Chemical Dependency in Nursing
• Sarah Casey
• Jeffery Hutchins
• Sumeka Rotasha
Johnson
• Samjhana Joshi
• Wai Yee Law
Introduction
• The terms “substance abuse” and “chemical dependency”
are often used interchangeably.
• “Substance Abuse” is associated with social factors, such as
the failure to meet important obligations, multiple legal
problems, drug-related arguments, and the use of drugs in
dangerous situations.
• “Chemical Dependency” is defined by physical factors, such
as increased tolerance to drugs, withdrawal symptoms, an
inability to control or decrease use, and continued use
despite acknowledgement of the drugs’ dangerous effects.
• The prevalence of substance abuse in general
population averages 16 percent, the prevalence
for nurses may be up to 20 percent.
• This equates to approximately one in every 5
nurses who have substance abuse issues.
• Substance abuse has been identified as an issue
threatening the nursing profession since the turn
of the last century.
History of Addiction among Nurses
• During nineteenth century opiates,
cocaine, and marijuana, were widely
available, publicly advertised,
unregulated, used as medicine before
their addictive potential was known at the
time.
• During 1880, women outnumbered three
to one to men in addiction.
• Harrison Narcotic Act was passed in 1914
to control and regulate non-medicinal use
of narcotics.
• In 1920, the AMA Committee on the Narcotic Drug
Situation, specifically mentions the overworked and
over stressed nurse as being at “high risk for
addiction”.
• Due to the hidden nature of problem substance abuse
in the nursing profession claimed little attention in the
few nursing journals that existed at the time.
• By the mid-1960s, narcotic addiction in nurses and
physicians came to be considered a more serious
problem than previously suspected.
• Federal rehabilitation program designed
specifically for addicted registered nurses
began in 1972 at the Clinical Research Center
in Lexington, Kentucky, but it was short lived.
• Major help for nurses with addictive disease
began in 1980 with National Nurses’ Society
on Addictions when the society passed a
resolution by acknowledging the problem and
guidelines for impaired nurse programs.
Impact in Future of Nursing
• “Best Nurse” is a label often given to impaired nurses
who also often have graduated in the top of their
classes, are perfectionists, highly motivated to be the
“best”, the manager can count on to work overtime,
come in on their day off, and to never say no.
• With chemical dependency problem nursing has to
loose such nurses especially during nursing shortage.
• Nursing dependency needs to be addressed, and those
already impacted need to be rehabilitated, not to lose
the best nurse from the profession.
Significance on Profession of Nursing
• Nurses with chemical dependency pose a
threat to patient safety, their own health,
and the reputation of the nursing
profession.
• In 1982, the American Nurses Association
(ANA) first defined “impaired nursing
practice” as the presence of dysfunction
related to alcohol and other substance
use or psychological problems that
interfere with judgment and the delivery
of safe care
• Chemically dependent nurses jeopardize the standard of
patient care as well as their own health.
• Exposure to life-and-death situation, stress, long hours,
difficult inter-professional relationships, workforce
shortages and mandatory overtime increases the risk for
these professionals to turn to substances as an unhealthy
way to decompress.
• Addressing this issue include assessment of late signs of
addiction, appropriately confronted, and a holistic view of
the causes and risk factors so that nurses can receive the
intervention needed, achieve recovery and gain reentry
into practice
• Barriers to effectively address this issue:
– Negative attitude
– Discrimination both by colleagues and within insurance payment
systems
– Education of referring and intervening health professionals continuing
punitive consequences to addicted nurses
– Resource utilization and sharing
– Research deficits
– Workplace modifications that make drug diversion more difficult
– Overall health promotion and prevention
Impact on 5 IOM Competencies
• The 5 IOM Competencies are:
– Provide patient-centered care
– Work in interdisciplinary teams
– Employ evidence-based practice
– Apply quality improvement
– Utilize informatics
• To provide patient-centered care, nurses need to
identify, respect, and care about patients’ differences,
values, preferences, and expressed needs; listen to,
clearly inform, communicate with, and educate
patients; share decision making and management; and
continuously advocate disease prevention, wellness,
and promotion of healthy lifestyles, including a focus
on population health.
• To work in interdisciplinary team, they need to
cooperate, collaborate, communicate, and integrate
care in teams to ensure that care is continuous and
reliable.
• To apply evidence-based care nurses, need to integrate
best research with clinical expertise and patient values
for optimum care, and participate in learning and
research activities to the extent feasible.
