Addiction: it’s a moral issue, right? Whoever starts abusing a drug is a bad person, making a bad choice, and should be punished. At the very least, they should be able to quit on the spot.
But it’s not that simple. According to Dr. Linda Barile, APRN, and advocate for nurses who are addicts, we need to stop blaming them and instead support them through recovery.
Here is Barile’s insight on how to help a nurse who is an addict:
RealityRN: How have hospitals historically dealt with nurse addiction?
Linda Barile: Through denial and punitive measures, unfortunately, addiction is not seen as a disease, even by many in the medical community.
Often no action was taken. When it was, we’d put them on nights; hide the problem–because we thought the addiction was due to stress. And if we could relieve the stress, then the addiction would just go away. While stress may have been the reason a person started abusing a drug, it’s no longer the reason they are addicted.
If caught diverting, most nurses were punished. You were sent before the State Board of Examiners for Nurses and you would have your license suspended for prolonged periods of time or taken away. Nobody wants to employ an addicted nurse, so they took away the nurse’s job—without seeing them through recovery.
Why are addicted nurses treated so harshly?
There is a mistaken belief that someone can stop using if they really want to. And in cases where nurses suspect or know something is wrong, they don’t know what to do. They’re not sure if they should confront their coworker, but they would feel like a traitor who could cause the nurse to lose his/her job, if they let someone know.
When a nurse is discovered to be an addict, other nurses struggle with bitterness and anger about having been manipulated. They’re not ready to jump to an addict’s rescue.
There is also the “family secret” mentality. It’s important to keep the image of the “healthy, happy, functioning” facility/unit/staff intact. Many institutions like to pretend addiction doesn’t happen in their establishment. But this cycle of enabling puts patients in jeopardy--and the addicted nurse becomes increasingly ill.
How should addiction be dealt with?
First, nurses need to become educated about addiction as an illness, an actual brain disease that causes people, even nurses, to act outside their normal moral behavior.
It is essential to document any incidents they are concerned about, followed by notifying their direct supervisor. An individual nurse should never confront another nurse alone. If a nurse comes to work intoxicated or high on some drug, call your supervisor or head nurse and seek the help of an addiction professional. But don’t confront the nurse yourself. On many occasions, they’ll argue with you, deny it, or get angry.
When a nurse is confronted, don’t send that person home alone. Legally and ethically, you can’t let someone who is under the influence of a drug get into a car and potentially harm someone. That person needs to be escorted home or, if indicated, to an appropriate medical facility for care.
During the intervention, the addicted nurse also needs to be guided through how and where they can get help—and not judged but supported through the process of recovery.
Where can nurses find help?
In many states, like Connecticut where I am an APRN, there are non-punitive alternatives to a disciplinary system (which typically are initiated by the Department of Public Health). Connecticut’s program is called HAVEN (Healthcare Assistance Intervention Education Network). Through programs like this, nurses can anonymously self-refer, and if they meet the criteria, their monitoring is done in a confidential manner. When the nurse successfully completes the contract, his/her license is clean and unrestricted.
In many states, there is also a peer support group called Nurses for Nurses, which is anonymous and confidential and provides a place where nurses can discuss the specific issues facing nurses with substance abuse. And at the very least, nurses can get involved in a 12-step recovery group, like AA or NA. AA and NA are welcoming and knowledgeable about addiction--and don’t cost a penny.
It’s crucial that help be sought to assist the nurse on the road to recovery, which is multifaceted: biological, psychological, social, and spiritual.
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November 30th, 2007 at 7:20 am
I like the idea nurses can seek help. As much as I like the idea, anyone can seek help. I like help. It is helpful.
Addiction treatment has been around for a long long time. No one is unable to recover.
In furthering the understanding; “There is a mistaken belief that someone can stop using if they really want to”. The reality is, it will not change unless the person really wants to.
But what of the patient safety issues? What of the co-nurse working under a manager or experienced colleague (or just a peer) who presents with the associated mood dysphoria and is just generally a bigger clinical management issue than the patients we are intended to care for?
Addiction IS a terrible thing, but it does not abrogate the responsibility of the nurse to protect patients from ourselves.
An understanding of the issues might help. as you suggest and I agree, but it will not better place the nurse who is then faced with the moral dilemma of seeing another nurse fail in their duties and places patients at risk, or steal from the service, or just not be able to perform to a satisfactory standard when they have to be mindful of “How can I help this nurse?”.
In another posting, and oft lamented issue, we discuss about where do we cut-off between health and social issues. It is not easy, and now we’re to determine where to cut off between incompetent care and needs of the nurse?
I support the supportive response to nurses with addiction issues. But let that be addressed within the counsel of those who are charged with managing the dilemma. Meanwhile, I will still ensure through whatever means the administration makes available to me, I maintain patient safety.
Although your actions and beliefs are morally laudible, and seek to support those disaffected through remedy rather than punishment, it is not something I can advocate I ought spend more time considering when I come across such a scenario. I do not support any movement that will make nurses who are delivering care feel like they have to make a moral determination that alters the fundamental beliefs of ‘patient comes first’.
Neither do the nursing boards – “If caught diverting, most nurses were punished”.
If you please, they are protecting patient welfare, as they were designed to do, not punishing nurses – that is just a secondary effect. Mentally ill patients are detained against their will in the millions every day; but we’re not punishing them, no. We’re supporting them to recovery, aren’t we?
If the nursing boards seek to address the issues in more supportive fashion than just removing someone from the register (or in whatever seemingly perfunctory other manner they determine) then it is at the boards discretion and I leave that for them to decide. With the imminent world shortage of nurses, I would suggest however, it is in the moral interests of society to repair as many nurses as we can.
Self-righteously speaking, it is not for me to decide if or when a compromised nurse is fit for practice, or by what means I ought support this person to address their issues other than initially seeking to withdraw them from patient care. I act to preserve patient welfare because, if I don’t, I WILL get punished by the nursing board.
I’m supportive of the principle. But please don’t make it my moral obligation to ‘accept’ there’s a disease out there that I need to be sympathetic with when it places my professional standing at risk.
December 4th, 2007 at 2:27 pm
Last year I found out that a co worker was addicted to narcotics. I would have never expected that she would do that. It taught me a lesson that sometimes it happens to the normal, ordinary person. Through much counseling and time she is now a nurse again and is doing well. This is a real problem in the nursing world and we as nurses need to be aware of the signs of addiction so that we can help our co workers and support them and not judge them because it could happen to any of us.
December 4th, 2007 at 4:38 pm
It’s unfortunate that addiction is perceived as a weakness, or a moral failing that only strikes the unworthy. We cannot put ourselves on a pedestal and be naïve to the fact that addiction plays no favorites. Yes, it does strike the doctors and the lawyers and the dentists and the nurses and the teachers of our communities. And turning a blind eye to this matter will not make the disease disappear.
