Substance abuse among nurses

The prevalence of substance abuse among nurses is rising and continues to rise. The American Nurses' Association (ANA, 2002) estimates that six to eight percent of nurses use alcohol or other drugs to the extent that they impair their professional performance (ANA, 2002). Because of the incidence of drug abuse among nurses, it is important all nurses to be aware that drug abuse exists among nurses and should know the proper steps to assist their co-worker get the support they need.

Some startling recent statistics show that in the United States, the problems in productivity and employment among individuals with substance abuse problems cost the American economy $80.9 billion. Of this, $66.7 billion was attributed to alcohol and $14.2 billion to other drugs (NIH, 2007). Of course, this does not include the emotional costs to families and individuals such as divorce, alcohol, and drug-related domestic and child abuse, automobile injuries, etc. One out of every ten nurses has engaged in substance abuse and this is a defiant problem for the nursing community. A great strategy for combating substance abuse is being aware of the signs of drug abuse; new nurses can be better equipped to take action against an ever growing issue. An additional strategy is knowledge of factors that contribute to drug abuse among nurses. Finally, learning early on how to manage one’s own stress level can greatly decrease the pervasiveness of drug abuse in the nursing community.
The majority of nurses who receive treatment for problems related to chemical abuse became addicted as students, and were academically in the top third of their class. A majority also hold advanced degrees. It has been estimated that approximately ten percent of nurses are chemically impaired and most disciplinary problems that are addressed by Boards of Nursing are related to nurses in this ten percent (Uris, 2002). Nurses should be educated on the signs and symptoms of substance abuse among their peers. It is important for all nurses to be aware of signs and symptoms of substance abuse, such as, mood swings, diminished alertness, increasing forgetfulness, defensiveness, decreased concentration. Additionally signs of withdrawal, impaired cognition, isolation or withdrawal from colleagues. Substance abuse issues in nursing usually are first noted by staff members. Whether a staff nurse acts on his or her knowledge or chooses to remain silent, directly affects patient care, safety and the reputation of the institution. It also ultimately affects the impaired colleague's level of functioning (Dunn, 2005). By the time a nurse demonstrates negative or inappropriate work habits, the problem already has reached a serious stage. It is advantageous for institutions to create systems that allow for reporting and tracking substance-abuse incidents and provide education and support to help nurses participate in rehabilitation and avoid placing patients in harm's way (Blair, 2003).
Being aware of signs and symptoms is important; however being aware of factors that contribute to substance abuse is another important step in understanding its prevalence. Some of the factors that have been identified as contributing to substance abuse are: psychological or physical pain, emotional problems, a demanding high-pressure and stressful work environment, and family problems. Additional factors that have been known to contribute are previous emotional or mental health problems, family members with chemical dependency, depression, anxiety, or mental, emotional, or sexual abuse (George, 2003). Some recent studies have shown that nurses who work in oncology have overall high substance use rates. One theory for this behavior is that controlled substances serve as a coping mechanism to help nurses distance themselves from the emotional pain they may experience while working with dying patients (Dunn, 2005). Psychiatric nurses also experience high levels of substance use. Nurses working in psychiatric areas may consider self-medication more acceptable because they work in a culture that accepts using psychotropic medications to cope with life (Anderson, 2004). Additionally, psychiatric nurses may be more willing to report their use of substances than other specialty nurses because they perceive this as an acceptable form of treatment. Pediatric and women's health nurses report the lowest use of addictive substances. This could be due to the lack of availability of these substances on their units, or it could be that this population of nurses is emotionally expressive (NIH, 2003). People who are able to express their feelings may have less need for substance use.
Learning about the signs and symptoms and knowledge about contributing factors are great ways to decrease the prevalence of substance abuse Furthermore, increasing education about management of stress levels is another strategy that can help reduces substance abuse in the workplace. Stress provides another explanation for why some nurses abuse substances. Increased workloads, decreased staffing, double shifts, mandatory overtime, rotating shifts, and floating to unfamiliar units all contribute to feelings of isolation, fatigue, and, ultimately, stress (Ponech, 2005). Each person feels stress and handles it in different ways; learning early on how to effectively manage stress can be extremely beneficial in finding alternative ways to decrease stress. Chronic stress can result in increased sensitivity to stress and cause more susceptible to the effects of stress. Research indicates that increased sensitivity to stress actually alters physical patterns in our brain, thus if stress is uncontrolled it can lead to emergency measure to decrease it, and thus leading to the use of substance abuse (Anderson, 2004). To aid in learning how to decrease stress here are a few strategies for decreasing stress: learning to take time out for self care, regular exercise, good communication with family, friends and co-workers, planning productive solutions to problems, ask for support when feeling stressed out, and learning to set clear limits.
To actively combat this issue of substance abuse that imperils patients and gives rise to a bad reputation toward nurses, all nurses should be aware of the signs and symptoms of substance abuse; to strive for better communication in their homes and within the work place. To find out what helps them manage their stress levels and to fervently practice self care that will aid in the decrease of physical, emotional, and psychological stress. By being aware of the signs and symptoms nurses’ know what signs may point to the need for intervention for their co-worker. By being knowledgeable about factors that contribute to substance abuse nurse can identify those factors if present in their own lives and can get help before those issues become uncontrolled. Understanding how stress correlates with substance abuse nurses’ can utilize alternative means to reduce stress in their life, ultimately reducing the prevalence of substance among the nursing community.

