IntNSA expressed concerns regarding the loss to the profession due to addiction, related to "professional deprival of the problem; judgmental attitudes regarding impaired healthcare providers; and lack of cognition of impairment, prevention, early on intervention programs, and available referral, handling, and support."33
The IntNSA has promoted the adoption of a consequent mechanism for identifying, intervening, treating, and supporting nurses with addictive diseases by healthcare employers and institutions, emphasizing three specific areas for improvement: (one) increasing education and so that all colleagues—including students, kinesthesia, and nurses employed in diverse institutions—are educated near substance abuse atmospheric condition, legal and ethical responsibilities, prevention, intervention skills and reentry considerations; (2) instituting workplace policies so that a proactive, systematic, and cost-effective approach to substance corruption based on research and evidence is adopted; and (3) incorporating peer assistance and monitoring programs for nurses on a broad international scale then that they are initiated in all countries and states.32 The IntNSA, like other professional nursing organizations, believes that nurses who take SUDs can successfully transition to safe practise with the appropriate handling, monitoring, and support.
Example Study: Canada
In 2009, the Canadian Nurses Clan (CNA)34 developed a position statement entitled "Problematic Substance Utilize by Nurses,"4 which viewed substance abuse past nurses in Canada as a critical issue because of the potential negative impact on persons receiving intendance, on the public trust, and on the nursing profession. The CNA determined that, when a nurse exhibits inappropriate beliefs, intervention is required for the protection of patients rather than punishment of the nurse. If nurses demonstrating substance corruption do not receive help, they are in danger of harming patients, themselves, and colleagues.34 This tin pb to damaging furnishings on the public's trust in the employer, with the individual, and among the profession.34 Many Canadian provinces such as Manitoba34 have monitoring programs already in place and use the CNA guidelines to protect the public through vigilant monitoring and reentry of nurses from recovery.
Case Written report: Australia
The Nursing and Midwifery Health Program (NMHP) located in Victoria, Australia,35 is an independent support service for nurses, midwives, and students of nursing and midwifery experiencing health bug related to substance employ or mental affliction. The NMHP provides screening, assessment, referrals, and individual and group support sessions for nurses seeking help to manage these concerns.35 The program is guided by the belief that early on intervention is the all-time way to accost problems. Nurses are encouraged to voluntarily contact the NMHP in addition to managers and human being resources personnel who may have identified nurses experiencing these types of issues.35 Similar to other monitoring programs elsewhere in the world, the NMHP values participants' confidentiality and—unless compelled by police or with consent—the names of participants are non divulged to anyone, a policy that is in compliance with the privacy act of Australia.35
Identified Gaps in Policy Statements
Our review of policy statements offers nurse administrators a useful foundation for addressing the concerns of the public, the media, and their home institutions in formulating and implementing SUD policies. In 2001, the ANA published a handbook for nurse managers regarding the identification and treatment of the chemically dependent employee.ii The NCSBN is developing new guidelines for substance corruption monitoring programs, scheduled to exist released in 2011. (Preliminary data are available at the NCSBN home page: https://world wide web.ncsbn.org/Alternative_Program_Survey_Results.pdf.) On the basis of our review of policy statements and current directions in the treatment of the SUD nursing professionals on a national and international basis, a set of key points and gaps has been identified (Table i).
Table ane.