Personally, I think nurses have such a difficult time accepting addiction among us as we wish we could “fix” everyone. And how are we supposed to accomplish this if we, ourselves, are broken?
Pick up a Narcotics Anonymous Basic Text and read through it with an open mind. If we do not understand the disease, who are we to judge? Addicts are not bad people. They are sick people.
Remember when AIDS was the “gay disease”…?
December 4th, 2007 at 7:08 pm
I would like to address and direct Mr. Ian to research some statistics about alternative to discipline for nurses. Nurses in confidential programs relapse at the rate of 10% or less, as opposed to any other statistic about addiction and relapse which is 35-50%.
With the statement that ” they stop if they really want to” and your response of ‘it will not change unless the person really wants to…it is not as simple as this. A nurse that is motivated to change does not know what to do, and if he/she does, they don’t know how to do it. Time after time, day after day, the addict tells themselves that they will stop, but the neurobiology that drives this machine is in the instinctive part of our brains that have no language, and tell us that the drugs are important to us as life sustaining food. During treatment the nurse learns how to change, and is given the tools to make it happen. The nurse develops incredible insight into the genesis of his/her underlying reasons for using drugs to cope in the first place. Nurses recovery at a remarkably high rate once they have these tools, people, recovery groups to keep the disease in remission. A diabetic can not just change their blood sugar by shear will, they need their tools. I know what I am talking about because I have diabetes and addiction.
Patient safety: The way to secure patient safety IS to remove the impaired nurse form the clinical setting, until the nurse is in an established a sound recovery. Do not fire the nurse! Allow the nurse to take a medical LOA and preserve the nurse’s health insurance so that he/she can receive the help they need. Support the nurse’s return to work with this monitoring in place. The nurses that become addicts typically are your highest functioning nurses, have advanced degrees, and are loved by other medical personnel and patients alike. I refer you to the website, “Nurses in Recovery” for the profile of a nurse addict. They are not the slackers or borderline performers. These truly are the nurses that you would be the last one you suspect. The workplace is where the nurse finds his/her identity, so is the last place that is affected by the addiction. The nurse’s home life may be falling down on all fronts, but the workplace is not affected until the nurse is well into the disease.
It is all of our jobs as a nursing community to preserve patient care. and the nursing board is mandated to protect the public from bad care, but nursing boards across the country support and promote alternative programs because they work. If a nurse is disciplined, his/her personal health/psychiatric information is public record…and if you think that HIPAA can protect that, you are wrong…prosecutors find ways to manipulate the nurse to surrendering this PHI. The information is there forever even if the nurse has been in recovery for over 20 years.
Mr. Ian, learn HOW to advocate for the patient BY advocating for our fellow nurses. There are many, many nurses in recovery from addiction that are doing every aspect of patient care imaginable…they may be working right next to you, or giving you your anesthesia, assistng taking our your appendix…or putting your foley in
I have written a book about my personal experience entitled “Walking Like a Duck: the True Story of a Nurse Walking from Addiction to Recovery” It is ALL TRUE…not like that book that other guy wrote that was on Oprah.
Thanks,
Pat Holloran
December 4th, 2007 at 8:43 pm
Patty thanks for stating it so wonderfully.
Mr Ian, my I please suggest you review the newest Nurses Code of Ehtics which specifically addresses the issue of impairment, or check out the position statement from ANA and the National COuncil of State Boards of Nursing’s support of alternative to discipline programs and NOAP (National Association of Alternative Programs). There is a wealth of information out there available to the willing, still teachable individual. Linda’s expertise in the area of addiction is extensive and you couldn’t want a more empathetic advocate.
I know Linda and Patty personally and my respect for them is unending.I strogly suggest reading Patty’s book for a straight forward account of a triumphant woman who hasn’t forgotten where she came from and who knows where her passion lies. Oh by the way, about Patty’s book,,,I’m chapter 36!
Whatever Linda, Patty or I say is for the educational value it brings, not an attempt to change anyone’s mind, we’re not that powerful.
Thanks
Dede Dwyer, RNC-E
(author of Memoirs of a Recovering Drug Addicted Nurse)
December 5th, 2007 at 9:32 am
With the greatest of respect to all those recovering addicts (nurses or otherwise) and others who may have found my post ‘offensive’ or overly negative, I accept your informed opinions. However, my first ever ‘boss’ told me – “If I want your opinion, I’ll give it to you” and this was the flavour of the article as I originally read it.
In responding to the comments, I do not and have never worked in the USA. Unfortunately, and for some obscure reason that defies me, I need to know obstetrics before I can work with the mentally ill in USA, but that’s another issue. Therefore my knowledge of ANA Code of Ethics and the NOAP, HIPAA & PHI are limited mostly because I either do not regularly use/review them or I just don’t know what some of those acronyms mean.
Patty identifies that: “A nurse that is motivated to change does not know what to do”. I agree with this mostly, tho some people do self-recover effectively. I merely stated the obvious that a person who doesn’t want to change, won’t. Motivation is a key ingredient and this is the theory of cost-benefit analysis that we all do every day for every decision we make before we act; outcome A must outweigh outcome B for us to choose it.
I did not suggest support wasn’t needed to change, but significant change does not occur unless and until that person decides to change.
Regarding ‘do not fire’ the nurse – If a nurses license is suspended or revoked they cannot be employed as a nurse. Licensing is the boards decision and, as I stated, it is their decision how they sanction such matters. I spoke of “discipline”, not dismissal. If all your ‘disciplinaries’ for addictive behaviours end up in dismissal then I’m sorry to hear that. It does sounds a bit harsh. The UK nursing council has retained powers to temporarily suspend a nurses right to practice on medical grounds, or to allow them to remain practising whilst undergoing treatment, for many years. This has been implemented for addicted nurses as much and as equally for any other ailment. Perhaps USA nursing is only just catching up to the idea and I’m arguing a moot point?
Notwithstanding, I strongly defend that ‘discipline’ from the nursing boards needs to remain a component for the issue of governance, but mainly for a monitoring and recovery evaluation purpose; or for the exercising of extreme action in exterme cases (ie revocation of license). If there were no fear of such redress, we’d all be popping pills just to make it through the night shift. Such leverage adds weight to the cost-benefit analysis as it imposes an external modifier to evoke change in the person. Some may argue it is an un-needed extra pressure – but I would suggest that the nurse with addiction needs to show not only willingness but also ability to understand the gravity of their situation.
I’m not sure from the information you gave wether nurses under a “confidential program” are required to submit to the boards for review. Nevertheless, nurses with addiction can and do pose a risk to patients, employers and fellow staff. If they didn’t, it wouldn’t be a problem. I maintain, the boards will be failing in their duties if they did not provide that protection.
