Publications such as Momentum, a quarterly magazine for public viewing of nursing regulation, lists, among other things, board disciplinary actions against nurses. A large sum of the published infractions are drug-related, whether it be drugs illegally obtained on the job site or breach of a drug testing policy. The process of licensure being reinstated is not an easy undertaking and, depending on the infraction, may not be possible at all.
Risk Factors For Substance Abuse Among Healthcare Professionals
When considering drug and alcohol addiction, one might not automatically think of a successful career professional as being susceptible. The common mindset might be to think of someone who is low income or without much of a support system. Unfortunately, there are healthcare professionals who are functioning drug or alcohol users who are able to work under the effects of such vices. This poses a very real danger to the patient population that is under their care.
The definition of healthcare professional drug use, abuse, or addiction could be likened to the inability or likely future inability to be able to confidently or safely carry out the job description of accepted standards of care due to the influence of a drug or alcohol. It carries with it social and professional consequences and can be identified by physical and behavioral patterns of substandard care and unacceptable behavior in and outside of the workplace. The statistics of abuse among healthcare professionals may be similar to that of the general population. But due to the gravity of the offense, that healthcare professionals are accountable for the safety and well-being of their patients, it is considerably more disturbing.
As unique individuals, everyone brings to the career table their own pre-established health status. This may or may not include a genetic inclination to drug and alcohol addiction or a previously diagnosed mental disorder. The stress factors involved in the healthcare field make it a potential recipe to be a harmful environment for someone unaware of the dangerous pitfalls it could present. Risk factors of substance abuse among healthcare workers include:
- Short staffing
- Drug accessibility
- Drug promoting a social environment
- Professional invincibility
- Daily practitioner practice survival
- Specialty subsets
- Baseline personalities and predispositions
Telltale Signs and Symptoms of Substance Abuse Among Healthcare Professionals
As healthcare professionals, the focus is on the care and well-being of others; however, it is becoming increasingly more apparent that it is equally as important to monitor the care and well-being of the caregiver. Healthcare professionals should be accountable to one another, monitoring the signs and symptoms of burnout and other factors that could lend themselves to unhealthy addictive behaviors. Preventative educational and intervention strategies would be beneficial in the healthcare field to enable professionals to be able to recognize signs and symptoms not only in their coworkers but also to recognize dangerous behavior tendencies within themselves to provide early intervention. Early identification is essential as patient and provider well-being may be at risk. Some of the most recognizable signs and symptoms include:
- Excessive work absenteeism
- Frequent and long unexplained disappearances on the job site
- Loitering near a drug supply room
- Unusual unreliability
- Subpar work performance alternating between inattention, poor judgment, and poor decision making
- Lack of concentration
- A marked decline in interpersonal relationships with colleagues and patients
- Blame shifting
- Excessive and unsupervised wastage of drugs
- Inaccuracies in drug counts
- Ill-suited prescriptions for large narcotic doses
- Inconsistencies of patient medication administrations
- A decline in personal hygiene and appearance
- A decline in handwriting and charting accuracies
- Inappropriate body covering of common drug use sites
- Unusual personality changes
- Increasing isolation
The Healthcare Professional Community
The diversity in healthcare fields is immense, as are the personality types of the professionals that go along with them. Generally, it takes a highly self-confident, dominant personality type to work in areas where life and death hang in the balance. These personality types generally hold their counterparts to the highest level of accountability and would not think twice to report a fellow for suspicion of addictive behavior.
Empathy and compassion lie at the other end of the personality spectrum. It is not uncommon for coworkers to “enable” colleagues suspected of addiction by not reporting their suspicions. Fear of causing a coworker to lose their livelihood or licensure might be cause for hesitation. In reality, reporting suspicions could be the saving grace of a coworker or patient’s life.
Because healthcare, in general, tends to be short-staffed, this could lend some supervisory leadership to turn a blind eye to the potential of a healthcare professional’s addictive behavior. Turning in a staff member might further compound the problem of not having enough staff coverage. Oftentimes early intervention by a supervisor regarding suspicious behavior is deterrent enough to cause a change in behavior and so a supervisor might opt to pull the colleague aside in hopes that this will be enough to discourage the questionable behavior.
Healthcare workers have an ethical responsibility to protect the public from harm and are therefore accountable to make the appropriate decision in any case. In some cases, healthcare professionals who relinquish themselves to help for their addictions can lessen the disciplinary actions against them. Most places of employment have an Employee Assistance Program where an employee can seek guidance to get help.
