When you suspect a colleague is addicted
Although attitudes are changing, there is still a stigma about substance abuse, notes Jill Pollock, RN, executive director for critical care and emergency services nursing at Loma Linda (CA) University Medical Center and Children’s Hospital.
"When I was a staff nurse, I remember a colleague we respected and loved being taken away in handcuffs," she recalls. "That’s like firing somebody who has diabetes. The main goal should be to get the nurse into treatment."
Here are steps to take when you suspect a colleague has a substance abuse problem:
• Know and address warning signs of substance abuse.
Be on the lookout for the following red flags, advises Pollock:
— a change in personality;
— being gone from the ED for a long time;
— lateness or calling in sick frequently;
— erratic behavior;
— mood swings;
— failure to pay attention to things they normally would;
— irritability;
— requesting the night shift.
"If we see a nurse moving slow and looking very pale, and the next half hour they’re perked up and ready to go, we may not pay attention because we’re so busy," says Pollock. "We work in such a hectic environment, but when we do sense something is wrong, we need to confront it immediately." (See Checklist: Characteristics of an Impaired Nurse, p. 81; Signs and Symptoms of the Alcoholic Nurse, p. 82; Signs and Symptoms of the Drug-addicted Nurse, p. 83; and screening tests for alcohol and drug abuse, inserted in this issue.)
• Follow your instincts.
Liz Jazwiec, RN, a Crestwood, IL-based consultant specializing in staffing issues, says, "Most of the time, everyone knows when someone has a substance abuse problem. But they try to deny it, just like they would in any typical family situation.
"As health care providers, we do know in our guts when something is not right. I don’t think we are often surprised, but like any other close group, we try and pretend it’s not there."
• Be sympathetic.
Too often, employers just want to get an impaired nurse dismissed and see them as a liability, says Pollock.
"But these nurses are good people; they just become ill," she emphasizes. "And they’re not malicious or bad."
When a nurse leaves the ED to go into treatment, colleagues tend to be unsympathetic, Jazwiec urges.
"When a nurse who worked the night shift was found to have a serious drug problem, that nurse had to go into rehab for eight weeks," she recalls. "The staff was upset because they had to cover the nurse’s shifts. I had to point out to them that the nurse isn’t off on a vacation, taking it easy. When this occurs to somebody, it’s absolutely devastating."
Realize that it’s far harder to undergo treatment for drug addiction than to work additional shifts, Jazwiec notes.
"When this happens to a nurse and your facility stands behind them and doesn’t fire them, you ought to be grateful that you’re working for an employer that does that. Because at any time, it could be you or someone you are close to," she says.
• Make sure impaired nurses know they’re not alone.
At Loma Linda, a peer support program enables nurses with a substance abuse problem to reach out to their colleagues to discuss their options.
"These are people who the ED nurses view as safe,’ who will respect their confidentiality," says Pollock. "There are certain people who are helpful and listen well, who nurses feel comfortable approaching with concerns. A nurse in trouble with drugs is more likely to go to one of these individuals than the nurse manager."
Nurses can ask for help without revealing the problem, Pollock explains.
"They can at least test the waters and talk it out with someone safer than a supervisor. They can ask, If I had a problem, how would I go about getting help? I don’t feel comfortable telling you what it’s about, but please refer me,’" she explains.
• Don’t hesitate to share concerns about a colleague.
Nurses fear they will devastate a colleague by reporting suspicions about drug use, says Pollock.
"In every class I teach, someone raises their hand and says, I cannot report somebody because I will ruin their life.’ Yes, there is a possibility of that person losing their license, but that doesn’t always happen," she stresses. "Our fear of confronting is one of the biggest obstacles we need to overcome."
Twenty states have alternative programs
Nurses may not realize that many states have a diversion board that allows impaired nurses to retain their licenses, notes Pollock.
"Five years ago, only eight states had an alternative program, and today there are 20. If you have a problem, you can enroll in a rigorous program and avoid having your license taken away as long as you comply," she says. (See story on alternative programs, p. 83.)
Care enough to confront, urges Pollock. (See story, p. 82, and guest column, p. 85, on how to confront a colleague. Also see chart, Reaction of Colleagues, p. 84.)
"Nurses may disappear from the ED for hours on end, but colleagues remain in denial," she says. "People are generally willing to believe anything, except the fact that the nurse has a problem with drugs or alcohol."
One ED nurse who had a substance abuse problem used to make excuses about having to go into the bathroom continually to change a dressing on a leg injury, Pollock recalls.
"We all accepted that explanation without questioning it," she says. "You need to really examine and look at what’s going on around you. Don’t accept excuses that don’t make sense."
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