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The key to tackling addiction

Support, not punishment, is the key to tackling substance abuse and addiction among nurses, study suggests.

As many as 10 to 20 per cent of nurses and nursing students may have substance abuse and addiction problems, but the key to tackling the issue – and protecting public safety – is support and treatment, not punishment.

That is the key message from researchers who said poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired students or professionals to ask for help.

In a paper published in the recent issue of Journal of Clinical Nursing, they recommend six key points that could be built into alternative-to-dismissal (ATD) strategies after reviewing latest research and professional guidance from countries such as the USA, Australia, Canada, New Zealand and the UK.

They believe that ATD programs provide greater patient safety, as they enable managers to remove nurses from the work environment quickly, unlike traditional disciplinary procedures that can take months, if not years.

ATD programs also provide non-judgemental support and treatment that encourages nurses to seek help and improve their chances of staying in the profession, they said.

“Addiction among nurses has been recognised by professionals in the field for more than 100 years” said lead author Dr Todd Monroe from the Vanderbilt University School of Nursing, Tennessee, USA.

“While research consistently reports incidence rates of 10 to 15 per cent, some studies suggest that this could be as high as 20 per cent.

“Doctors and nurses are only human and face the same problems as everyone else, which can include chemical dependency. The fact that they work in a highly stressful environment with easy access to powerful drugs can expose them to an increased risk of substance misuse and abuse.

“They are expected to show compassion when caring for patients who are alcohol or drug dependent and they should extend the same compassion to colleagues struggling with chemical dependency, which is an illness.”

Research suggests that ATD programs help many nurses recover from addiction, reduce the chance of dismissal and return to work under strict monitoring guidelines, with random substance checks, support and meetings with managers and regulators.

ATD programs can also lead to a 75 per cent reduction in practical problems, like helping nurses to re-enter the workforce.

“ATD programmes appear to be the best way to protect patients and retain nurses at a time when the profession is facing serious shortages of experienced professionals,” Monroe said.

The review covers nearly three decades of research papers and professional guidance from nursing regulators and brings together a number of previous studies by Monroe on substance abuse policies in the nursing profession.

“We believe that the incidence of substance abuse among nurses, and especially nursing students, is both under-researched and under-reported, partly because it is considered taboo among many healthcare providers and nursing school faculty and staff,” he said.

“Poor or ineffective policies that mandate punitive action are more likely to endanger the public, as they make it more difficult for impaired nurses or students to seek help.

“That is why we support ATD strategies that motivate individuals to voluntarily seek assistance for their dependency or encourage colleagues to urge them to seek the help they need.”

Monroe teamed up with Dr Heidi Kenaga, from The University of Tennessee Health Science Center, to come up with six key points that they believe should be incorporated into ATD programmes developed by regulators, educators and healthcare facilties:

1. Promoting open communication by discussing substance abuse in healthcare and nursing education settings.
2. Encouraging an atmosphere where people feel they can report problems confidentially.
3. Providing information about the signs and symptoms of impairment.
4. Conducting mock interventions to help people feel less fearful or uncomfortable about approaching a colleague or fellow student about suspected chemical dependency.
5. Inviting ATD experts to speak to hospital or school administrators.
6. Participating in scholarly forums about addiction among healthcare providers.

“We believe that these key points will help to transform perceptions of substance abuse among nurses, so that they are seen as a medical disorder requiring treatment, rather than a moral failing,” said Monroe.

“There is a long history of substance abuse in the medical profession and ignoring the problem may perpetuate fear, anxiety, poor outcomes for the nurses and risks for the people they care for.

“Providing early intervention and assistance is essential to help nurses and nursing students to recover from an addictive disorder. And providing a confidential, non-punitive atmosphere of support may well be a life-saving step for nurses and those in their care.”

Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions.

Such a service in Australia is the Victorian Nurses Health Program (VNHP). Run by nurses, it works with nurses and midwives with substance abuse or mental health issues to provide confidential assessment, treatment and referral to a variety of services. For details go to www.vnhp.org.au.

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