Chemical Dependency in Nursing

Chemical Dependency in Nursing

Although the terms “substance abuse” and “chemical dependency” are often used interchangeably, there are differences between them.

According to the Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision, published by the American Psychiatric Division,

· “substance abuse” is associated with social factors, such as the failure to meet important obligations, multiple legal problems, drug-related arguments, and the use of drugs in dangerous situations.

· “chemical dependency” is defined by physical factors, such as increased tolerance to drugs, withdrawal symptoms, an inability to control or decrease use, and continued use despite acknowledgement of the drugs’ dangerous effects.

American Psych, A. (2000). Diagnostic and statistical manual of mental disorders, dsm-iv-tr.. (4th ed. ed.). Arlington VA: American Psychiatric Publishing, Inc.

Both substance abuse and chemical dependence are an illness affecting a significant portion of our population, and nurses are no exception.

Substance abuse has been identified as an issue threatening the nursing profession since the turn of the last century (Monroe & Kenaga, 2010).

According to the National Council of State Boards of Nursing (2012), while the prevalence of substance abuse in the general population averages approximately 16 percent, the prevalence for nurses may be up to 20 percent (Monroe & Kenaga, 2010; Horton-Deutsch, McNelis, & O’Haver Day, 2011).

This equates to approximately one in every 5 nurses who have substance abuse issues (Trinkoff, Shou & Storr, 1999; Trinkoff, Eaton, & Anthony, 1991, as cited by National Council of State Boards of Nursing, 2007).

Substance abuse and chemical dependency is a prevalent disease that has the potential to affect nurses, patients and society.

Monroe, T., & Kenaga, H. (2011). Don’t ask don’t tell: Substance abuse and addiction among nurses. Journal Of Clinical Nursing, 20(3-4), 504-509. doi:10.1111/j.1365-2702.2010.03518.x

National Council of State Boards of Nursing (2007). Alternative programs. http://www.ncsbn.org.

Trinkoff, A. M., Eaton, W. W., & Anthony, J. C. (1991). The prevalence of substance abuse among registered nurses. Nursing Research, 40, 172-175.

Trinkoff, A. M., Shou, Q., & Storr, C. L. (1999). Estimation of the prevalence of substance use problems among nurses using capture-recapture methods. Journal of Drug Issues, 29, 187-198.

What is nursing?

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

How does substance abuse and chemical dependence affect nursing?

Nurses with chemical dependency pose a threat to patient safety, their own health, and the reputation of the nursing profession.

In 1982, the American Nurses Association (ANA) first defined “impaired nursing practice” as the presence of dysfunction related to alcohol and other substance use or psychological problems that interfere with judgment and the delivery of safe care (ANA, 1982).

The literature on chemical dependency in nurses lags far behind that for other health-care professionals, especially physicians. However, with nurses on the front lines of patient care, it stands to reason that their risk of chemical dependence is at least as high as that of other health-care professionals.

Chemically dependent nurses jeopardize the standard of patient care

as well as their own health.

American Nurses Association. (1982). Position statement on impaired nursing practice. Kansas City, MO: Author.

Nurses are exposed to life-and-death situation, stress, long hours, difficult interprofessional relationships, workforce shortages and mandatory overtime, which all increase the risk for these professionals to turn to substances as an unhealthy way to decompress (Lillibridge, 2010; National Council of State Boards of Nursing, 2011).

While some methods of addressing this comprehensive issue include assessment of late signs of addiction, recent consensus is that for the challenge of addiction and dependency in nursing to be appropriately confronted, a more holistic view of the causes and risk factors need to be assessed so that nurses can receive the intervention needed, achieve recovery and gain reentry into practice (Lillibridge, 2010; National Council of State Boards of Nursing, 2011).

While much has been done to raise the awareness and effort to assist those afflicted with addiction, many challenges still remain as barriers to effective addressing of this issue. Some of the most difficult obstacles to overcome include: Negative attitudes, discrimination, both by colleagues and within insurance payment systems, education of referring and intervening health professionals, continuing punitive consequences to addicted nurses, resource utilization and sharing, research deficits, workplace modifications that make drug diversion more difficult and overall health promotion and prevention (Naegel, 2003; National Council of State Boards of Nursing, 2011).

Lillibridge, J. (2010). Impaired nursing practice – what are the issues? In C. J. Huston (Ed.), Professional issues in nursing: Challenges & opportunities (2nd ed.) (pp. 275-286). Philadelphia, PA: Lippincott Williams & Wilkins.

National Council of State Boards of Nursing (NCSBN). (2011). Substance Use Disorder in Nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs. Retrieved from https://www.ncsbn.org/SUDN_10.pdf.

Naegle, M. A. (2003). An overview of the American Nurses’ Association’s action on impaired practice with suggestions for future directions. Journal Of Addictions Nursing, 14(3), 145-147. doi:10.1080/10884600390245730

References

American Nurses Association. (1982). Position statement on impaired nursing

practice. Kansas City, MO: Author.

Horton-Deutsch, S., McNelis, A., & O’Haver Day, P. (2011). Enhancing mutual accountability to promote quality, safety, and nurses’ recovery from substance use disorders. Archives Of Psychiatric Nursing, 25445-455. doi:10.1016/j.apnu.2011.02.002

Monroe, T., & Kenaga, H. (2011). Don’t ask don’t tell: Substance abuse and addiction among nurses. Journal Of Clinical Nursing, 20(3-4), 504-509. doi:10.1111/j.1365-2702.2010.03518.x

National Council of State Boards of Nursing (2007). Alternative programs. http://www.ncsbn.org.

Trinkoff, A. M., Eaton, W. W., & Anthony, J. C. (1991). The prevalence of substance abuse among registered nurses. Nursing Research, 40, 172-175.

Trinkoff, A. M., Shou, Q., & Storr, C. L. (1999). Estimation of the prevalence of substance use problems among nurses using capture-recapture methods. Journal of Drug Issues, 29, 187-198.