Transcript NPSN Power Point - Nurses Peer Support Network

Nurses and Substance Use
Disorders (SUD)
Definition
Substance Use Disorders (SUDs):
“…occur when the recurrent use of
alcohol and/or drugs causes clinically and
functionally significant impairment, such
as health problems, disability, and failure
to meet major responsibilities at work,
school, or home. According to the DSM5, a diagnosis of substance use disorder is
based on evidence of impaired control,
social impairment, risky use, and
pharmacological criteria” -- (Substance Abuse
and Mental Health Services Administration, [SAMHSA], 2015)
SUDs are:
• Chronic Diseases (not a moral
problem)
• Potentially fatal
• Manageable if:
• Treatment completed
• Recovery strategies become a
priority
• Self-care activities practiced
Society’s Image of Nursing
“Nurses #1 Again in Honesty, Ethics; Top
Gallup Poll Ranking in 15 of 16 Years”
--Gallup Poll, December 2015
Nurses:
• Held to high standards by society
• Are trusted by the public (yearly Gallup poll
rankings)
• Experience professional and/or personal
failure to meet these high expectations
when SUD is diagnosed (Shame and stigma)
The Problem…
Nurses with SUDs:
• Prevalence studies indicates SUD prevalence
rate in nurses is similar to general population:
Around 10% (Monroe, Kenaga, Dietrich, Carter, & Cowan, 2013).
• Nurses use prescription drugs (especially
opioids) at a higher rate (Baldisseri, 2007; Cook, 2013;
Dunn, 2005).
• Opioids are the most common illicit drugs of
abuse for nurses who are in monitoring
programs (Bettinardi-Angres , Pickett, & Patrick, 2012).
• Certified registered nurse anesthetists have
high prevalence rates of SUD (Wright et al., 2012)
Risk Factors Among Nurses (NCSBN, 2011)
• Widespread stigma and shame among nurses regarding SUDs
• Lack of education regarding SUDs and addiction
• Positive attitude towards medications and their use
• Role strain
• Problems of daily living / coping
• Enabling by nursing peers and managers
• Nurses self-diagnosing own health problems
Occupational Risk Factors for Nurses to
Develop SUDs
1. Attitude
2. Access
3. Stress
4. Lack of Education
--(NCSBN, 2011)
Risk Factor #1: Attitude
• Familiarity and education in administration of medications
• Rationale for self-medication:
• Fatigue and sleep deprivation
• Physical pain and emotional stress
• Loss of supportive relationships
• Workplace tensions
• Negative attitude & behavior toward substance abusers
leads to perpetuation of professional SHAME and STIGMA
Risk Factor #2: Access
• Lack of institutional controls in storing and
distributing narcotics
• Easily obtained prescriptions
• Administering drugs to others increases
willingness to self medicate
• Drugs are seen as a “panacea” for ailments
• Critical care areas with easier access and
increased risks
• Social drinking and self-medicating is
sanctioned & socially justified
Risk Factor # 3: Stress
• Responsibility for life and death situations
• Dealing with trauma, emergencies, & losses
• Work overload and burnout due to:
• Irregular and extended work hours
• Frequent shift changes
• Staffing difficulties
• Lateral violence / bullying in nursing
• Ineffective coping skills in managing
personal stress
Risk Factor #4:
Lack of Education about SUDs leads to…
• Perpetuation of stigma and
negative stereotypes
• Avoidance / denial of one’s
own possible SUD
• Underground culture of
mistreatment
• Fear of repercussions &
reluctance to get help or
disclose SUD
Consequences
• Patient safety
• Health of affected nurse
• Career of affected nurse
• Impact on nursing profession
• Impact on healthcare systems
Any diversion of medications is considered theft
and subject to legal consequences!
Recognizing the Nurse with SUD
PHYSICAL SIGNS:
• Unkempt appearance
• Long sleeves
• Constricted / pinpoint pupils or tinted glasses
• Incoherent statements/slurred speech
• Excessive sweating, hand tremors, clumsiness
• Smell of alcohol on breath
Recognizing the Nurse with SUD
BEHAVIORAL SIGNS:
• Excessive overtime/extra shifts
• Frequent tardiness and absenteeism
• Mood swings/changes in personality
• Uncooperative with other staff
members
• Increasingly longer breaks
• Excessive/unwitnessed wasting of
controlled drugs
• Discrepancies between patient's charts
and MAR
When Suspicions Occur…
Reporting a Nurse Colleague
must be Based on the Code
of Ethics for Nurses
ANA Code of Ethics (2015: “The nurse
promotes, advocates for, and protects
the rights, health, and safety of the
patient.” (Provision 3)
“Nurses must understand that if
nurses with a substance use disorder
are not helped they are in danger of
harming patients, the facility’s
reputation, the nursing profession and
themselves” (NCSBN, 2011, p. 54).
Reporting a Nurse
Colleague
WHAT to report to the Nurse Manager:
• Deviation of job performance from
normal baseline
• Personality changes / emotional
lability
• Alterations of mental status
• Possible / probable diversion of drugs
from the workplace (miscounts, poor
patient pain control, etc.)