As for the act of dismissal; I understand that to be down to the employer and not the nursing boards/councils – however, they are unlikely to remain employed if their license is revoked or suspended. Similarly, when hospitals are performance driven and standards are required; employing a nurse with a current addiction problem is hardly quality cost-effective for them. It would be as sensible as employing a paedophile at a day care centre. It is not surprising then that such information is still relevant even after “20 years of being in recovery” (note: “in recovery” is the philosophy that addiciton is never ‘cured’ – and is the understanding of NA, not nursing boards or hospital managers, implying there is forever a ‘risk’).
Regarding the process of change for addicts, I totally agree with Patty’s post regarding the treatment and the “tools” to change and already indicated that anyone can recover. I’ve been working with addicts for 14 years. Some do, some don’t and treatment approach has a large part to play in that. I respectfully suggest though, the ‘treatment’ point is somewhat irrelevant to the debate as it does not effect the issues facing the nurse on the shop floor who has an impaired nurse at their side, which was my posting.
I emphasise, I did not disagree with the remedial treatment actions that might be afforded a nurse with addiction; I supported it. As much as I support the people I work with towards recovery and breaking habits of a lifetime.
The American Nurses Code of Ethics, speaks expansively of protecting the patient and in a small part also addresses the issue of ‘impairment’. It identifies that nurses disaffected by addiction should be directed to care and treatment and that nurses should receive them back to practice to resume professional duties. I can’t find any fault with that and, reiterate, I support the process of remedy rather than revoking a license. Assisting an impaired nurse is an additional requirement to protecting patients and the integrity of the profession and I submit that I was not aware of the USA Code of Ethics specific address on the issue. It was an interesting read, even if somewhat obsolete to my needs in another country.The fact it has to be written into a Code of Ethics somehow makes me feel that the USA has a much bigger issue of nurses with addiction than other countries might have. It might have been helpful to have made reference to the Code within the original article and perhaps have expanded from there.
What I actually disagreed with about the article was the title and flavour that begins by implying that any nurse who redresses a nurses unethical practice is acting out of “self-righteousness” and ‘blame’. They are not. They are doing exactly what the nursing board (and the public/patients they serve to protect) and the Code of Ethics expects them to do – protect patient safety and the integrity of the nursing profession above all else. Supporting the nurse back into the workplace is fine – as long as you remember the nurse is “in recovery”. If such ‘blame’ and ‘self righteousness’ was a reference to nurses attitudes for nurses with addiction when returning to work while going through recovery, then – to educate me – it warranted more than one line on telling me to support such nurses when they return, but not how – other than not judging them.
If the article was aimed at those senior nurses who simply wish to ‘sweep it under the carpet’ or ‘manage’ the issue by avoidance or alternate disposal, then I do not disagree with its flavour. However, I would implore cautionary reservation at the somewhat biased perspective that “it’s all going to go well if you just follow this simple rule…” . It will not. It might help many – 90% according to Patty’s statistics – which is not that surprising since Linda indicates the nurses have to anonymously self-refer in the first instance, demonstrating the necessary predisposing motivational factor I mentioned.
(Just a note on the research to Patty: you did not identify if the other 35-50% was relevant to nursing or general populations. I am unable to compare these values as nurses would generally fair better as they have acquired knowledge and understanding of pharmacokinetics, behaviour, self-awareness, etc relevant to the treatment; Jo Public requires significantly more ‘training’ in these areas to be successful)
If the article was directed at ‘shop floor’ nurses then I suggest demanding professional nurses to abandon all sense of apprehension or fear (or blame and self righteousness, as you term it), that an impaired nurse is “ok and just needs a little support”, that the unimpaired nurse also has to remain fearful of not breaking the law by seeing them home safely, but should not approach this person alone, and on their “recovery” all you have to do is not judge them and they’ll be alright, is somewhat misleading, fear invoking and not very eduicating.
The moral position they are placed in is heart and mind wrenching and, although I acknowledge the Code of Ethics rightful declaration to assist and support the impaired nurse, I would not want to be the one to ‘out’ an impaired nurse knowing that I might be sending them to damnation for eternity – as the original article suggests we have been doing. What might have been more encouraging, and educational, is to know first what is happening to ‘fix’ the problem and the positive outcomes for the impaired nurse (90%); not just having my “self righteous” attitude declared to me.
It seems, despite dede’s assurances that “Whatever Linda, Patty or I say is for the educational value it brings, not an attempt to change anyone’s mind, we’re not that powerful”, the title, introduction and flavour of the article is nothing less than a forthright admonishment of nurses who feel fearful, apprehensive or ‘manipulated’, and demands such nurses redress their attitudes to ‘addiction’ and must do it now because our own nurses are suffering.
I have re-read the article and subsequent postings and, in the light of the further information I am now availed, there appears to be a significant talking at crossed-purposes. The subsequent postings of Patty and dede have certainly helped clarify the position of the National and State initiatives and the current attention the matter is receiving. However, the original article directs me to ‘stop blaming them’ and, when it asks why are nurses treated so harshly, the answers identify the issue to be in the attitude of nurses like myself who actually have no control or involvement in the management of such an issue other than perhaps initiating the action and this is the representation that flares my response. The ‘harshness’ that leads to nurses losing their license is the boards’ decision – not mine..
The posting on a generic nursing forum of suggestion that I am blaming nurses with addicition for their own problem behaviours and “When a nurse is discovered to be an addict, other nurses struggle with bitterness and anger about having been manipulated. They’re not ready to jump to an addict’s rescue.” is a sweeping generalisation that I find offensive. I believe the ‘harshness’ debate was originally directed at the boards and managers, yet somehow has been manipulated to imply that it is my ‘harsh’ and ‘self righteous’ attitude towards impaired nurses that is the problem.
Changes to the way State and National bodies are addressing the issue might reduce that risk. That’s fine with me, but I don’t see how my attitude, good or bad, has anything to do with nurses with addiction being dismissed. It certainly has a lot to do with how well the rejoin the workplace, but that didn’t seem to be the nature of the article. I would proffer that many nurses at the shop floor are already very supportive of their colleagues and the inference that such nurses do not exist is condescending.
Notwithstanding, the implications for a nurse who, on witnessing an unethical or unlawful behaviour when faced with an impaired colleague who may be ‘diverting’, are immense. Are you really that surprised that a nurse might feel a little upset (or self righteous) when it comes down to him/her to take action; knowing that somewhere along the way that impaired nurse may be dismissed or that they themselves may be called to write statements or testify against a colleague or, by the serruptitions behaviours that addicts employ, to be left wondering wether the deviant behaviour of the addict ever left them compromised or implicated? You’re asking (demanding?) that the nurse forgive and forget and never have to worry that it’s going to happen to them again?
I also find the focus on other nurses attitude something of an attempt to subvert the ‘problem’ from the nurse with the addiction to the nurses attitudes around them, which is absurd. The problem was already identified as harshness and lack of support at board/employer level – yet the ‘answers’ are directed at how nurses should change their ‘self righteous’ attitudes. I would agree, bad attitudes won’t help in rejoining the workforce, but I’m kind of lost on who we’re actually directing this article to now.