“Helping the impaired nurse is difficult, but not impossible. The choices for action are varied. The only choice that is clearly wrong is to do nothing.”
National Council of State Board of Nursing








Intervention # 1 Being aware of signs & symptoms of substance abuse.
Intervention # 2 Knowledge of factors that contribute.

Intervention #1
~ Disadvantages
a.) If nurses are aware of signs and symptoms they may be better able to hide there problem. Nurses may become more capable of masking there substance abuse by being more cautions not to exhibit the signs and symptoms that they were taught are associated with substance abuse in the workplace (Dunn). Examples of signs and symptoms that are taught are as follows, and being aware of these can contribute to the ability to facade the issue in a nurse set on not getting caught. Attendance. Look for sporadic absences, a day at a time and usually on a Friday or Monday. Appearance. Take note of a nurse who shows a sudden dramatic change in her personal grooming. Affect. Watch for disturbing shifts in a nurse's personal traits-her facial expressions, voice, posture, and gestures. For example, an outgoing nurse may suddenly become stone-faced and uncommunicative. Attitude. Pay attention to any changes in a nurse's attitude toward work. A staff member noted for her efficiency may suddenly begin taking longer to complete tasks. And listen closely to patients' complaints: A neglectful nurse may have a drug or alcohol problem.

b.) While researching this paper it became unambiguous to see all the many different, well thought out, techniques nurses use to steal medications. It is outlined in many different articles step-by-step how nurses go about obtaining controlled substances. By merely researching the signs and symptoms it could potential lead to an open door for someone who might be interested in obtaining medication to be aware of techniques that others have tried (NIH). Below is an example of how knowledgeable impaired nurses are about their addiction habits.

More than 15 years of my life are a blur I remember only a few landmarks through the fog of alcohol, cocaine. Dilaudid, Demerol, heroin, and other drugs. I was in and out of psychiatric units and drug treatment programs. I cycled through a dozen or so boyfriends. For extra money, I waited on tables or tended bar. But mostly I worked in hospitals-as a nurse. Yes, I took vital signs, changed dressings, gave medications, charted-the same things you do
every day. Many of the drugs I used came from the medication cabinets of some very well run hospitals.
But no one ever confronted me about my addiction. It's easy for an impaired nurse to "hide." I preferred to work the night shift, when staffing was minimal and there were no supervisors or visitors around. I also liked neurosurgery units; patients with head or spinal cord injuries were less likely to complain about taking a p.r,n medication. The final turn of events came one night when I told a patient with a spinal cord injury he needed medication he didn't want, I gave myself the Demerol, and then tried to give him sterile water. He refused it, so I put the syringe back in the drawer. Apparently, my nurse-manager suspected me because as soon as I put the syringe in the drawer, she confiscated it. I knew she'd fire me once she found out it contained only water, so I quit. I participated in group meetings with other recovering doctors and nurses. That was one of the toughest parts of treatment. I told them I felt good about the work I'd done as a nurse. Immediately, they confronted me, pointing out that 1 couldn't be an addicted nurse and a good nurse at the same time. I was surprised by their frankness. They knew about lying to yourself. And they knew that only friends who cared enough to be tough and honest could break through that denial. My recovery hasn't been easy. I haven't made it without stumbling but I wanted to live my life without taking drugs-and I've reached that goal. Today, I counsel adolescents at the treatment center that helped me recover. It's the best job I've ever had. Now I'm grateful that I have the chance to give back some of what I've been given. That's one reason I'm telling my story. If you have a problem with drugs or alcohol, you can get help. Recovery isn't easy, but it's worth the price.
(Alexander).


