By Christina Orlovsky, senior staff writer

Nurses are so accustomed to caring for others that they often neglect to care for themselves. Nurses who are challenged with substance abuse problems are no exception. In an effort to assist addicted nurses with the care they need to conquer their addiction and keep their job, many states are offering alternative-to-discipline programs for health care providers.

It has been estimated that 10 to 15 percent of all nurses in the United States are addicted to some type of illegal or controlled substance, explained Art Zwerling, MS, MSN, CRNA, FAAN, a nurse anesthetist educator and member of the peer assistance program at the American Association of Nurse Anesthetists (AANA). While the risk of addiction is not limited to any one specialty, the specialties with the highest prevalence of substance abuse issues are ICU, ER, OR and anesthesia.

Zwerling added that alternative-to-discipline programs have evolved over the past few decades as recovering nurses and physicians began to seek out groups where they could share their addiction issues related to their profession without alienating or frightening non-medical professionals.

“Physicians were far more progressive than nurses,” Zwerling added. “They would get referred to an alternative-to-discipline program and enter into a three-to-five-year monitoring contract, which says in lieu of suspension, you will do ‘x, y and z’.”

As more light has been shone on the issue, more nurses are seeking similar programs.

“There was a lot of shame-based isolation, and part of the process is finding out that you’re not alone and that you’re not the only nurse that made some pretty egregious behaviors around patient care,” he added.

The Philadelphia Recovering Nurses Association is one organization that evolved from the need for nurses to share their stories and eliminate some of the stigma associated with chemical dependency. Additionally, the state of Pennsylvania has a Voluntary Recovery Program, in which nurses enter into an agreement with the state’s Board of Nursing to be monitored for three years and complete a treatment and rehabilitation plan. Nurses who have diverted drugs from patients to sell or distribute or who have failed a similar program in another state are ineligible for the volunteer program, but the state is also working toward developing other alternative-to-discipline and peer support programs.

While not all states have designated alternative-to-discipline programs that are affiliated with their state boards of nursing, the majority have established some sort of diversionary program to assist nurses in seeking treatment and keeping their licenses.

One such state program is the New Jersey Recovery and Monitoring Program (RAMP), which, according to the organization’s Web site, is “designed to encourage health professionals to seek a recovery program before their impairment harms a patient or damages their career through a disciplinary action.” While it is not guaranteed that nurses involved in RAMP will keep their jobs, the program, which is administered by the Trenton, New Jersey-based Institute for Nursing, offers advocacy for nurses in talks with their employers, assistance dealing with licensing boards, drug screening, treatment resources and other services. Nurses can voluntarily involve themselves with RAMP, or they can be recommended for the program by a coworker, family member or even the state Board of Nursing.

Zwerling pointed out that data that comes out of alternative programs reports a high success rate that should encourage more such programs to be developed and assist in the re-entry of recovering nurses into the workplace—although not always in the unit where they were initially working.

“We know from these alternative programs that once nurses are identified, treated and monitored in an appropriate monitoring program, their outcomes are good, but often there are units they can’t re-enter,” he said.

“You have to look at the unit and the nurse manager and do a lot of education on the unit. Some are wonderful and will bend over backwards because they know up to the time the person was intervened upon and went for treatment, they were a wonderful provider,” he added. “But there are some that are so toxic that re-entry just is not going to happen. The culture of the unit wins out every time.”

The American Nurses Association addresses the issue of chemical dependency in the impaired practice section of its Code of Ethics, as well as the issue of nurses’ return to work after completing treatment. The organization puts the responsibility on nursing professionals to, first and foremost, protect the patient, and second, to advocate for the assistance of their fellow nurse.

“In a situation where a nurse suspects another’s practice may be impaired, the nurse’s duty is to take action designed both to protect patients and to assure that the impaired individual receives assistance in regaining optimal function,” the Code reads. “Nurses in all roles should advocate for colleagues whose job performance may be impaired to ensure that they receive appropriate assistance, treatment and access to fair institutional and legal processes. This includes supporting the return to practice of the individual who has sought assistance and is ready to resume professional duties.”

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