The article further suggests that nurses who are addicts are merely ‘victims’ of a sequalae of events. I generally agree – but then, anyone who suffers is a victim, just like someone who smokes crack is a victim of their circumstance, or a person who breaks the law is a victim of their circumstance. Do they receive the same supportive and non-judgmental attitudes of society? If they commit an offence or are merely under the influence, are they as vindicated or are they vilified for their unfortunate circumstances?
Nurses with addiction invariably come under disciplinary action only because they have acted in an unscrupulous way at work – not just because they suddenly realise they are addicted and seek help. These more scrupulous, yet addicted, nurses draw no attention to themselves and thus remain ‘undetected’ and may seek private recovery.
What I loathe mostly are double standards that are being asked; when we consider how those persons were placed in a position of trust by the nursing body, colleagues and the employer – and then might abuse that trust to sustain their addiction and crying outrage at being asked to account for themselves for the next “20 years”. How do we react to a financial investor who squanders our monies or commits fraud? We are outraged at the abuse of trust. We demand their license to practice be revoked. But it wasn’t their fault? – they needed money to repay this bad debt, this bad bill, this unfortunate investment, etc. Or further, the paedophile who, only because he was systematically abused throughout his childhood (hardly his fault?) knows no other way of making a relationship. Should we not remain aware of that risk and simply allow them to be alone with children because they are “in recovery”? If we are going to become sympathetic to one unfortunate turn of events, then we must be sympathetic to them all. Or are we suggesting that the risk to a patient of an impaired nurse is of less importance than these examples?
Nursing is a sub-culture, a micro-society. The admonishment of those nurses who feel fear or apprehension regarding nurses with addiction in their workplace is like telling society they should just be understanding of all those who were sent to prison for breaking the law; or not ever wonder if a convicted paedophilic priest might be permitted to teach Sunday School again? You ask for a huge culture change and just expect nurses to do it because you say so.
If this was an attempt at destigmatisation then I would respectfully suggest ‘tartgetting’ other nurses attitudes, who have effectively done no wrong, as being problematic will probably not invoke the desired change. I did not find it educational.
I remain unchanged in my sentiments, but if you would like me to change them, do not make me sympathise by subversion, make me feel guilty for my fear and apprehension or attack my moral values (which I did not ask to be tested by the impaired nurse in the first place).
Yes, these things happen.
Yes, I think it can be harsh.
Yes, I do want to help.
But my opinion is formed by how well I am made aware.
Please, just tell me what’s going on, do not give me my opinion.
December 6th, 2007 at 6:01 am
For Ian…
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These were not opinions, these are facts. Addiction is the only illness that is treated through a funnel of attitude
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Addiction removes our ability to choose. I did not know that I had to change until I was in treatment where the most robust defense mechanism a human has, denial, was lifted. Then, and only then, did I became motivated. In addictive disease, motivation rarely precedes a life altering event or consequence.
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I think that we all know that a nurse can not work as a nurse if the license is suspended or revoked, I was talking about prior to this…so that the nurse can utilize his/her benefits to get well.
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Hurray for England! Perhaps you are arguing a moot point. I hope that the USA will catch up across the board.
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I also agree with this, but not for the nurse who is a first timer and is following all of the stipulations in the contract with the Alternative Program. If he/she fails the program then the nursing board should decide the outcome.
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I think we have to differentiate a nurse that is actively using and one that is in a real recovery with monitoring in place…cost-benefit (I hate that term) is no different than any other nurse.
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I am talking about a nurse who has not had any further disciplinary action and meets all the requirements of being a solid, respected, functioning nurse. “In recovery” is an active term for any chronic disease…remission can be used in place of it…people are in “recovery’ when they have a mental disorder as well, so it is a term that is used by nursing boards and the medical/psychiatric community. Merely being a human being with the vulnerability to any physical, emotional or chemical disease is then a ‘risk.’
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The nurse who has an impaired nurse on their side has the ethical (and sometimes legal) responsibility to report that nurse to start the process of reporting to removing the nurse from the bedside and get that nurse into treatment. It is highly relevant to the whole issue to the floor nurse and every other venue that nurses work in. It is not a debate.
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The article never stated or implied that redressing a nurse’s addiction or other inappropriate behaviors was part of the self-righteousness and blame. It is the overall attitude of nurses toward other nurses with the disease of addiction, period. Why should you have to remember that the nurse is in recovery? That is really none of your business, unless you are supervising a nurse with a monitoring program in place. Would you like others knowing if you have a mental illness like depression and are on meds? Like I said before you have no idea who may be in recovery…we’re everywhere!
Not judging them is a start…now get educated about nurses and addiction.
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They usually are made aware of the program through treatment facilities…so absolute self-motivation does not have to be a factor.
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I was referring to all populations, nursing included. You can not apply nursing education and knowledge to the predisposition of any disease.
Knowing pharmacokinetics is actually a documented predisposing factor in addiction…we think that we are immune because we are pharmacologically trained. We self medicate a lot and do not see the risks. We have a Pavlovian response to our patients when they are given pain medication—give shot…pain gone…and we internalize this and apply it to ourselves not realizing the risks…because like I said, we think we are immune. Knowledge of diabetes did not prevent me from getting it…and nurses with cancer work in oncology sometimes!
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The article did nothing of what you mentioned above…you are just being sarcastic. Nurses need not be full of apprehension and fear…they need the practical knowledge of what to do if one suspects a colleague to be impaired.
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Your words.
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If the shoe fits, wear it…if not LET IT GO…you are harping on this so much that you must have an issue of some guilt surrounding this. No one is accusing you. Dr. Barile was attempting to raise the consciousness of the nursing community, not Mr. Ian himself.
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A nurse who takes action, saves another nurse’s life, is a professional who wants to be a part of the solution, so that the surreptitious behaviors can be addressed and patient safety is ensured. To not do so is to enable the situation to continue, and the impaired nurse to become increasingly ill. It is OK for the nurse that has to report to feel angry and betrayed…even as a recovering nurse, I would probably feel the same, but feelings do not solve the problem. We need to afford our fellow nurses with the same compassion and empathy we give our patients, regardless of our personal feelings.
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This nurse was not asked to account for herself in the last twenty years…just that it remains a matter of public record with no statute of limitations. That is unfair to someone with a DISEASE.
A financial investor, by your description, does not have a disease.
And your last point about the pedophile is just stupid.
Nurses is a good recovery usually choose a safe working environment for themselves, and are mandated to while they are under monitoring.
You sound really angry. No one accused you of anything in this article.
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Again we are not telling society to do anything that is against the best interest of society.
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No one is trying to give you an opinion…you obviously have your own strong ones,,,and like Dede said, we are not that powerful.
It is just our ongoing attempt to educate the nursing community about addiction, and raise awareness about how nurses respond to this fatal disease…through attitude…yours is showing so self-righteously.
