Occupational Hazard of Nursing….How a Stressful Career Can Lead to a Substance Use Disorder

One more drink when you come home from work after a tough day; a Xanax to calm you down before a major test; a little extra something to help you stay awake so you can take care of all the things you need to get done in a day. 

Substance use disorders can start innocently, and nurses are at a higher risk for disorders than the general population because of the stresses of the job and the accessibility of medications.  The reality is that substance use disorders are on the rise, and agencies work to take a proactive approach to help those at risk before use can lead to a use disorder.

In the early 1990’s New York’s State Nurses Association began a demonstration program in Long Island to see if support groups for nurses facing substance use disorders would be able to help nurses manage their disorders and enable them to return to the workforce.  In 2001 the NYSNA was awarded the state contract to administer the program now called SPAN (Statewide Peer Assistance for Nurses) which is available to all nurses in NY even if they are not members of the NYSNA, explains Barbara Nahmias, NPP, PMHCNS-BC, SPAN Eastern NY Regional Coordinator.  Today, funding in NY is provided through a $15 surcharge on all nurse license registrations.  No tax dollars are needed for the program, and because nurses already pay for the services with this surcharge, they are, perhaps, more willing to seek out the services when needed.  Peer assistance programs exist in many states nationwide, and it is important for people to know what services are available to them.

SPAN is dedicated to much more than providing ongoing support and advocacy for nurses battling substance use disorders, says Leslie Mangano, M.Ed., Western NY Regional Coordinator.  SPAN’s programs promote creating healthy work environments and providing information and educational seminars for nursing students and faculty in schools and staff in health care settings.  SPAN asserts that a substance use disorder is an occupational hazard for nurses and a disease that can be carefully managed so affected nurse can have careers. “SPAN’s mission is to be the resource for New York State nurses affected by substance use disorders, while fostering public safety through outreach and education.”

The services are confidential and voluntary, and people are encouraged to use the program before they get into trouble.  SPAN works closely with the Office of Professional Discipline and the Professional Assistance Program (PAP); both are offices within the State Education Department.

The Office of Professional Discipline investigates and prosecutes licensed professionals charged with mental or physical impairment, incompetence, malpractice or misconduct, including accusations of patient harm. Counts of Habitual Misuse or Being Under the Influence While Practicing can result in the loss of license even without criminal conviction.  In New York State a licensee must wait a minimum of three months before applying for reinstatement.

The PAP is a resource for licensed professionals who realize they are at risk.  They may voluntarily and confidentially surrender their licenses and seek treatment without being subject to professional discipline charges as long as they have not harmed patients or clients.  While nurses don’t have to report substance use disorders if they have no convictions or are in treatment, they do need to let employers know if they are in a PAP.  They will be monitored by the PAP for at least two years after license reinstatement.  While some argue that people in a PAP are at less of a risk in a health care setting because they must have frequent drug testing and are carefully monitored, hospitals can deny employment because of the perceived risk.  It is recommended that nurses not be assigned to high-stress situations; this alone can limit job opportunities for returning nurses.

SPAN works to help employers see substance use disorders as treatable, and advocates that employees should be given a second chance.  Of course, because SPAN is voluntary, it’s sometimes difficult to get people to come forward initially.  People with disorders often go into denial and will not admit to a problem until it’s too late.  The key to a successful fight is early intervention which is why SPAN takes its program into nursing schools and provides educational programs to students at all levels.

“Educators in Nursing” caught up with Leslie Mangano on the road and asked for some advice to help students manage stress.  She pointed out that time management and stress management skills are essential.  As she said, “Nurses always do for other people, but they don’t do for themselves.”

Of course finding ways to deal with stress can be challenging, but she offers some great places to start:

Ask people to help.  You can’t do everything by yourself, and adding school on top of work and family responsibilities can be very difficult.  Those around you will pitch in, but you have to ask and set the expectations.

Keep yourself educated.  It’s really important to understand and recognize the symptoms of substance use disorders.

Nursing students learn them in class, but we need to help students transition them to real life applications.

• Personality traits that could indicate substance use disorders are rapid mood swings; irritability; complaints of chronic pain; suicidal thoughts; the tendency to isolate.
• Physical symptoms include dilated or constricted pupils; frequent bathroom trips; the odor of alcohol; deteriorating writing and the wearing of long sleeves.
• In a work setting, signs of drug use disorders include frequently breaking or spilling drugs; going to the bathroom after being in the narcotics cabinet; patient complaints of ineffective pain control; coming to work early and leaving late; volunteering to give medication.
• Specific signs of alcohol misuse include:  increasing time/attendance deficits; elaborate excuses for lateness or absence; alcohol on breath; hangovers; and blackouts.

If a student feels he or she may be at risk, Mangano would encourage the student to contact the appropriate agency (like SPAN) in his or her state.  While SPAN doesn’t provide treatment, the organization can provide information about available treatment programs.

She advises that students can also go to an outpatient treatment program to get an evaluation to see if the use has crossed over to a disorder, or they could go to an Alcoholic Anonymous or Narcotics Anonymous meeting–a safe and confidential environment.

Finally, she advises that students could go to a trusted faculty member, and she stresses that schools should create an environment of trust and an opportunity for a confidential interaction.  Faculty also needs to continue working to address substance use disorders issues in class.  Talking about them makes it easier for students to deal with substance use disorders if they do occur.

She warns that faculty needs to understand that many students today have a very different perception of substance use disorders.  Daily users of recreational drugs may see nothing wrong with such frequent use and may be less likely to see themselves at risk.  Bringing in outside programs like SPAN helps students to better understand when they’ve crossed the line into a use disorder. If students do get into trouble, they may not be able to sit for the NCLEX®, and any criminal conviction would most certainly affect the licensing process.

The reality is that nurses are at a great risk for disorders, but with programs like SPAN, nurses can receive a second chance. “Every nurse deserves the opportunity to have access and availability to needed treatment, help in preserving license and employment status, and ongoing support throughout the recovery process.  SPAN is designed to provide a balance between the needs of the nurse and the nurse’s patients.  SPAN’s efforts are directed toward restoring the nurse to optimum health, preserving a career, and returning a valuable resource to the healthcare community.”

“Educators in Nursing” is grateful to the extensive contributions made to this article by the SPAN program of the NYSNA.  We would like to cite the SPAN Mission Statement and their Statement of NYSNA Philosophy from September 2009, and also thank the following coordinators for SPAN:

Leslie Mangano, M.Ed., Western NY Regional Coordinator has extensive experience in setting up and designing training and facilitating workshops.  She has worked 30+ years at Jamestown Community College as a Professor of Psychology — teaching Interpersonal Group Dynamics.  Additionally, she designed the position of Director of Community Outreach at the branch campus in Olean, NY.  She developed and became the Acting Director of Community Outreach.  Duties of this role included brokering industrial and community agency training workshops.

Barbara Nahmias, NPP, PMHCNS-BC, Eastern NY Regional Coordinator, has worked as a psychiatric nurse and psychiatric nurse practitioner for the past 30 years in a variety of settings. She has been a regional coordinator for the Statewide Peer Assistance for Nurses Program for 10 years and was instrumental in implementing the SPAN program in the Eastern region of the state.