Chemical Dependency among Nurses Most people in the general population are unaware of how widespread drug addiction has become. Even fewer are aware of the number of healthcare professionals that are addicts. This paper will discuss the impact of substance abuse on the nursing profession; the various behaviors that are suggestive of an impaired coworker; an understanding of the professional responsibility to report impaired coworkers; and an understanding of the legal, ethical, and safety implications of substance abuse as well as the policies in place to help the affected individual.

According to the American Nurses Association, an impaired nurse is unable to meet the requirements of the code of ethics and standards of practice of the profession. The nurses professional judgment becomes “impaired” when their inability to perform the essential functions of his or her practice with reasonable skill or safety because of chemical dependency on drugs or alcohol. Not only do these nurses create a potential threat to their clients, but they have also neglected to care for themselves.

It has been suggested that registered nurses have a 50% higher rate of substance abuse than the general public, and 1 in 7 nurses remains at risk for addiction. The data out there suggests that approximately 5% of registered nurses are alcoholics and 3% are dependent on drugs (Dittman, 2008). Another source estimates that among registered nurses, 10% may have a drug or alcohol problem (Talbert, 2009). Drug use varies among nursing specialties: emergency department nurses are 3. times more likely than nurses in pediatrics, general practice, and women’s health to abuse substances, and oncology and administrative nurses are twice as likely to binge drink (Young, 2008). It is clearly evident that substance abuse exists within the profession, and that more than likely we will have some connection, either directly or indirectly so it becomes important to understand the various risk factors associated with substance abuse.

There is also documented evidence that offspring of alcoholic parents are more likely to grow up and become alcoholics themselves (Dunn, 2005). This combination of genetics, environment, and psychological factors plays an important role in the disease process of addition. Of interest is that people in the helping professions, particularly nurses, have significantly higher incidences of alcoholism in their families of origin (Fisk & Devoto, 1990). Stress in the workplace 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 alienation, fatigue, and, ultimately, stress. The numbers tell us that we will most likely be working alongside an impaired coworker, so how will we know and what should we do? It is important that we familiarize ourselves with typical behaviors of substance abuse and recognize that many of them are general and nonspecific, however when analyzed overtime the picture may become a bit more clearer.

The more common behaviors include changes in work habits, absence from work, consistent tardiness, and inappropriate behavior or conflicts with colleagues, staff members, patients, and patients’ families. It is common to see inconsistent job performance as the individual’s ability to function declines. The individual begins to forget the detail and will have more charting errors and omissions than usual. He or she will exhibit changes in personal hygiene, demonstrate dramatic mood swings, inappropriate behavior, personality changes, anger, cynicism, and social and professional isolation (Baldisseri, 2007).

Aside from the personality changes, other signs to watch for include increased absenteeism, frequent disappearances from the department or unit, excessive amounts of time spent in medication rooms or near medication carts, work performance that alternates between high and low productivity (Epstein, Burns, & Conlon, 2010). Upon recognizing these behavior in a colleague you are faced with the decision of whether or not you become involved. The answer might not be a clear cut as you think. There tends to be some hesitance when it comes to reporting the coworker, nurses usually avoid dealing with impaired colleagues.

Nurses who work together develop friendships, which can be an obstacle to recognizing and addressing problematic behavior (Dunn, 2005). The nursing profession is unique in that it often relies on teamwork practices, such as helping each other during stressful times, this loyalty to the team can also represent a major obstacle. In addition, nurses have a tendency not to report other nurses for fear of retribution, creating problems in the work environment, or being labeled as a whistleblower (Dunn, 2005).

As nurses, we all know we have an ethical and legal obligation to report colleagues who exhibit behaviors that could be detrimental to patients, yet hesitancy exists. There is little doubt that the most important intervention the nurse can make is to report the suspected coworker. Most often, this means reporting her to the nurse manager and also may involve notifying the State Board of Nursing. By notifying the manager or the State Board, you are advocating for the patients, the coworker, the nursing association, and the profession.

Nurses with chemical dependence typically fear they will lose their jobs and possibly their nursing license, suffer financial loss, and face criminal or other legal consequences (Angres, Bettinardi-Angres, & Cross, 2009). There are several programs available to the nurse as treatment options. These resources include employee-assistance programs, employee health services, and human resources departments. Legal consultation, behavioral treatment, peer support groups, and the meetings of 12-step programs such as Alcoholics Anonymous, and Narcotics Anonymous, are also often necessary.

Approximately 40 states have alternatives to disciplinary action, including peer assistance and recovery monitoring programs (Dunn, 2005). Health care professionals who participate in assistance programs have a higher rate of long-term recovery than other addicted people. For example, Florida’s alternative-to-discipline program, the oldest in the country, more than 80% of impaired nurses returned to practice, and fewer than 25% experienced a relapse. The program is focused on support, confidentiality, and stringent on the job monitoring lasting up to 3 years.

Nurses unable to complete the program successfully are then reported to the department of health for possible disciplinary action (Epstein, Burns, & Conlon, 2010). Although the focus on rehabilitation over discipline may be controversial, the rationale is to attain a higher rate of reporting and self-reporting of the impaired nurse in order to help him or her overcome the addiction. Substance use disorders are conditions that require comprehensive intervention to promote successful recovery.

A nurse struggling with this disease must have support from their without being stigmatized, which may delay timely intervention and treatment. Nursing must integrate a comprehensive course on chemical dependency as a disease into all nursing curricula. It is necessary for all nurses to become educated on chemical dependency, self-care, signs of abuse, and support available to the impaired nurse. A nurse’s primary duty is to care for and maintain the safety of patients. Upon entering into the field of nursing, we take an oath to provide the best care we can by advocating for our patients in a professional manner.

It is our responsibility as nurses to advocate for those patients who may be under the care of an impaired nurse by reporting the person to the appropriate authority. It is the responsibility of every nurse to assist an impaired nurse in seeking recovery. We must, also, be willing and competent to help fellow nurses in their recovery process. In order to do this, nurses must be educated in the area of chemical dependency, as they are educated in all other diseases. Maybe equally important, nurses must learn to care for themselves before they are able to care for others. ?

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