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The silent enemy
Editorial Roxane Spitzer, PhD, MBA, FAAN, RN
The Silent Enemy Recently, as I was reviewing statistics on my hospital’s recruitment efforts, I was delighted to see large numbers of nurses applying for open positions. However, when I looked to see how many had been hired, I was appalled—less than 10%. The usual obvious answer is that key people, such as the nurse manager, didn’t have time to interview, human resources didn’t expedite the interviews rapidly enough, we did not present a good image, etc., but that was not the case. After meeting with the CNO and the director of HR, it seemed that numbers of nurses had failed the drug test. Needless to say, I was shocked. How big a problem is this—is it local, regional, or national? I decided to do some investigating. Some researchers believe nurse impairment to be as high as 10% of the profession,1 whereas other research indicates that 1 in 7 nurses “will experience a problem with drugs and/or alcohol during their career.”2 The American Nurses Association cites a rate of about 6% to 8%.3 Some studies correlate nurse specialties, such as emergency department and critical care, and work shift issues as indicative of greater incidence of abuse, whereas oncology and nurse administrators report greater likelihood of binge drinking.4 Other researchers have identified underlying psychologic and social mechanisms in substance abusers that can be traced to deep-rooted problems in early life, such as chaotic family history, low self-esteem, and victimization.5 This type of past leads to difficulty with trust and intimacy in adult relationships.5 Add to this the nurse who has role strain, anxiety, depression, lack of emotional support, and ready access to controlled substances on the job—a huge risk factor. It is amazing that the reported abuse
April 2005
rate is as low as it is; I would believe it is much higher, with many choosing not to report. One thing needed immediately is a national study on relapse rates. The common wisdom among recovery programs for health professionals says participants must stay under an aftercare contract for 5 years. The Idaho Nursing Board’s study indicated a 47% recovery rate with a minimum of 5 years’ participation. This figure matched 1983 research for the proposition that the overall recovery rate nationwide is 50%, with relapse highly likely within the first year of treatment.6 There is no question that the states’ impairment programs are doing a great job over time, but what about prevention? We already know the factors that can lead to substance abuse. Are we screening prospective nursing students for potential problems, not necessarily to turn them down for the program but to initiate interventions to help them deal with deep-seated issues? At the least, when nurses enter a high-stress environment, what kind of social support are we giving them? Are stress management classes offered that are convenient, supportive, and as anonymous as possible? As a part of workplace responsibility, we must acknowledge the consistent strain that nurses (and other staff) are under. Formalized mentors and support groups can help diffuse the high tension in workplaces. Providing opportunities to laugh and participate in fun activities needs to be the norm. As a young nursing administrator, I recognized that pulling staff and floating them to other units was not only counterproductive for a variety of obvious reasons but groups, particularly in high-stress areas such as intensive care, count on their colleagues profes-
Nurse Leader 7
Editorial (continued) sionally and socially. When this support and camaraderie are not maintained, morale goes down, stress goes up, more patient safety issues arise, and nurses become depressed or flat leave the institution. Managing crisis in the short-term and not having a long-term strategy ultimately proves disadvantageous to individual caregivers, patients, and the organization. Prevention must be the norm to avoid crises in the first place. What we see today in nursing may be indicative of an entire generation of substance abusers, but the situation is even more dangerous in health care because patient care and safety are threatened. With ever-decreasing resources in nursing, we must nurture and care for each nurse and prevent a debilitating disease before it ever starts.
8 Nurse Leader
References 1. Coleman EA, Honeycutt G, Ogden B, McMillan DE, O’Sullivan PS, Light K. Assessing substance abuse among health care students and the efficacy of educational interventions. J Prof Nurs 1997;13:28-37. 2. Von Burg L, Foreman MA. Substance abuse among nurses at teaching hospitals. Nurs Manage 1992;23:68-70. 3. American Nurses Association. Addiction and psychological dysfunction in nursing: the profession’s response to the problem. Kansas City: The Association; 1984. p. 2. 4. Trinkoff AM, Storr CL. Substance use among nurses: differences between specialties. Am J Public Health 1998;88:581-5. 5. Mynatt S. Effect of intervention into substance abuse disorders in women with comorbid depression. J Psychosoc Nurs Ment Health 1999;37:16-29. 6. Vaillant GE. Prospective study of alcoholism treatment: 8-year follow-up. Am J Med 1983;75:455-63.
Bibliography Cantanzarite A. Managing the chemically dependent nurse: a guide to identification, intervention, and retention. Chicago: American Hospital Association Publishing, Inc. AHA Catalog #154200. 1992. Clark C. Descriptive study of the impaired nurse in Idaho. Boise State University 2004. Available at: http://familystudies.boisestate.edu/pd f/Clark1.pdf. Accessed on Jan 20, 2005.