Patty
December 7th, 2007 at 12:47 pm
To Patty, and with respect,
Firstly, I’d like to request RealityRN adopt a “quote text” option for these posts. 🙂
Secondly, I mean no ill to your opinions, they are valid to you and I, as stated before, accept them as such. I too have an opinion which unfortunately, in this instance and in some aspects, differs to yours.
“These were not opinions, these are facts. Addiction is the only illness that is treated through a funnel of attitude”
I have not come across the term “funelling of attitude” and found nothing on the net
(Your search – “funnel of attitude” – did not match any documents) therefore I can form no opinion nor find any fact with this statement.
Although I’m not quite sure what you’re alluding to with this term I will hazard a guess; whether it be the treatment modality or the stigmatism that is associated with addictive behaviours, addiction has no right of exclusivity in either regard.
Addiction does not remove the ability to choose; it emphasises the choice to you by the presence of ever-changing gains, preferences or needs. Eventually these needs may become physiological addiction which is where it becomes a disease as the ‘preferences’ that direct our decisions are now biological as well as psychological.
Semantics perhaps, but the ‘disease’ effectively cripples the choice process by making Choice B always better than Choice A because it is stronger and overwhelming.
However, when we make a decision about our behaviour, we always have a choice, even if that choice seems forced by our physiology. Diabetes is not a behaviour, it is a physiological condition that requires no behavioural input to exist. Homoeostasis, however, for someone with diabetes or not, does require a behavioural input. Just as addiction causes an imbalance in our physiology, so too does thirst, hunger, diabetes, pain. If you choose not to enact the necessary ‘treatment’ it continues to effect the biological imbalance of your body. That is where motivation comes in. People would simply rather not be unbalanced. Ergo, I maintain that, although it is becomes physiological in its dependency, addiction relies on motivational change to alter that behavioural input.
Addiction may initially be psychological, environmental, economical, physiological or social but in any event, it requires a behavioural decision to exist. How else could it be stopped if we had no control?
I actually subscribe to the theory that being human is a disease, so perhaps I’m not best placed to argue this point with you, as I’m pathologically ill.
In regard the debate on motivation; you recognise that you only became motivated to change once denial was removed. I understand that and I reiterate, what comes before and after to create that opportunity for change is equally necessary but the primary factor in making change is motivation. I did not obviate any of the other processes such as defeating denial. I simply maintain that motivation is what creates a behaviour for change. It’s a fairly simple psychological fact. Denial itself is defeated by motivation – why else would you change your belief system if you weren’t motivated to somehow?
Denial is a defense mechanism, but then so are many other psychological traits such as delusions, dissociative identity disorder or even anti-social personality disorder (the list does go on) – they all protect the person from psychological ‘damage’ – which are far more complex and are not as easily overcome as denial.
“In addictive disease, motivation rarely precedes a life altering event or consequence.” which was, as I stated, that an addictive personality rarely becomes noticed until it becomes necessary by others or the person for its serrupticious or self-damaging behaviour.
“I think that we all know that a nurse can not work as a nurse if the license is suspended or revoked, I was talking about prior to this…so that the nurse can utilize his/her benefits to get well.”
Regarding not suspending licenses prior to them being suspended, if I read you right; the job of the board remains protection. It seems the issue, of which I admit I am somewhat ignorant as I do not live in a country where you have to pay or have insurance for access to treatment (Hurray for England! – well, the whole UK,… and Australia.. and most of Europe too), I am guessing that once a license is suspended and a nurse cannot work as a nurse, they lose their health insurance and cannot commence treatment as they can’t pay for it? This is indeed a most unsatisfactory deal; but I believe the flaw lies in the bureaucratic health care system that requires such insurance to avail treatment.
It is not for the board to compromise safety, and it is not fair to expect the employer to accept risks that may result in huge litigation. If you were to advocate for a free healthcare system for nurses (and anyone) with addiction then I would be 100% supportive of you. But you cannot blame the board or the employers for a health care system that is provided by the government, as elected by your people. Take the issue to them, this is the system they voted for.
“I also agree with this, but not for the nurse who is a first timer and is following all of the stipulations in the contract with the Alternative Program. If he/she fails the program then the nursing board should decide the outcome.”
Not sure which point this related to, but thanks for agreeing. I’ll just agree with you also, to be fair.
“I am talking about a nurse who has not had any further disciplinary action and meets all the requirements of being a solid, respected, functioning nurse. ….”
I’ll agree with this one too to a point. Risk behaviour management loosely requires the behaviour to be absent for as long as it was present in order to begin to consider it reduced. If a nurse with addiction for 5 years stays good for, say, 10 years, sure, expunge the record. I return to this point below.
“The nurse who has an impaired nurse on their side has the ethical (and sometimes legal) responsibility to report that nurse to start the process of reporting to removing the nurse from the bedside and get that nurse into treatment”
Ok, so this was one of my original concerns. How is the shop floor nurse supposed to be responsible for getting that nurse into treatment? Surely their obligation stops at the ethical reporting (with support to the impaired nurse) to the appropriate persons? If that nurse also happens to be a manager then I understand a duplicate role; but to expect the shop floor nurse, going thru all that emotion, to then be liable for getting the nurse into treatment? Surely we are not expecting a newly qualified RN to assist a perhaps seasoned RN with addiction who happened to divert some drugs on the young RN’s shift to support her into treatment? This is human resource and nurse management responsibility.
I do not think the Code of Ethics was extending to such lengths as to make the shop floor RN so responsible; otherwise, why stop there? It might as well be construed that nurses reporting should also be giving the treatment too?
“The article never stated or implied that redressing a nurse’s addiction or other inappropriate behaviors was part of the self-righteousness and blame.”
Neither did I. I argued that characterising unimpaired nurses as being ‘self righteous’ or ‘blaming’ the other nurse with addiction was condescending and now I’m thinking about it again, it’s also pretty sanctimonious.
“It is the overall attitude of nurses toward other nurses with the disease of addiction, period. Why should you have to remember that the nurse is in recovery? That is really none of your business,”
I have a disease; it’s in my brain and my blood and my bones. I’m human. Yet you do not have to consider that when telling me how to think or behave? My brain tells me to think certain things and to behave in certain ways based on who I am at this moment in time. Why is an addict then unfortunate, and I am just plain wrong?
If I work with a nurse such as yourself who is diabetic; do you tell your colleagues or do you not? It is your own business, I agree, but what if you fall hypo? What if you have an injury at work and require treatment? Is that information not relevant? Sure you may give it to your HR department in confidence; but if you collapse on your colleagues – would it not be fair and right for them to know what they might be dealing with or have to consider?