Seeking help on one’s own is a better case scenario than being the recipient of disciplinary action in a case as serious as addiction in the workplace. Taking a leave of absence and submitting oneself to a recovery program could possibly avoid any punitive action against professional licensure. Although not impossible, this would be no small feat when dealing with a drug or alcohol addiction.
Deficiencies in Healthcare Facility Policy and Procedures
The organizations that are meant for promoting optimal health could be endangering their employees by lackluster surveillance practices. A solid foundation of practice guidelines is only as effective as they are enforced. Providing high-quality care and protection to the public must begin with care and consideration of the professionals who provide the care.
People entrust their personal welfare and safety to those in the health professions. Patients have to be their own health advocates in a healthcare setting. If a patient is to receive pain medications, it is a patient’s right to know the dosage and frequency in which it can be received. Unfortunately, diversion of medications is a tactic of healthcare members who may be taking them for themselves or selling them outside the facility. If pain relief is not being met, it might be advantageous for a patient or patient’s advocate to speak to charge personnel to verify that the correct previous dosages have been documented as given.
It is a common healthcare policy that unused narcotics be wasted with the witness of another healthcare professional. Often, in the current state of staff shortage, it is not carried out as such. Too frequently, drug wasting is not done in the presence of a witness, but is documented that it was on the assumption of staff member trust. This is an accessible avenue of drug diversion and has been the focus of healthcare governing organizations such as The Joint Commission to call for higher levels of comprehensive surveillance and observation.
Policies should promote early discovery of professionals who are suspected to be using, abusing, or being addicted to drugs or alcohol in order to minimize the period of time that patients are at risk of being harmed. Various healthcare professional organizations have worked to shape policies with regard to substance use among healthcare professionals. Some of the most prominent being:
- Physician’s Leadership on National Drug Policy
- American Pharmacists Association
- American Association of Colleges of Nursing
- Drug Enforcement Administration
- State departments of health, medical boards, state medical associations
- Colleges teaching healthcare professional programs
As mentioned earlier, disciplinary action may be lessened if the healthcare provider submits to successful treatment and ongoing management. Recovery rates for healthcare professionals who were impaired have shown to be impressive, more so with inpatient treatment and ongoing follow-up care. Programs specific to healthcare professionals are designed to assist the clinician with reentry into clinical practice.
Proactive education at the medical student level may be prudent with on-going education throughout the career path. Most healthcare professionals are required to participate in mandatory educational credits at increments throughout their careers. It might be beneficial to make healthcare professional drug addiction education part of that training.
Addressing Addiction Treatment For the Healthcare Professional
It can be grueling to watch someone struggle with addiction. Recovery most likely will not begin until the problem is addressed. Talking about it does not mean the person with the addiction is willing to admit the problem exists or is ready to get help. This is a common problem at the family member level. Healthcare professionals often are embarrassed that they themselves, who are supposed to be helping others, are in need of treatment. When the problem is affecting a person’s livelihood, however, there is a little more incentive to get the problem resolved.
One of the more common barriers to getting help for these professionals is the shame of perceived weakness. This may be the reason for what is termed “rehab tourism” in which professionals travel abroad for treatment to avoid seeking treatment where everyone will know them. Once the healthcare professional decides they are ready to seek help, they need to decide what kind of treatment is right for them. There are many options to consider including:
- Options that offer flexibility to meet the needs of the healthcare professional’s busy schedule such as intensive outpatient treatment.
- Day treatment programs are an outpatient option with a little less flexibility at the start but progressively becomes less rigid as improvement is achieved.
- Once most of the work of recovery is accomplished, traditional outpatient rehab and therapy is a highly recommended follow-up commitment option.
- Some professionals require more structure and accountability with their recovery while they continue on with their profession. Sober living is an option that offers a safe place to live while focusing on recovery efforts. This is a very regimented option to enable a more thorough life reset while still offering the flexibility to work.
- In many instances, healthcare professionals are dealing with additional mental health illnesses along with drug or alcohol addiction. These co-occurring conditions, also known as dual diagnosis, can be addressed at the same time as drug or alcohol addiction, leading to better outcomes.
Addressing Healthcare Professional Vulnerability
Society holds healthcare professionals in such high regard that these professionals are less likely to think of themselves as vulnerable. When they do find themselves in a position of needing help they may find it hard to get help from peers. The fear of losing their job or licensure because of an addiction could potentially be a barrier to seeking help. There may not seem to be much incentive to reach out for help.
Recognizing the vulnerability of the people who take care of our health and well-being should not be overlooked. Healthcare professionals are on the front line of defense for our health.
Being sensitive to their treatment needs should be a high priority. Healthcare professionals are, after all, somebody’s mother, father, sister, brother, son, or daughter.