Experts Eschew Punitive Approach to Nurses with Substance Use Issues

Experts Eschew Punitive Approach to Nurses with Substance Use Issues

For nurses and nursing students who struggle with addiction, a new position statement in the Journal of Addictions Nursing (JAN) emphasizes an “alternative-to-discipline” (ATD) approach, including specialized treatment and a pathway for return to practice.

JAN is the official journal of the International Nurses Society on Addictions (IntNSA).

As in society in general, substance use is a serious problem among nurses and nursing students. “Alcohol and other substance use by nurses potentially places patients, the public, and nurses themselves at risk for serious injury or death,” write authors Stephen Strobbe, Ph.D., R.N., Clinical Associate Professor at the University of Michigan School of Nursing and President of IntNSA; and Melanie Crowley, M.S.N., R.N., CEN of the Emergency Nurses Association (ENA).

In their statement, the authors urge the use of ATD programs for nurses and nursing students with substance use disorders, “with the stated goals of retention, rehabilitation, and re-entry into safe, professional practice.” Drug diversion for personal use “is viewed as a symptom of a serious and treatable disorder, and not exclusively as a crime.”

Traditional disciplinary methods toward nurses with substance use disorders often result in harsh penalties, especially when diversion of prescription medications is involved. These nurses may face job termination, loss of their nursing license, and criminal charges. Nursing students may be expelled from school, without appropriate treatment or follow-up.

In contrast to this “moral or criminal model,” the ATD approach would treat substance use disorders as a “chronic disease leading to biological, psychological, social, and spiritual manifestations.”

“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,” said Strobbe.

Strobbe and Crowley write, “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.”

In the ATD approach, nurses with substance use disorders would abstain from practice for some time, while undergoing specialized treatment to establish sobriety and a program of recovery. Treatment may include residential or intensive outpatient programs, individual and group therapy, urine drug testing, and support group attendance.

Return-to-work agreements may include restrictions of work hours and assignments, with continued treatment and monitoring for periods of up to three to five years.

The paper also calls for healthcare facilities to provide education and policies that would help promote a safe, supportive, and drug-free workplace. Furthermore, nurses and nursing students should be made aware of the risks associated with substance use, and the responsibility to report suspected concerns.

The ANA has officially endorsed the ENA/IntNSA joint position statement with plans to further promote and disseminate this stance. The authors note that ATD strategies are consistent with the American Nurses Association (ANA) code of ethics, and are recommended by the National Council of State Boards of Nursing.

“Health care facilities and schools of nursing [should] adopt ATD approaches to treating nurses and nursing students with substance use disorders, with stated goals of retention, rehabilitation, and re-entry into safe, professional practice,” according to the joint statement of the ENA and IntNSA.

The authors assert that programs that use an ATD approach have been shown to be effective in the treatment of health professionals with substance use disorders, and are considered a standard for recovery, with high rates of completion and return to practice.

Source: Wolters Kluwer Health

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Posted by Patricia Adams