I can understand the reluctance to want to tell your colleagues, “Hey I am a recovering drug addict” as much as I am reluctant to tell them I might be depressed (tho in my experience many nurses seem to take a great relief from talking things out with understanding colleagues). However, my depression is less risk and hardly likely to cause a serious issue at work – unless of course I decide to end it all mid-procedure with some patient. Notwithstanding, I believe it is the responsibility of all nurses to declare anything significant to their colleagues in regard anything that may effect the function of their role. I think it also courteous (and sensible) to supply relevant information to people around you – I would tell my colleagues I was diabetic, even if I worked in a fish market. Who knows when I might need them to know that for me?
I refer back to the expunging of records once treatment is considered successful and remission has lasted the sufficient amount of time. I think it is the business of nurse management to know someone who has had a prior history of soliciting drugs from hospital supplies and is still in treatment or reaching recovery, but only to the extent I referred to above. I don’t see how this can be a problem since the Code referred to now directs other nurses to support the impaired nurse who returns to work. Any breach of this ethos would be ‘unethical’.
Now this is where I become, once again, confused:
“Like I said before you have no idea who may be in recovery…we’re everywhere!”
ok.. so I don’t know who “they” are.
“Not judging them is a start…”
How am I judging them if I don’t even know who they are?
“…your last point about the pedophile is just stupid.”
On the contrary, it is a comparison of high risk behaviours that have –
detrimental effects to others
where the risk is substantially increased by the presence of de-stabilising factors
and there is a known predilection to the risk behaviour.
The nature of the behaviour is inconsequential to the comparison. The processes, treatment and risk management modalities remain identical. Though both share a substantial risk to other persons.
Why are paedophiles any less an unfortunate victim of circumstance than addicts?
Now take a moment, and please re-read my postings.
I have spoken of the nurse who has to deal with the impaired nurse; the boards; the managers; the health care system; the process of dealing with addiction; the sanctimony of telling me to adjust my attitude and feelings to something that may compromise my legal and professional standing; motivation; the ethical and moral dilemmas for the unimpaired nurse and the issues of asking me to obviate my own feelings over something that may deeply effect me for the sake of another who is deeply effected by their own issues.
In no part have I judged a nurse (or anyone) with addiction other than in a need for treatment and monitoring.
In fact, I have recognised it as a disease requiring of treatment.
I have also recognised it as a risk, requiring of management.
I have further recognised the synergistic and systemic flaws of boards, employers and even the healthcare system.
I have deeply recognised it as an ethical and emotional issue that may strongly effect more than just the person who is addicted.
“now get educated about nurses and addiction.”
So far all I have been told is how I should be adjusting my self righteous attitude to nurses with addictions, even though I don’t know who they are; and that I should not blame or judge them even if I did know who they were, because this is wrong of me to have an opinion (or fear) on someone’s behaviour that might compromise my legal and employment standing; and, even tho I don’t know who it might be, it would just be a lot better for them if I didn’t worry about it all.
As I have continued to say, my problem is not with nurses who have addiction, it is at the flavour of the article that judged me to be self righteous. The subsequent postings have continued to demonstrate everything they accuse me of having – a judgmental attitude.
You have judged me to be;
uneducated
sarcastic
guilty
angry
and stupid
“No one is accusing you. Dr. Barile was attempting to raise the consciousness of the nursing community, not Mr. Ian himself.”
It seems this article was nothing more than accusing me, as indicated by your reposts:
“how nurses respond to this fatal disease…through attitude…yours is showing so self-righteously”
If not me, then whom?
The article and subsequent debate, apparently intended to ‘educate’ me to alter my “self righteous” attitude towards nurses with addiction by not judging them for their issues, is constructed by judging me for mine. How is this equitable?
It does nothing to educate me about overcoming my own fears or apprehensions. It does not inform me of ‘treatments’. It does not advise me of how good or bad the outcomes are. It does not highlight how to deal with the ethical and moral dilemmas of a nurse found diverting, only the managerial ones. It does not mention the Code that was later pointed out in another post.
The article merely tells me, nurses with addiction should be “…not judged but supported through the process of recovery” and if I don’t do that, I’m just being self-righteous – apparently I am not allowed to be “just human”.
I have no clue what this “recovery” is; how to “support” these people through recovery and, tho I’m not allowed to know who is or isn’t in recovery, I must support them regardless. I’m not even sure how I’m meant to support myself when I get concerns about working with someone with addictions or previous illegal behaviours.
Once again, I’M ALL FOR IT. I do not dispute the sentiment of the intent.
I dispute the flavour of the article and the subsequent postings that judge me, amongst other things, to be self-righteous simply because I’m not a nurse with addiction and have no right to be human.
This is sanctimony.
It’s not logical, it’s not fair and it’s not helping, honest.
“Judge not, lest ye be judged by your own measure. For in the way you measure, it will be measured unto you.”
Eventually there is going to come a time where the person who has nothing for which to be discriminated against is the only one being discriminated against.
January 4th, 2008 at 11:35 pm
To Mr. Ian:
I am a grateful recovering nurse. I self reported to my State Board of Nursing in January 2002. I do not find any of your comments as self righteous, only as self inflating. Obviously, you are well educated, well read and have a passionate belief/moral system. I understand that you believe all that you have said to be true. I find them to provoke emotions and thought – probably your sole intention.
I found great humor in your use of “these people”. These people are your co-workers, your friends and I dare to say your family members. I commend your insight regarding your opinion as “fear”. I believe that you will agree that Franklin D. Roosevelt brought it home when he said “we have nothing to fear, but fear itself” (Hurray! for such a profund thinker).
You can’t find the answer to these matters on the net or in a textbook, but in the heart where all things are proved to be true.
God Bless
January 5th, 2008 at 11:07 am
Perhaps I can agree to “self-reinflating” – since I felt my own persona to have been stabbed by the generalised sweeping and derogatory comments made herein towards my representations and concerns.
I am not well “educated” by academia standards, I have but a basic nursing qualification and will never leave the nursing floor – perhaps for my passionate belief/morale system – as I decline to be puppeteered by anyone who “tells” me my virtues. I’m often referred to by controlling managers as the loose cannon, yet those who strive to “teach” me, will find me different.
As for “fear”; you misread me – I took offence for my co-workers, my friends and I dare say my family, who were all denounced and judged for being human. In the paradoxical elevation of the status of recovering nurses by sanctimoniously denegrading those who having not suffered such a situation, yet unwittingly having it thrust upon them, I do not accept that the possibility they may fear such recovering people, is, as being declared, nothing more than “self-righteousness”.
For those nurses who may not appear supportive or may appear to distance themselves from the recovering nurse, who says it is because they are judging them? Perhaps they merely fear the potential consequences to themselves if such a nurse should lapse. Or merely that they do not know how to support them and doing/saying nothing is better than doing/saying the wrong thing? Is this person to be judged as having contemptuous self-righteousness for the realistic fear of potential of harm (to themselves or the recovering nurse)?
