Voluntary programs encourage impaired nurses to admit problem
Fear of losing their medical license often keeps drug-impaired clinicians from seeking help with their problem, a situation that endangers not only their welfare but that of the public they serve.
Recognizing this problem, nursing boards in several states, including California, Michigan, and Ohio, have adopted voluntary, confidential compliance programs as an alternative to formal license discipline. Without early intervention, nurses who are terminated from one position may simply go to another facility without getting help. "If they’re just bouncing from job to job, that’s a menace to public safety," says Valerie Murchake-Wright, RN, MLHR, alternative program coordinator of the Ohio Board of Nursing in Columbus, which started an alternative program for chemically dependent nurses last year. The law now allows the board the option of abstaining from taking formal disciplinary action against the nurse, if the nurse is willing to seek treatment for his or her chemical dependency and abide by the program contract," says Wright.
An individualized contract is drawn up for each nurse that may include reports from employers, treatment team members, court officials, and random drug screening. "The focus of our program is to encourage early intervention and treatment by recognizing that it is possible for nurses to recover from addiction and continue to be a valuable part of the health care team," says Wright.
Even with an assurance of confidentiality, it’s rare for nurses to come forward on their own. "Most of the time, it’s still the employers who will call to report a nurse with a problem," says Wright. "Over time, I hope word will get out that it’s safe for nurses to do this." By the time most nurses get help, they’ve been confronted by an employer, she says. Nurses are reluctant to come forward for fear of prosecution, since hospital pharmacies are required by law to report suspicions of drug diversion to law enforcement.
Recent research indicates that 6-10% of health care professionals may have a drug or alcohol problem that impairs their practice. Often, drug abuse begins with a legitimate prescription for treatment of an injury or illness. "Some nurses started out being exposed to pain medicine for legitimate treatment and then get hooked on it," she explains. "They’ll start by having physicians write them prescriptions inappropriately and then, when they can’t get enough, they will start stealing drugs from work or forging prescriptions."
Future employers are always notified of the nurse’s previous substance abuse problem, and sanctions are imposed if the nurse fails to abide by the contract. "The bottom line is protecting public safety," says Wright. "The alternative program is a way to do that, while recognizing that it’s possible for nurses to get into treatment and recovery and still be a nurse."
There is still a lot of denial about the disease of addiction, says Wright. "People are so frightened of being sued for even hinting that someone might have a drug problem that the obvious signs may be totally ignored. "Usually by the time a nurse gets caught and confronted, most of the people in the unit know that there is a problem, and pharmacy audits may show the theft of hundreds of doses of medication," says Wright. "Sometimes it takes finding the nurse passed out in the bathroom with a needle in his or her arm."
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