Roxane Spitzer, PhD, is CEO of the Metropolitan Nashville Hospital Authority, which operates Nashville General Hospital at Meharry and Bordeaux Long-Term Care. She can be reached at roxane.spitzer@ gh.nashville.org. 1541-4612/2005/$ see front matter Copyright 2004 by Elsevier Inc. doi:10.1016/j.mnl.2005.01.014
April 2005
The Silent Enemy Recently, as I was reviewing statistics on my hospital’s recruitment efforts, I was delighted to see large numbers of nurses applying for open positions. However, when I looked to see how many had been hired, I was appalled—less than 10%. The usual obvious answer is that key people, such as the nurse manager, didn’t have time to interview, human resources didn’t expedite the interviews rapidly enough, we did not present a good image, etc., but that was not the case. After meeting with the CNO and the director of HR, it seemed that numbers of nurses had failed the drug test. Needless to say, I was shocked. How big a problem is this—is it local, regional, or national? I decided to do some investigating. Some researchers believe nurse impairment to be as high as 10% of the profession,1 whereas other research indicates that 1 in 7 nurses “will experience a problem with drugs and/or alcohol during their career.”2 The American Nurses Association cites a rate of about 6% to 8%.3 Some studies correlate nurse specialties, such as emergency department and critical care, and work shift issues as indicative of greater incidence of abuse, whereas oncology and nurse administrators report greater likelihood of binge drinking.4 Other researchers have identified underlying psychologic and social mechanisms in substance abusers that can be traced to deep-rooted problems in early life, such as chaotic family history, low self-esteem, and victimization.5 This type of past leads to difficulty with trust and intimacy in adult relationships.5 Add to this the nurse who has role strain, anxiety, depression, lack of emotional support, and ready access to controlled substances on the job—a huge risk factor. It is amazing that the reported abuse
April 2005
rate is as low as it is; I would believe it is much higher, with many choosing not to report. One thing needed immediately is a national study on relapse rates. The common wisdom among recovery programs for health professionals says participants must stay under an aftercare contract for 5 years. The Idaho Nursing Board’s study indicated a 47% recovery rate with a minimum of 5 years’ participation. This figure matched 1983 research for the proposition that the overall recovery rate nationwide is 50%, with relapse highly likely within the first year of treatment.6 There is no question that the states’ impairment programs are doing a great job over time, but what about prevention? We already know the factors that can lead to substance abuse. Are we screening prospective nursing students for potential problems, not necessarily to turn them down for the program but to initiate interventions to help them deal with deep-seated issues? At the least, when nurses enter a high-stress environment, what kind of social support are we giving them? Are stress management classes offered that are convenient, supportive, and as anonymous as possible? As a part of workplace responsibility, we must acknowledge the consistent strain that nurses (and other staff) are under. Formalized mentors and support groups can help diffuse the high tension in workplaces. Providing opportunities to laugh and participate in fun activities needs to be the norm. As a young nursing administrator, I recognized that pulling staff and floating them to other units was not only counterproductive for a variety of obvious reasons but groups, particularly in high-stress areas such as intensive care, count on their colleagues profes-
Nurse Leader 7
Editorial (continued) sionally and socially. When this support and camaraderie are not maintained, morale goes down, stress goes up, more patient safety issues arise, and nurses become depressed or flat leave the institution. Managing crisis in the short-term and not having a long-term strategy ultimately proves disadvantageous to individual caregivers, patients, and the organization. Prevention must be the norm to avoid crises in the first place. What we see today in nursing may be indicative of an entire generation of substance abusers, but the situation is even more dangerous in health care because patient care and safety are threatened. With ever-decreasing resources in nursing, we must nurture and care for each nurse and prevent a debilitating disease before it ever starts.
8 Nurse Leader
References 1. Coleman EA, Honeycutt G, Ogden B, McMillan DE, O’Sullivan PS, Light K. Assessing substance abuse among health care students and the efficacy of educational interventions. J Prof Nurs 1997;13:28-37. 2. Von Burg L, Foreman MA. Substance abuse among nurses at teaching hospitals. Nurs Manage 1992;23:68-70. 3. American Nurses Association. Addiction and psychological dysfunction in nursing: the profession’s response to the problem. Kansas City: The Association; 1984. p. 2. 4. Trinkoff AM, Storr CL. Substance use among nurses: differences between specialties. Am J Public Health 1998;88:581-5. 5. Mynatt S. Effect of intervention into substance abuse disorders in women with comorbid depression. J Psychosoc Nurs Ment Health 1999;37:16-29. 6. Vaillant GE. Prospective study of alcoholism treatment: 8-year follow-up. Am J Med 1983;75:455-63.
Bibliography Cantanzarite A. Managing the chemically dependent nurse: a guide to identification, intervention, and retention. Chicago: American Hospital Association Publishing, Inc. AHA Catalog #154200. 1992. Clark C. Descriptive study of the impaired nurse in Idaho. Boise State University 2004. Available at: http://familystudies.boisestate.edu/pd f/Clark1.pdf. Accessed on Jan 20, 2005.
Roxane Spitzer, PhD, is CEO of the Metropolitan Nashville Hospital Authority, which operates Nashville General Hospital at Meharry and Bordeaux Long-Term Care. She can be reached at roxane.spitzer@ gh.nashville.org. 1541-4612/2005/$ see front matter Copyright 2004 by Elsevier Inc. doi:10.1016/j.mnl.2005.01.014
April 2005