Specialised treatment and a pathway for return to practice should be favoured over discipline for nurses that have been found to have substance and alcohol use disorders, according to US experts.
Famously and controversially, the lead character in US comedy-drama serious Nurse Jackie, which ran from 2009-15, took prescription painkillers and benzodiazepines, bringing the issue to the attention of the public.
“Treatment outcomes for substance use disorders are comparable to those of other diseases”
It acknowledged the heightened risk from alcohol and other substance use by nurses, as it “potentially places patients, the public, and nurses themselves at risk for serious injury or death”.
However, it noted that traditional disciplinary approaches to nurses with substance use disorders often resulted in “harsh penalties”, especially when prescription medications were involved.
For example, nurses may lose their job and their registration, and possibly face criminal charges, while students may be expelled from school, without appropriate treatment or follow-up.
In contrast to this “moral or criminal model”, the two organisations argued that substance addictions should be viewed as long-term conditions and treated as such.
“When viewed and treated as a chronic medical illness, treatment outcomes for substance use disorders are comparable to those of other diseases…and can result in lasting benefits,” said the authors in the Journal of Addictions Nursing.
They suggested drug use for personal reasons should be “viewed as a symptom of a serious and treatable disorder, and not exclusively as a crime”, emphasising “alternative-to-discipline” approaches.
“Patient safety is of paramount importance”
They called on healthcare facilities and nursing schools to adopt such approaches to help affected nurses and nursing students through the use of “stated goals of retention, rehabilitation, and re-entry into safe, professional practice”.
They also recommended that nurses with substance use disorders refrain from practice for some time, while undergoing specialist treatment to establish “sobriety” and a programme of recovery.
Treatment may include residential or intensive outpatient programmes, individual and group therapy, urine drug testing, and support group attendance, they suggested.
Meanwhile, return-to-work agreements might include restrictions of work hours and assignments, with continued treatment and monitoring for periods of up to three to five years.
Drug-addicted nurses ‘should be supported not punished’
The position paper, which has been endorsed by the American Nurses Association, added that employers should provide education and policies promoting a “safe, supportive, and drug-free workplace”.
Nurses and nursing students should be made aware of the risks associated with substance use, and the responsibility to report suspected concerns, it highlighted.
The joint statement was co-written by the society’s president Dr Stephen Strobbe, clinical associate professor at the University of Michigan school of nursing.
He said: “Patient safety is of paramount importance, and one of the best ways to achieve this is through effective prevention, intervention, treatment and recovery, and professional monitoring of nurses and nursing students with substance use disorders.”