It is estimated that at least 10% of the U.S. population will develop a substance abuse disorder during their lifetime, according to the New York State Education Department, and nurses and other professionals are not immune.
Someone with an addiction often goes against his or her own moral standards and ethics, and it often takes the emergence of symptoms or external consequences to challenge the denial before he or she is willing to seek help. The symptoms of addiction are the physical, psychological and social consequences of using substances, such as tremors, defensiveness or a DWI.
As a nurse volunteer with the Statewide Peer Assistance Program for Nurses (SPAN) of the New York State Nurses Association, Howard Doughty, RN, BSN, CNOR, has seen this firsthand and heard stories of addiction from nurses of all ages.
Even though alcoholism is just as common among nurse addiction cases as drug use, he said many people most often associate nurse addiction with stealing drugs intended for distribution to patients.
Today, so many hospitals and healthcare facilities have better safeguards and practices in place than what it was like years ago for preventing the theft of patient meds, says Doughty of Congers, N.Y.
Most medical institutions use large wheeled carts with locked compartments for medicine that require individual number combinations from nurses to gain access, but Doughty said nurses with addictions have been known to steal other nurses codes.
But the chief symptom of addiction is denial, and the people and institutions surrounding the addict also are prone to it. Hospital staff, managers, friends and co-workers often miss the signs of addiction. Healthcare institutions that have policies and procedures about fitness for duty, drug testing, returning to work and the handling of narcotics are better equipped to assist employees, says Justine Ellerman, RN, MSN, ANP, regional coordinator for SPAN. Policies and procedures for employees facing an addiction also make it more likely an institution will intervene early and effectively, Ellerman adds.
Admitting AddictionJustine Ellerman, RN
The SPAN program links nurses with available resources and was created to support nurses because of the belief that nurses with an illness deserve compassion and rehabilitation and that approach is in the best interest of public safety.
We help the nurse navigate treatment, legal, professional and workplace programs, Ellerman says. They are devastated, shamed and confused when they first contact me. They need an advocate until they can become an advocate for themselves. SPAN offers the support necessary to begin the road to recovery.
Doughty said he has found most nurses realize they have an addiction problem, but it usually requires an incident before help is arranged to address the problem. If its alcoholism, it can be a DWI, he says. If nurses are caught in situations at work, they usually know they must seek help if they are going to save their nursing license.
Nurses are directed to SPAN when they have had an employment problem, but no one is forced to participate. Some nurses seek help on their own, but most seek treatment after theyve been referred to the program by an employer or doctor. About 1,668 nurses have enrolled in the SPAN peer support program since 2001, Ellerman says.
SPAN works collaboratively with the New York State Education Departments Professional Assistance Program. PAP is the alternative to discipline for 44 licensed categories in New York State and offers professionals the opportunity to surrender their licenses while undergoing treatment and offers immunity from two charges of professional misconduct. PAP accepts voluntary and temporary surrender of license, reinstates licenses under practice conditions and monitors professionals in recovery.
Once a nurse has been discovered to have an addiction problem, they have this option to enter the PAP program for treatment and surrender their license until successfully completed, Ellerman says. Following treatment, the nurse can then lobby to regain the license, and if that happens, he or she will be closely monitored for the next two years.
Ellerman says the mission of SPAN, created by the New York State Nurses Association, was in response to a need expressed by nursing and healthcare professionals disciplinary boards. Instead of punishing these nurses with addictions, it was decided its far better to offer the ability for rehabilitation, she says.
As for the programs funding, she said the state provides the financial resources by requiring a $5 fee be included per year for each nurses license when renewed. In New York, since nursing licenses are renewed every three years, that amounts to $15 added to the fee, $5 per year, to generate the needed money for the SPAN budget, Ellerman says.
Because the State of New York offers a second-chance opportunity to nurses with addiction, providing there hasnt been any patient harm or extreme legal concerns, Ellerman says SPAN and PAP have found a high success rate, which she attributes to the support groups and volunteer efforts of nurses such as Doughty in the SPAN program.
Nurses in the SPAN program attend support groups and weekly meetings and seminars to learn how to face and handle addiction problems. Only a nurse who wants to get better and break free of these holds can succeed, Ellerman says. Once a nurse is willing to seek help they can begin the healing process and break free of the hold of addiction. If there is family and friend support, the process is even smoother and quicker.
Nurses can remain in the SPAN program as long as they require, and it is encouraged that nurses in recovery stay involved so that they can help newcomers. Thats the beauty of peer support sharing experience, hope and strength with each other, Ellerman says. To become a volunteer advocate in SPAN, a nurse must have five years of recovery from addiction. Volunteer advocates receive education and supervision and can facilitate support groups, offer one-on-one peer support and speak at colleges and hospitals about the SPAN program.
One RNs Story
Eddie*, RN, is a 53-year-old nurse from Staten Island, who has been a nurse for 18 years while struggling on and off with addiction. As a success story of the SPAN program, he not only still is working as a nurse, but also agrees to anonymously share his story of addiction to help other nurses.
I fought my addiction with alcoholism my entire life and grew up in a family with addiction problems, says Eddie, an ED nurse. After years of addiction, I was clean and sober for eight years, and then I had a six-year relapse before SPAN helped me regain my path in the right direction. Ive been clean now since Dec. 29, 2001.
New Jersey Program
Louis Baxter, MD, FASAM, is the executive medical director for the Professional Assistance Program of New Jersey and has been with the 20-year program since 1999 helping nurses seeking treatment for addiction.
Averaging about 110 cases per month, he said the program has an annual caseload of 700 nurses.
Addiction is a medical illness, and when people ask me about our success rate, I always explain it has to do with each individual participant and how he or she accepts treatment, Baxter says.
He said some of the nurses are self-sent to the program, and others are enrolled with licensing boards. We start by evaluating each patient and then diagnose and refer for the needed programs and support groups, he says. Some of the people we help need a more intensive inpatient program while others are ideal for outpatient.
Baxter said PAP has had a 96.3% success rate over a five-year period which results in nurses returning to their licensed profession. We are here to help these men and women help themselves, before they return to doing what they love most, which is helping others, Baxter says.
* Not his real name.