Do not judge according to appearance, but judge with righteous judgment. (John 7:24)
Gesundheit
July 14th, 2008 at 3:16 pm
Is there a site like this for impaired (addicted) school teachers that anyone knows of? I am trying to find help for a patient of mine who is an alcoholic school teacher looking for perhaps a support group
thanks
November 26th, 2008 at 11:30 pm
I’m an RN in Texas and was turned in to the BON for a charting error with morphine.I was asked to take a drug screen which I passed. The BON required me to take a polygraph which I also passed. It took the BON 3 years to finally make a decision. There was no
evidence on me and they decided to place a warning on my license for one year.I’ve been a nurse for 13 years and with that one incident I have not been able to find a job. They have made my life hell and there is not one thing I can do about it.
November 28th, 2008 at 11:51 am
Morphine is a controlled drug.
Charting errors with morphine is a serious business.
If they pulled you up on it – and are making your life hell for it – then perhaps it’s a reminder to us all about taking charting controlled drugs serious.
But why are you posting this in a thread on recovering drug-addicted nurses if it was just a simple charting error?
November 1st, 2009 at 5:23 pm
Mr. Ian
I suspect you are an unhappy person, and have too much time on your hands. I’ll pray for you.
February 6th, 2010 at 10:27 am
Hi Guys,
Just joined up, thought i would say Hi
November 4th, 2010 at 6:21 am
With the greatest of respect to all those recovering addicts (nurses or otherwise) and others who may have found my post ‘offensive’ or overly negative, I accept your informed opinions. However, my first ever ‘boss’ told me – “If I want your opinion, I’ll give it to you” and this was the flavour of the article as I originally read it.
In responding to the comments, I do not and have never worked in the USA. Unfortunately, and for some obscure reason that defies me, I need to know obstetrics before I can work with the mentally ill in USA, but that’s another issue. Therefore my knowledge of ANA Code of Ethics and the NOAP, HIPAA & PHI are limited mostly because I either do not regularly use/review them or I just don’t know what some of those acronyms mean.
Patty identifies that: “A nurse that is motivated to change does not know what to do”. I agree with this mostly, tho some people do self-recover effectively. I merely stated the obvious that a person who doesn’t want to change, won’t. Motivation is a key ingredient and this is the theory of cost-benefit analysis that we all do every day for every decision we make before we act; outcome A must outweigh outcome B for us to choose it.
I did not suggest support wasn’t needed to change, but significant change does not occur unless and until that person decides to change.
Regarding ‘do not fire’ the nurse – If a nurses license is suspended or revoked they cannot be employed as a nurse. Licensing is the boards decision and, as I stated, it is their decision how they sanction such matters. I spoke of “discipline”, not dismissal. If all your ‘disciplinaries’ for addictive behaviours end up in dismissal then I’m sorry to hear that. It does sounds a bit harsh. The UK nursing council has retained powers to temporarily suspend a nurses right to practice on medical grounds, or to allow them to remain practising whilst undergoing treatment, for many years. This has been implemented for addicted nurses as much and as equally for any other ailment. Perhaps USA nursing is only just catching up to the idea and I’m arguing a moot point?
Notwithstanding, I strongly defend that ‘discipline’ from the nursing boards needs to remain a component for the issue of governance, but mainly for a monitoring and recovery evaluation purpose; or for the exercising of extreme action in exterme cases (ie revocation of license). If there were no fear of such redress, we’d all be popping pills just to make it through the night shift. Such leverage adds weight to the cost-benefit analysis as it imposes an external modifier to evoke change in the person. Some may argue it is an un-needed extra pressure – but I would suggest that the nurse with addiction needs to show not only willingness but also ability to understand the gravity of their situation.
I’m not sure from the information you gave wether nurses under a “confidential program” are required to submit to the boards for review. Nevertheless, nurses with addiction can and do pose a risk to patients, employers and fellow staff. If they didn’t, it wouldn’t be a problem. I maintain, the boards will be failing in their duties if they did not provide that protection.
As for the act of dismissal; I understand that to be down to the employer and not the nursing boards/councils – however, they are unlikely to remain employed if their license is revoked or suspended. Similarly, when hospitals are performance driven and standards are required; employing a nurse with a current addiction problem is hardly quality cost-effective for them. It would be as sensible as employing a paedophile at a day care centre. It is not surprising then that such information is still relevant even after “20 years of being in recovery” (note: “in recovery” is the philosophy that addiciton is never ‘cured’ – and is the understanding of NA, not nursing boards or hospital managers, implying there is forever a ‘risk’).
Regarding the process of change for addicts, I totally agree with Patty’s post regarding the treatment and the “tools” to change and already indicated that anyone can recover. I’ve been working with addicts for 14 years. Some do, some don’t and treatment approach has a large part to play in that. I respectfully suggest though, the ‘treatment’ point is somewhat irrelevant to the debate as it does not effect the issues facing the nurse on the shop floor who has an impaired nurse at their side, which was my posting.
I emphasise, I did not disagree with the remedial treatment actions that might be afforded a nurse with addiction; I supported it. As much as I support the people I work with towards recovery and breaking habits of a lifetime.
The American Nurses Code of Ethics, speaks expansively of protecting the patient and in a small part also addresses the issue of ‘impairment’. It identifies that nurses disaffected by addiction should be directed to care and treatment and that nurses should receive them back to practice to resume professional duties. I can’t find any fault with that and, reiterate, I support the process of remedy rather than revoking a license. Assisting an impaired nurse is an additional requirement to protecting patients and the integrity of the profession and I submit that I was not aware of the USA Code of Ethics specific address on the issue. It was an interesting read, even if somewhat obsolete to my needs in another country.The fact it has to be written into a Code of Ethics somehow makes me feel that the USA has a much bigger issue of nurses with addiction than other countries might have. It might have been helpful to have made reference to the Code within the original article and perhaps have expanded from there.
What I actually disagreed with about the article was the title and flavour that begins by implying that any nurse who redresses a nurses unethical practice is acting out of “self-righteousness” and ‘blame’. They are not. They are doing exactly what the nursing board (and the public/patients they serve to protect) and the Code of Ethics expects them to do – protect patient safety and the integrity of the nursing profession above all else. Supporting the nurse back into the workplace is fine – as long as you remember the nurse is “in recovery”. If such ‘blame’ and ‘self righteousness’ was a reference to nurses attitudes for nurses with addiction when returning to work while going through recovery, then – to educate me – it warranted more than one line on telling me to support such nurses when they return, but not how – other than not judging them.
If the article was aimed at those senior nurses who simply wish to ‘sweep it under the carpet’ or ‘manage’ the issue by avoidance or alternate disposal, then I do not disagree with its flavour. However, I would implore cautionary reservation at the somewhat biased perspective that “it’s all going to go well if you just follow this simple rule…” . It will not. It might help many – 90% according to Patty’s statistics – which is not that surprising since Linda indicates the nurses have to anonymously self-refer in the first instance, demonstrating the necessary predisposing motivational factor I mentioned.
