Chemical Dependency among Nurses, Research Paper Example

The topic of chemical dependency among nurses has been the subject of much discussion, although not many formal research studies have actually been conducted.  These inquiries are difficult to develop since there typically have not been random drug screening for nurses at hospitals and other medical settings.  As a result, any data collected is based on the statements of nursing staff, which may or may not be accurate or entirely honest.  One study that was performed in the 1990s concluded that nurses were no more likely to abuse drugs than their non-nursing colleagues Another study conducted in the late 1990s cited the American Nurses’ Association as claiming that as many as 20% of nurses may have chemical dependency issues (Chait, 2008.).

The question of what to do when an institution discovers that nursing staff has chemical dependency issues is a highly complex issue: should the staff member be fired?  Given an option to attend rehabilitation?  Should they be permitted to continue to work while receiving treatment?  This paper will define the term “chemical dependency, “ and will discuss a highly organized and sophisticated California program that deals with the issue of nurses who are abusing drugs.

For purposes of this paper, the term “chemical dependency “will be used to describe the disease or illness characterized by dependence on a mood-altering substance.  This dependency involves all drug addictions including alcoholism.  A key aspect to the definition refers to a person’s inability to stop using the chemical, despite the detrimental effects on the person’s lifestyle, relationships, work life, personal life, health and finances.  It is a chronic illness that is progressive and is often fatal if untreated.

The drug addict invariably chooses their substance over anything else despite the consequences and losses occurring in their lives.  They may make many attempts to stop using, but without treatment which often needs to occur again and again before finally causing actual change, they will usually return to their drug of choice, or possibly replace it with a different one.

A key feature of addiction is a strong level of denial, a huge range of psychological myths that allow the chemically dependent person to believe that the substance is not the cause of all of their problems but instead, a way to resolve their problems.  Even when confronted by strong evidence and constant urging and expressions of concern by those who care about him or her, the addict typically insists that they can stop drinking or using anytime they want to and that it is not a problem.

Chemical dependency is never cured, but can be arrested or in remission for long periods of time.  Simply stopping using does not necessarily alter the behaviors that accompanied the drinking or drug use, hence the term “dry” drunk is used to describe a person who is no longer using but is still engaging in the behaviors that accompanied their addiction such as lying, shirking responsibilities, and being irresponsible with finances.

The problems that accompany nurses with chemical dependency problems are complex and extremely dangerous, bringing up legal and ethical issues.  Some of these risks include quality of care to patients, staff turnover, low morale, and problems of risk management to the institution.  Chemical dependency on the job will affect judgment, observational ability, and concentration, all of which can easily compromise patient care and result in serious complications and even death (Raia, 2004.) In addition, there are significant financial risks to the setting that include sick time, absenteeism, lower productivity, and the expenses involved in advertising for, recruiting, hiring and training new staff.  There are other serious drawbacks involved as well, such as a decrease in the public confidence in the setting and the reactions of the rest of the staff which often include feelings of anger, betrayal, guilt and shame. (Raia, 2004.)

Nurses that suffer from chemical dependency issues have been found to share certain characteristics such as a strong wish to take care of others.  In addition, a large majority (70%) have a family history of substance abuse.  They are high achievers, generally graduating in the upper end of their classes and often their first instances of substance abuse occurred during nursing school.  Certain beliefs will increase the risk that a nurse will become chemically dependent; these include: their professional knowledge of drugs will prevent them from becoming addicted; addiction is a moral defect rather than a disease; and other risk factors such as burnout, insomnia, having physical pain, low self esteem, and feelings of helplessness.

Nurses who abuse drugs are likely to keep their addictions a secret in order to protect their professional licenses.  They will usually avoid buying drugs illegally, instead taking drugs from the unit or obtaining legal prescriptions from physicians.

Still, as the disease progresses, it becomes harder to hide from coworkers since the enormous energy it takes to mask the symptoms begins to break down and it becomes more obvious.  Even when job performance begins to decline, the nurse will usually make excuses or blame others for her deficiencies.  Coworkers will often to act as the enablers, making excuses for the substance abuser, covering up with supervisors, and tolerating the staff member’s abusive behavior.  Rather than being helpful, covering up for a substance abusing nurse actually makes the problem worse because by not holding him or her accountable, they delay the impaired nurse from seeking treatment, and also expose patients and other staff to dangers and risks that will affect them all.

Some of the behaviors that should raise red flags to other staff are: staff or patient complaints, accidents, injuries, mistakes in documentation or medication administration, arriving early or staying late to perform medication counts, absenteeism, mood swings, requesting different or increase in pain medication for patients, and volunteering to be the medication nurse.

Due to the great concern over nurses who are chemically dependent, there are various programs designed to address the issue in an effort to decrease the stigma and make it easier for nurses to seek help.