Intervention # 2
~ Disadvantages
a) By being aware of the all the contributing factors, nurses might tend to think that anyone that has some of these factors are suspicious of substance abuse. Therefore, being untrusting of their colleague, and constantly watching over there back, which in turn may bring down the units trust and moral (Ponech). Nurses are at risk for drug abuse because of the availability of medications in the workplace and the cultural acceptance within nursing that pharmacologie agents provide a desirable method to cure one's ills. Health care provides a permissible climate in which to use exogenous substances to correct internal feelings or illnesses. Nurses have been taught that medications solve problems. They have seen medications alleviate pain, cure infections, and diminish anxiety. Not only are prescription medications accessible, but nurses also have a mistaken belief about their personal skills and level of knowledge to self-medicate without becoming addicted. Self-medicating behaviors may only be viewed as inappropriate when the magnitude and regularity of these behaviors increases. Access creates a familiarity with controlled substances that can increase the likelihood that nurses will use them on their own. Nurses may erroneously believe that they have the ability to control and monitor their own use of medications because of their experience with administering medications and observing their effects on patients Some nurses "believe that they are immune to the negative consequences of drug use because they are so familiar with drugs." (Dunn).


b.) Nurses that may have contributing factors, or who are at high risk for substance abuse may feel that they are being targeted or looked down on by their nursing peers. Thereby, discouraging them form asking for help if needed, or feel un-apart of the team because they don’t feel comfortable discussing their personal life with any of their co-workers; which may lead to depression and feelings of inadequacy in their careers (ANA). Recognizing that substance abuse is a medical illness that requires treatment is the first step in removing the stigma associated with it. Current philosophies of the ANA and boards of nursing support helping addicted nurses seek treatment and rehabilitation to become productive members of society and nurses again. Certainly, communication and information sharing are paramount for this process to be effective.
It is only logical that a nurse who is suspected of abusing substances should be reported. It is the emotional aspect that undermines the reporting process. Being fearful that a colleague may lose his or her job or terminate a friendship are powerful motivators to withhold or dismiss anecdotal or subjective information. As social beings, people are motivated by emotions; the ability of nurses to report a colleague would be less hampered, however, if one of their loved ones was being cared for by a nurse who was impaired. As patient advocates, this is the level of nursing at which all nurses should practice.


 

References:


Alexander, D. (2005). When nurses are addicted to drugs. Nursing. (2) 50-58 Retrieved for Proquest February 29th 2008.

American Nurses Association (2002). ANA code of ethics for nurses. Washington DC.


Anderson, J. (2004). Treatment considerations for the addicted nurse. Behavioral Health Management. (14) 22-26. Retrieved from Proquest September 30, 2007


Blair, P. (2003). Report impaired practice-stat. Nursing management. (33) 23-25. Retrieved from Proquest October 12, 2007


Dunn, D. (2005). Substance abuse among nurses-defining the issue. Association of operating room nurses. (82) 592-596. Retrieved from Proquest October 1, 2007.


George, M. (2003). Substance abuse among healthcare professionals. Nursing Ethics. (14) 843-849. Retrieved from Proquest October 9, 2007


National Institute of Health (2007) www.drugabuse.gov/infofacts/costs.html


Ponech, S. (2005). Telltale signs. Nursing Management. (31) 32-37. Retrieved from Proquest October 12, 2007


Uris, P. (2002). Chemical dependency handbook for nurse managers. National Council of State
Boards of Nursing. Retrieved from www.dora.state.co.us/nursing October 12, 2007