When Suspicions Occur…
Disciplinary Consequences for Nurses with SUD
1. The board can dismiss the complaint without taking action
2. The board can refer a nurse to HPSP
3. The board can take disciplinary action(s):
• Deny license
• Revoke license
• Suspend license
• Impose limitations on practice
• Impose civil penalty
• Order unremunerated services
• Censure or reprimand
• Other action, as justified
Alternative-to-Discipline Programs
• Alternative programs were developed to
offer rehabilitation (especially monitoring)
prior to or in lieu of discipline from state
Boards of Nursing (BON)
• Alternative programs offer some nurses the
option to bypass BON investigation and
disciplinary hearings
• Nearly every state in U.S. has an alternative
program (In Minnesota – Health
Professionals Services Program [HPSP])
HEALTH PROFESSIONALS SERVICES PROGRAM (HPSP)
Minnesota’s Alternative-to-Discipline Program:
• Mission: Minnesota's Health Professionals Services Program
protects the public by providing monitoring services to regulated
health care professionals whose illnesses may impact their ability
to practice safely.
• Goals: The goals of HPSP are to promote early intervention,
diagnosis and treatment for health professionals with illnesses,
and to provide monitoring services as an alternative to Board
discipline.
Click here for: HPSP Video
Benefits of Alternative Programs (HPSP)
• Quick entry into practice monitoring
• Cost savings of monitoring versus discipline
• Intense scrutiny of recovery compliance
• Early detection of relapse / noncompliance
• Ongoing monitoring through discipline or
removal from practice = maintenance of
patient safety
• Nurses report they are better nurses after
treatment and while practicing recovery
-- (Darbro, 2005; Matthias-Anderson, 2015)
Recovery
Definition: An active, ongoing process
for a person with a substance use
disorder to:
• Admit having a substance use disorder
• Abstain from drugs/alcohol
• Acceptance of SUD
• Improve health through the
integration of body, mind, and spirit
-- (Betty Ford Institute Consensus Panel, 2007).
Recovery and Re-entry for Nurses:
• Re-prioritization of
life goals, values,
and priorities
• Recovery and selfcare strategies
• Modification of
nursing career goals
/ boundaries
(Matthias-Anderson, 2015)
Nurses Peer Support Network:
Mission:
• Meaningful peer support for nurses with substance use disorder in
a safe environment with the purpose of giving hope and healing
the individual nurse
• Education and outreach about substance use disorder in nursing
to promote safety to the public
Vision: All nurses in Minnesota will have access to a communitybased peer support for substance use disorder
Click here for website: NPSNetwork
NPSN Peer Support Groups
“Finally there is a place…” (Participant Quote)
• Peer support group meetings
provide a safe forum for nurses
to help themselves and support
others to overcome stigma and
shame by offering a place to:
• “Heal the healers”
• Practice mutual respect and hope
• Honestly face issues / concerns
• Learn about self-care strategies
and new ways of coping
References
American Nurses Association. (2015). Code of ethics for nurses: With Interpretive statements. Silver
Springs, MD: NurseBooks.org:
Baldisseri, M.R. (2007). Impaired healthcare professional. Critical Care Medicine, 35, S106-S116.
doi:10.1097/01.CCM.0000252918.87746.96
Bettinardi-Angres, K., Pickett, J., & Patrick, D. (2012). Substance use disorders and accessing
alternative-to-discipline programs. Journal of Nursing Regulation, 3(2), 16-23.
Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford
Institute. Journal of Substance Abuse Treatment, 33, 221-228. doi:10.1016/j.jsat.2007.06.001
Cook, L.M. (2013). Can nurses trust nurses in recovery reentering the workplace? Nursing 2013, 43(3), 214. doi:10.1097/01.NURSE.0000427092.87990.86
Darbro, N. (2005). Alternative diversion programs for nurses with impaired practice: Completers and noncompleters. Journal of Addictions Nursing, 16, 169-185. doi:10.1080/108860050032815
Dunn, D. (2005). Substance abuse among nurses: Defining the issue. AORN Journal, 82, 573-596.
Retrieved from http://dx.doi.org.ezproxy.undmedlibrary.org/10.1016/S0001-2092(06)60028-8
Gallup (2015). Americans’ faith in honesty, ethics of police rebounds. Retrieved from
http://www.gallup.com/poll/187874/americans-faith-honesty-ethics-policerebounds.aspx?g_source=Social+Issues&g_medium=newsfeed&g_campaign=tiles
Health Professionals Services Program. (2016). State of Minnesota: Health Professionals Services Program
(HPSP). Retrieved from http://mn.gov/health-licensing-boards/hpsp/
References
Matthias-Anderson, D. (2015). The process of work re-entry for nurses after substance use
disorders treatment: A grounded theory study. (Unpublished doctoral dissertation).
University of North Dakota, Grand Forks, N.D.
Monroe, T.B., Kenaga, H., Dietrich, M.S., Carter, M.A., & Cowan, R.L. (2013). The prevalence of
employed nurses identified or enrolled in substance use monitoring programs. Nursing
Research, 62(1), 10-15. doi:10.1097/NNR.0b013e31826ba3ca
National Council on State Boards of Nursing. (2011). Substance use disorder in nursing: A resource
manual and guidelines for alternative and disciplinary monitoring programs. Retrieved
from https://www.ncsbn.org/SUDN_11.pdf
Substance Abuse and Mental Health Services Administration. (2015). Substance use disorders.
Retrieved from http://www.samhsa.gov/disorders/substance-use
Trinkoff, A.M. & Storr, C.L. (1998). Substance use among nurses: Differences between specialties.
American Journal of Public Health, 88, 581-585.
Wright, E.L, McGuiness, T., Moneyham, L.D., Schumacher, J.E., Zwerling, A., & Stullenbarger,
N.E.N. (2012). Opioid abuse among nurse anesthetists and anesthesiologists. AANA
Journal, 80, 120-128.