How We Can Speed up our Aid to Nurses with Substance Use Disorders

Health


You might think twice about flying if you knew your pilot was impaired, yet every day, many of us entrust our care to nurses who are under the influence of Percocet, fentanyl or other opiates.

While research varies, several studies suggest about 10% of nurses are dependent on drugs and alcohol, and as many as 1 in 5 have misused drugs or alcohol at some point in their career. In states like Wisconsin, which employ 100,000 fulltime and part-time nurses, that’s the equivalent of 10,000 or more RNs, LPNs and other nursing professionals.

Sadly, it’s not until a major incident occurs — such as a nurse’s drug overdose, a hospital’s Hepatitis C outbreak or a clinician’s arrest and imprisonment for diverting drugs — that the issue of substance use among healthcare professionals, and the concurrent issue of healthcare diversion, receives national attention.

By then, it’s often too late. Not only are patients and communities impacted by healthcare drug diversion on the part of nurses and other clinical professionals, but nurses themselves are impacted in immeasurable ways.

I can say these things are true because of my own personal experience with stealing prescription drugs while employed as a nurse, which led to me serving a four-month jail sentence and losing the career of my dreams.

Owning my story, part of a silent epidemic

My story doesn’t begin on the night I was finally arrested in January 2005—outside a pharmacy where I was trying to refill a prescription for painkillers that I obtained by lying to my physician employer. My story actually began more than two decades before that when I entered college in the 1980s. Away from home for the first time and experiencing my first years of real adulthood, I drank heavily at bars with my friends. I loved the feeling of confidence that I felt while under the influence of alcohol.

During the early years of my career, I managed to keep it together, working as a pediatric nurse during the day and giving my “all” to my patients. I was a young, single, mother—having gotten pregnant in my 2nd to last year of college—and I patted myself on the back for being the kind of mom who drank heavily only after I put my daughter to bed.

My drinking escalated steadily, only slowing down when I was prescribed Percocet in 1997 after a surgical procedure. From that point forward, painkillers were my drug of choice. They eased my stress and anxiety, without the byproducts of alcohol. By 2000, I started stealing waste medications from the emergency room where I was working. I’d always rationalize my actions, telling myself “This will be the last time.” It never was.

I somehow survived like this for another four years, before I lost my ED nursing job in the summer of 2004 because my employers were onto me. I managed to get a new job at a physician’s office three months later, and it wasn’t long before I figured out how to call in prescriptions for myself. But on January 18, 2005, my luck had run out when I was finally caught, arrested and incarcerated for drug diversion. It did help me to get sober, but there was no escaping the other consequences.

I’m extremely lucky that I had access to a support system and tools to keep me sober as I rebuilt my life with my family, including my two daughters, after I left jail. But my career was permanently damaged, and my shame became a constant companion. I felt very lonely for many years.

Today I’m hoping to help nurses with similar substance-use disorders [SUDs] so they don’t share my fate.

My recommendations for moving forward

In 2022, I was finally pardoned by the State of Wisconsin for stealing prescription drugs in 2005. But my work isn’t done, and my story doesn’t end here. Today, I’m an advocate for behavioral health interventions for clinicians with SUDs, and someone that other nurses can turn to if they need to talk to someone who truly understands what they’re going through.

Based on what I’ve learned, here are six things that health systems and other stakeholders can do to help more nurses get the care they need to address SUDs, keep patients safe and potentially return to the careers they love:

1. Make it easier to sign up for state programs. While my home state of Wisconsin leverages a Professional Assistance Procedure, or PAP through its department of Safety and Professional Services, which enables a nurse to stay employed under the condition that they receive drug monitoring, only a few dozen nurses are actively enrolled. More would enroll if they knew about the program, or if it were easier to sign up without so much red tape.

2. Create a culture of transparency. Hospitals and health systems that want to prevent drug diversion must do their best to create a culture of transparency where clinicians with substance-use disorders feel “safe” to openly seek help and forge a new path. They can do this by emphasizing the best practices in anonymous reporting or implementing alternative-to-discipline programs, which encourage clinicians with substance use disorders to obtain treatment and a path to workforce re-entry.

3. Improve accessibility and awareness of alternative career-support programs. While group-based recovery and rehabilitation programs such as 12-step fellowships are great sources of peer support among those with SUDs, clinicians with SUDs also need others who understand their unique challenges. There is a special camaraderie among nurses who are struggling from similar SUDs and have to face the constant presence of triggers such as opioids. A couple of years after I became a nurse recovery coach for clinicians with SUDs, I founded the Wisconsin Peer Alliance for Nurses (WisPAN) so nurses could have a safe space with people who understand what they are going through. It’s in these groups that I can do things like show them how messy my nursing license looks, riddled with footnotes that detail my criminal charges. This can sound a strong alarm and help them rethink their lives and actions.

4. Strengthen education training within health systems. Health systems typically offer their clinical staff basic education around drug diversion, but leaders need to go one step further by emphasizing both the prevalence of drug diversion, as well as the consequences. Education materials should be specific, even graphic: They need to know what SUD looks like. Inviting nurses who have struggled and recovered from a SUD to speak about their experiences to healthcare workers is one way to do this.

5. Bolster internal drug diversion efforts. More than 8 in 10 healthcare professionals (82%) know or have met someone who has diverted drugs, according to a 2021 report by Invistics and Porter Research. However, the same survey noted that healthcare organizations are scaling back resources to address this problem. Hospitals and health systems need better tools, such as advanced machine learning software, which can synthesize information from multiple sources (e.g., automated dispensing cabinets and patients’ self-reported pain assessments) to uncover incidents correlated with drug diversion.

6. Advocate for stronger guidelines and oversight. I take medication safety and transparency very seriously, given my history with SUD and my desire to stay sober. For this reason, I believe we need stronger guidelines from the Joint Commission and others around drug-wasting procedures and other hospital practices intended to stop diversion. For example: It’s far too easy for a nurse to quickly retrieve a medication that’s been disposed of if her colleague steps out of the room for a moment. We need stronger guidelines that leave no room for sneaky behavior as well as stiffer penalties for ignoring guidelines. This will help to lower the temptation to divert medications.

Our clinicians dedicate their lives to helping others, so we need to help them. By arming our health leaders and health systems with the right tools and strategies, and pushing for stronger advocacy, we’re giving our nursing workforce the best chance of getting the help they need to achieve and maintain recovery.



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