Key Points and Gaps in Professional Nursing Organisation Substance Abuse Policies (National and International)
| Central Points | Gaps |
|---|---|
| (one) Alcoholism and drug addiction are considered treatable diseases. | (1) How many drug or alcohol relapses are allowed before disciplinary action is taken? |
| (2) Chief purpose of all drug/alcohol monitoring programs is to protect the public. | (2) How can nurse executives help prevent poor patient outcomes attributed to employees with SUDs? |
| (iii) Public protection is accomplished past providing an artery for nurses to cocky-report or report a colleague in need of help without fear of castigating outcomes. | (3) How do nurse executives brainwash and implement intervention training with staff? |
| (iv) Xl-three U.s. states and territories in Canada, New Zealand, and Commonwealth of australia take monitoring programs in place for nurses. | (four) How are drug screening tests used in the facility and what is the process? |
| (five) Student nurses should be given the opportunity to take monitoring and reenter educational programs. | (v) How is random drug and alcohol testing viewed within the organization? |
| (six) Hospitals and nursing schools that support monitoring and reentry are in line with the objectives of the The states Government document Salubrious People 2020. | (half dozen) How are nurse executives made aware of private nurses in recovery programs or under monitoring contracts? |
| (7) Hospital administrators are bound to follow ANA's Code of Ethics for nurses, which back up helping colleagues to recover from SUDs and return to work. | (7) Are substance employ problems and admission to assistance discussed openly in orientation with new staff? |
| (8) Nurses who are unwilling or unable to be rehabilitated should be terminated and referred to the state board of nursing for license revocation. |
Discussion
Nurses are responsible for more half of the full hours (mean, 56%) worked in hospitals.36 Nursing administrators, in all likelihood, will be confronted with substance abuse issues given that between 2% and 20% of nurses may have an SUD during their careers.i–11 Many professional person nursing organizations support reentry into the workplace by nurses recovering from substance abuse.2,32,34,37 Infirmary and nursing administrators are key individuals who are responsible for employing condom qualified staff. Administrators are likely to be approached by the media and need bear witness-based responses and current knowledge to reply appropriately.38 Ten preparatory suggestions for media interviews are presented for the nurse ambassador or executive confronted with questions regarding SUD (Figure three).38
Training tips discussing SUDs with the media. Source: Sevel.38
Nurse executives should contact their land board of nursing and/or state ATD program to hash out the identified gaps in local and regional policies and how these gaps tin can be addressed in individual organizations. Nurse executives tin can contact the NCSBN (www.nscbn.org), NOAP (www.alternativeprograms.org), or ANA (www.nursingworld.org) for help in farther addressing substance misuse and abuse amongst nursing professionals. The Texas Peer Assistance Programme for Nurses has developed an educational program for nurse leaders, displayed in Supplemental Digital Content 1, http://links.lww.com/JONA/A57.39
Conclusion
The need for an international, comprehensive approach to the trouble of substance corruption among nursing professionals is well documented, with an estimated 9,000 or more nurses in the United states alone reentering the workforce in recovery each year. Best practices for approaching this result in healthcare institutions are bachelor in the literature. It has been demonstrated that nurses and other healthcare professionals with SUDs tin effectively be treated and return to safe practise, with no threat to public health or individual patients. Nursing organizations need rigorous and supportive mechanisms in place in order to support nurses recovering from SUDs. A crucial kickoff footstep for leaders is to exist well versed on key points related to habit too as gaps in current policies developed by professional organizations. These policies and guidelines support optimal outcomes for the employer, nursing leaders, nurses, and our profession in dealing with SUDs.
Supplementary Material
Supplemental Digital Content
Acknowledgment
The authors thank Ann Minnick, PhD, RN, FAAN, Vanderbilt University, and Gail Spake, MA, The University of Tennessee Wellness Science Center, for their assistance in article refinement.
Footnotes
The authors declare no conflict of interest.
Supplemental digital content is available for this article. Direct URL citations announced in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jonajournal.com).
Contributor Information
Dr Todd Monroe, School of Nursing, Vanderbilt Academy, Nashville, Tennessee.
Mr Michael Vandoren, Texas Peer Assistance Program for Nurses, Austin.
Ms Linda Smith, Florida Intervention Project for Nurses, Jacksonville Beach.
Ms Joanne Cole, New Jersey Recovery and Monitoring Programme, Trenton.
Dr Heidi Kenaga, Department of English, Oakland Academy, Rochester, Michigan.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472925/
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