Nurse Jackie was a popular show on HBO which depicted its main character as a pill popping emergency room nurse. Great concept for a dark comedy, but how real was the premise? It turns out, it is all too real a problem among nurses nationwide, particularly among emergency department nurses who, according to research by Trinkoff and Storr, are 3.5 times more likely to use drugs as nurses in other specialties. This tendency might dovetail with the fast-paced and hectic work environment of the ER, and the nurses who seek this specialty might be sensation seekers, a risk factor for substance use.
Other risk factors that increase the likelihood of substance abuse among nurses include family history of substance abuse, work demands such as mandatory overtime and long shifts, lack of free time, shift changes that lead to inconsistent sleep patterns and sleep deprivation, stress responses that include using substances more frequently or excessively, and inadequate knowledge about the risks related to developing a drug dependence.
The three specialty fields with the highest rates of drug abuse are oncology (42 percent), psychiatry (40 percent), and emergency and adult critical care (38 percent). This can be attributed to the particular stresses involved in these specialties.
Danger to patients
A nurse with a substance addiction is referred to as an “impaired nurse,” and the term “impaired practice” refers to cases in which active addiction impacts a nurse’s ability to work. Several forms of action have been put into place based on ethical obligations to protect patient safety. They include educating the nurses about impaired practice, legislation whereby discipline can result in probation, licensure suspension or revocation, peer assistance programs to provide support, mandatory support group attendance, monitoring and relapse prevention counseling.
There are strict disciplinary measures for nurses caught diverting drugs, defined as the redirection of drugs from legitimate use into illicit channels, including arrest for theft and felony charges. Drug diversion is a huge problem, occurring at every medical facility where controlled substances are dispensed. Nurses might take a portion of a patient’s medications for themselves, steal from the dispensary, or even replace injectable medications with water or saline solutions and keep the drugs for themselves, potentially endangering a patient’s life.
Signs a nurse might be diverting drugs include:
- arriving early, staying late and coming to work on scheduled days off
- volunteering often to give medication to other nurses’ patients
- taking frequent bathroom breaks
- excessive wasting of drugs
- patients reporting unrelieved pain despite adequate pain medication prescription
- signing out medications for patients who have been discharged
- documentation discrepancies for controlled substance administration
The American Nurses Association (ANA) states that about 10 percent of nurses in this country, which translates to 300,000 nurses, are dependent on drugs. The organization reports that, of the 688 disciplinary cases presented to the Advanced Practice Registered Nurses (APRN), 147, or 21.5 percent, were related to chemical impairment.
Help for nurses
When nurses admit to having a drug dependency problem and seek help, employers tend to be more lenient, permitting them to enter treatment with their job secure. Most states now have alternatives to disciplinary action, such as peer assistance and recovery monitoring programs. Workplace resources available to nurses with substance use disorders include employee-assistance programs, human resources departments and employee health services.
Because of the intense pressures in the medical field, learning healthy ways to cope with job stress is imperative for health care professionals. Psychotherapy, meditation and yoga, exercise and hobbies can promote a balanced life and alleviate stress loads.
Because health care professionals have easy access to drugs, they need to be aware of the conditions that can lead to self-medicating with narcotics or alcohol. Knowing one’s family history and the risks of self-medicating, in addition to understanding the professional consequences of drug diverting practices, will help prevent a drug problem from starting.
Sovereign Health of California is an addiction, mental health and dual diagnosis treatment provider, offering several locations in California as well as centers in Utah, Arizona and Florida. For more information on substance abuse and mental health programs for the general public, including health care professionals, please call (866) 819-0427.