• Applying quality improvement needs identifying error,
providing safety, understand and measure quality of
care, and design and test interventions to change
process and system of care.
• To utilize informatics, nurses need to communicate,
manage knowledge, mitigate error, and support
decision making using information technology.
• Nurses under chemical influence often make errors in
judgment and are involved on a number of incidents or
mistakes.
• Mood fluctuations, inappropriate responses or
behaviors, confusion or memory lapses, isolation from
colleagues and providing implausible excuses for
behavior are a few of the social warning signs that a
nurse with a chemical dependency may show.
• These all affect the nurse to provide care based on the
5 competencies.
Legal and Ethical Issues
• Most nurses with chemical dependency will not reach
out for help because they are afraid of legal action.
• According to the Technical Assistance Manual: Title I of
the Americans with Disabilities Act; alcoholism is a
disability, but drug addiction is not listed as a disability.
• An individual pulling narcotics from workplace is open to
disciplinary or legal actions such as the employer may deny or
discharge employment. The employer will not be considered liable
for disability discrimination.
• There is a “Last chance agreement” to provide the individual with
one more chance to change his/her current issues, where employee
agree to frequent drug screenings, improvement, probation period,
attend a detox program, and abide by all workplace rules and
regulations.
• Title I of the Americans with Disabilities Act also state that an
employer may not discriminate against individuals who have
successfully recovered from chemical dependency.
Impact on NC Nurses
• According to the Nursing Practice Act obtained from
NCBON, the board of nursing can deny licensure to a
nurse, revoke the license of an RN, refuse to renew the
license, and/or place the individual on probation.
• A nurse’s scope of practice might also be temporarily
or permanently limited, may be required to work in an
office setting or on a unit with no access to narcotics.
The time frame is usually from 6 months to a year after
a chemical dependency recovery program has been
completed.
Impact on Role of Nursing
• Professional Practice
– Increased risk of harming patient(s)
– May lose respect & trust of colleagues
– Loss of self respect
– May be fired, suspended and/or placed on probation
– Loss of income and seniority
– May lose license
– Will be monitored if allowed to return to practice
• Why are Nurses at Risk?
– Impaired nurses share some contributing and
predisposing factors with the general population:
•
•
•
•
Chaotic family background
Low self esteem
History of victimization
Family history of substance abuse
– Risk factors that relate to their profession:
• They see evidence of the efficacy of drugs, also known as
“pharmacological optimism.”
• They have access to drugs.
• They have a stressful workload and a demanding work
environment.
• Professional Responsibility:
– As a licensed professional, your primary responsibility is
the care and safety of patients.
– You are legally and ethically required to report violations of
your state’s nursing code and statutes that put patients at
risk.
– ANA suggests: Consult supervisory personnel; Follow
organizational policies for documenting or reporting; If
organizational policies are non-existent or inadequate,
consult your professional association, state peer assistance
program, employee assistance program or a similar
resource.
References
•
American Psych, A. (2000). Diagnostic and statistical manual of mental disorders, dsm-iv-tr.. (4th ed. ed.). Arlington
VA: American Psychiatric Publishing, Inc.
•
American Nurses Association. (1982). Position statement on impaired nursing practice. Kansas City, MO: Author.
•
American Nurses Association, the Center for Ethics and Human Rights. (2002). Code of Ethics for Nurses, with
Interpretive Statements. Washington, DC: American Nurses Publishing.
•
Guidelines for Managers Working with Impaired Nurses: Nurses with Chemical Dependency and/or Psychiatric
Issues. Ohio Nurses Foundation. Retrieved from
http://www.ohnurses.org/Content/NavigationMenu/Resources/PeerAssistanceGuidelinesforManagersofImpaired
Nurses/Impaired_Nurses.pdf
•
Health Professions Education: A Bridge to Quality. Institute of Medicine, 2003.
•
Heise, B. (2003). The historical context of addiction in the nursing profession: 1850-1982. Journal of Addictions
Nursing, 14(3), 117-124.
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Lillibridge, J. (2010). Impaired nursing practice – what are the issues? In C. J. Huston (Ed.), Professional issues in
nursing: Challenges & opportunities (2nd ed.) (pp. 275-286). Philadelphia, PA: Lippincott Williams & Wilkins.
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•
National Council of State Boards of Nursing (2007). Alternative programs. http://www.ncsbn.org.
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National Council of State Boards of Nursing (NCSBN). (2011). Substance Use Disorder in Nursing: A
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Trinkoff, A. M., Eaton, W. W., & Anthony, J. C. (1991). The prevalence of substance abuse among
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