(Just a note on the research to Patty: you did not identify if the other 35-50% was relevant to nursing or general populations. I am unable to compare these values as nurses would generally fair better as they have acquired knowledge and understanding of pharmacokinetics, behaviour, self-awareness, etc relevant to the treatment; Jo Public requires significantly more ‘training’ in these areas to be successful)
If the article was directed at ‘shop floor’ nurses then I suggest demanding professional nurses to abandon all sense of apprehension or fear (or blame and self righteousness, as you term it), that an impaired nurse is “ok and just needs a little support”, that the unimpaired nurse also has to remain fearful of not breaking the law by seeing them home safely, but should not approach this person alone, and on their “recovery” all you have to do is not judge them and they’ll be alright, is somewhat misleading, fear invoking and not very eduicating.
The moral position they are placed in is heart and mind wrenching and, although I acknowledge the Code of Ethics rightful declaration to assist and support the impaired nurse, I would not want to be the one to ‘out’ an impaired nurse knowing that I might be sending them to damnation for eternity – as the original article suggests we have been doing. What might have been more encouraging, and educational, is to know first what is happening to ‘fix’ the problem and the positive outcomes for the impaired nurse (90%); not just having my “self righteous” attitude declared to me.
It seems, despite dede’s assurances that “Whatever Linda, Patty or I say is for the educational value it brings, not an attempt to change anyone’s mind, we’re not that powerful”, the title, introduction and flavour of the article is nothing less than a forthright admonishment of nurses who feel fearful, apprehensive or ‘manipulated’, and demands such nurses redress their attitudes to ‘addiction’ and must do it now because our own nurses are suffering.
I have re-read the article and subsequent postings and, in the light of the further information I am now availed, there appears to be a significant talking at crossed-purposes. The subsequent postings of Patty and dede have certainly helped clarify the position of the National and State initiatives and the current attention the matter is receiving. However, the original article directs me to ‘stop blaming them’ and, when it asks why are nurses treated so harshly, the answers identify the issue to be in the attitude of nurses like myself who actually have no control or involvement in the management of such an issue other than perhaps initiating the action and this is the representation that flares my response. The ‘harshness’ that leads to nurses losing their license is the boards’ decision – not mine..
The posting on a generic nursing forum of suggestion that I am blaming nurses with addicition for their own problem behaviours and “When a nurse is discovered to be an addict, other nurses struggle with bitterness and anger about having been manipulated. They’re not ready to jump to an addict’s rescue.” is a sweeping generalisation that I find offensive. I believe the ‘harshness’ debate was originally directed at the boards and managers, yet somehow has been manipulated to imply that it is my ‘harsh’ and ‘self righteous’ attitude towards impaired nurses that is the problem.
Changes to the way State and National bodies are addressing the issue might reduce that risk. That’s fine with me, but I don’t see how my attitude, good or bad, has anything to do with nurses with addiction being dismissed. It certainly has a lot to do with how well the rejoin the workplace, but that didn’t seem to be the nature of the article. I would proffer that many nurses at the shop floor are already very supportive of their colleagues and the inference that such nurses do not exist is condescending.
Notwithstanding, the implications for a nurse who, on witnessing an unethical or unlawful behaviour when faced with an impaired colleague who may be ‘diverting’, are immense. Are you really that surprised that a nurse might feel a little upset (or self righteous) when it comes down to him/her to take action; knowing that somewhere along the way that impaired nurse may be dismissed or that they themselves may be called to write statements or testify against a colleague or, by the serruptitions behaviours that addicts employ, to be left wondering wether the deviant behaviour of the addict ever left them compromised or implicated? You’re asking (demanding?) that the nurse forgive and forget and never have to worry that it’s going to happen to them again?
I also find the focus on other nurses attitude something of an attempt to subvert the ‘problem’ from the nurse with the addiction to the nurses attitudes around them, which is absurd. The problem was already identified as harshness and lack of support at board/employer level – yet the ‘answers’ are directed at how nurses should change their ‘self righteous’ attitudes. I would agree, bad attitudes won’t help in rejoining the workforce, but I’m kind of lost on who we’re actually directing this article to now.
The article further suggests that nurses who are addicts are merely ‘victims’ of a sequalae of events. I generally agree – but then, anyone who suffers is a victim, just like someone who smokes crack is a victim of their circumstance, or a person who breaks the law is a victim of their circumstance. Do they receive the same supportive and non-judgmental attitudes of society? If they commit an offence or are merely under the influence, are they as vindicated or are they vilified for their unfortunate circumstances?
Nurses with addiction invariably come under disciplinary action only because they have acted in an unscrupulous way at work – not just because they suddenly realise they are addicted and seek help. These more scrupulous, yet addicted, nurses draw no attention to themselves and thus remain ‘undetected’ and may seek private recovery.
What I loathe mostly are double standards that are being asked; when we consider how those persons were placed in a position of trust by the nursing body, colleagues and the employer – and then might abuse that trust to sustain their addiction and crying outrage at being asked to account for themselves for the next “20 years”. How do we react to a financial investor who squanders our monies or commits fraud? We are outraged at the abuse of trust. We demand their license to practice be revoked. But it wasn’t their fault? – they needed money to repay this bad debt, this bad bill, this unfortunate investment, etc. Or further, the paedophile who, only because he was systematically abused throughout his childhood (hardly his fault?) knows no other way of making a relationship. Should we not remain aware of that risk and simply allow them to be alone with children because they are “in recovery”? If we are going to become sympathetic to one unfortunate turn of events, then we must be sympathetic to them all. Or are we suggesting that the risk to a patient of an impaired nurse is of less importance than these examples?
Nursing is a sub-culture, a micro-society. The admonishment of those nurses who feel fear or apprehension regarding nurses with addiction in their workplace is like telling society they should just be understanding of all those who were sent to prison for breaking the law; or not ever wonder if a convicted paedophilic priest might be permitted to teach Sunday School again? You ask for a huge culture change and just expect nurses to do it because you say so.
If this was an attempt at destigmatisation then I would respectfully suggest ‘tartgetting’ other nurses attitudes, who have effectively done no wrong, as being problematic will probably not invoke the desired change. I did not find it educational.
I remain unchanged in my sentiments, but if you would like me to change them, do not make me sympathise by subversion, make me feel guilty for my fear and apprehension or attack my moral values (which I did not ask to be tested by the impaired nurse in the first place).
Yes, these things happen.
Yes, I think it can be harsh.
Yes, I do want to help.
But my opinion is formed by how well I am made aware.
Please, just tell me what’s going on, do not give me my opinion.
June 6th, 2014 at 12:03 pm
Hi,
My name is Nicole Wood. I live in Seattle, WA. I have to begin the monitoring program & desperately what to talk with someone how as or is participating in one. Please help! My email address is [email protected]
Thank you,
Nicle