In California, the Board of Registered Nurses (BRN) has a program called the Diversion Program which is a voluntary, confidential program for registered nurses who are impaired either through chemical dependency or mental illness.  The program’s goal is to protect the public by early identification of chemically dependent nurses so that they can receive treatment; and in appropriate cases, the nurse is suspended from practicing and is required to receive careful, ongoing supervision.

The program’s objectives are:

• To identify customers’ expectations for services and to meet or exceed them.
• To increase public access for services, increase consumer awareness of services and expand public outreach and education regarding the program.
• To address the changing diversity and needs of the population.
• To increase program effectiveness and innovation using newly developed technology.
• To evaluate the effectiveness of all BRN programs ongoing through a significant performance evaluation system.
• To coordinate activities with other governmental agencies to maximize consumer protection.
• To plan and allocate resources to effectively fulfill the mission. (State of California, 2010).

The BRN program in California is staffed by contracted experts in strategic planning, a representative task force of staff, management, and board members, and will include periodic surveys submitted by customers to determine their satisfaction with the board services.

The Board is the licensing agency for registered nurses in the state of California and as such, it conducts initial licensure in the state, regulates and approves pre-licensure and advanced nursing programs, and registers and approves continuing education providers.  The Board’s customers include consumers, employers, health insurance companies, and other groups that are interested in nursing regulations.  It provides brochures and videos and a toll-free 24-hour phone line that can verify licenses.  In addition, it receives thousands of complaints per year which are then investigated to determine whether or not disciplinary action is warranted.

In 2001, the Board also began to offer licensing renewal services online via credit card.  Its success can be attributed to the fact that it conducts monitoring of participants for an average of three years, but more importantly, it is attributable to the encouragement, support and guidance provided to nurses by other nurses. Over 1,200 registered nurses have successfully completed the program. To complete the Diversion Program, a chemically dependent nurse must demonstrate a change in lifestyle that supports continuing recovery and have a minimum of 24 consecutive months of clean, random, body-fluid tests. A nurse with a history of mental illness must demonstrate the ability to identify the symptoms or triggers of the disease and be able to take immediate action to prevent an escalation of the disease. (State of California, 2010)

The most recent available statistics regarding the Diversion Program’s budget is for 2006, when the Governor’s budget for the program was $20,350,000. (State of California, 2010).

This program has many advantages both to the nurses involved in the program in terms of helping them to continue their career while developing a healthy lifestyle, as well as to the public who are likely to be exposed to a more competent group of healthcare practitioners.  The program is a dignified and respectful way to address a serious and complex issue without the stigmas involved in being identified as a chemically impaired healthcare provider.  There were no apparent disadvantages to this program that could be identified, except for a constant struggle to secure a budget that will support it, especially in light of California’s recent budget difficulties.

In addition, due to the great stigma associated with being a nurse that has chemical dependency issues, there has been a body of literature that discusses how difficult it is for such a person to seek help; to do so would jeopardize their anonymity and professional standing.  The worry about facing discrimination as well as having fingers pointed at them whenever there is a discrepancy in medication counts.  One book, Unbecoming a Nurse: Bypassing the Chemical Dependency Trap (Simeca, 2008) discusses the need to educate and provide support to nurses in order to prevent and treat alcohol and other drug problems.  Simeca’s new book, From Unbecoming A Nurse To Overcoming Addiction: Candid Self-Portraits Of Nurses In Recovery, released in June, 2010, tells the story of 29 nurses from all over the country who are extremely varied regarding region, social class, age, backgrounds, and specializations as well as a wide range of drugs of choice from alcoholism to prescription medication to cocaine—whatever is available, legal or illegal.  The book brings to the surface the silence and barriers that keep professional nurses behind closed doors with their secret addictions, and describes their struggles and eventual successes in maintaining a sober lifestyle.

References

Chait, J. (2008, January 17). Drug abuse among nurses. Retrieved July 25, 2010, from Love to   know: http://addiction.lovetoknow.com/wiki/Drug_Abuse_among_Nurses

David G. Levine, P. A. (1974, September). The American journal of psychiatry. Retrieved July 25, 2010, from Hazelden: http://ajp.psychiatryonline.org/cgi/content/abstract/131/9/1036

Paula Davies Simeca, R. M. (2010). Unbecoming a nurse: bypassing the hidden chemical dependency trap . Staten island,NY: sea meca inc.

Raia, S. (2004, November/December). Understanding chemical dependency. Retrieved July 25, 2010, from New Jersey Nurse: http://findarticles.com/p/articles/mi_qa4080/is_200411/ai_n9466489/pg_2/?tag=content;col1

State of California. (2010). Board of registered nursing. Retrieved July 25, 2010, from Department of consumer affairs:http://www.rn.ca.gov/

World network central office. (2009). Retrieved July 25, 2010, from Dual recovery anonymous:http://draonline.org/index.html