Providing treatment for addicted HCWs
Handle it like a chronic illness
Health care systems handle cases of employee substance abuse in a variety of ways from punitive measures to providing treatment and long follow-up care and monitoring.
Almost all states offer some type of treatment program for health care professionals, says John Furman, PhD, MSN, executive director of Washington Health Professional Services in Olympia, WA.
"We monitor the employees, and as long as they are successful at the program, they can return to practice as successful health professionals," he explains. "Our contracts are generally for five years. Research has shown that at least five years of rigorous monitoring provides the best chance of long-term recovery."
Hospitals should value the opportunity to help health care workers return to work because they are valuable resources, and treatment and monitoring preserve that resource and investment, Furman says.
"Nurses and some other health care professionals have about a 70 percent success rate when they’re in a risk monitoring program for five years," he says. "Physicians have a higher rate — about 85 percent."
This alternative to the discipline route benefits everyone and is a fair way of handling employees with a problem that many public and health authorities now compare to a chronic illness like diabetes, Furman argues.
"Once an action is taken against a health care professional in Washington state, that action is a public record and is attached to their professional license forever," he explains. "An alternative to discipline allows someone to voluntarily come into monitoring and avoid that formal action against their license."
A health system’s top priority should be to protect the patients while safely returning the addicted professional back to practice, he adds.
Furman offers these suggestions for handling substance use problems:
Provide a culture of transparency: "Develop a culture where it’s okay to talk about substance issues," he says. "And make it clear that the employer is concerned about that — not just about the diversion of medications — but also about the health and safety of their employees."
Health systems should have clear policies and procedures regarding reporting suspected cases of medication misuse and for safety of employees and patients. They also should emphasize a non-punitive and treatment-oriented approach, he adds.
Educate employees and managers about substance use signs: Workplace education and messages about substance use are important.
Brochures and other information could highlight signs and symptoms of a substance use problem, including when an employee:
- changes his or her behavior;
- becomes more irritable and defensive;
- performs poorly and work practices deteriorate;
- starts to take more time off;
- has unexplained absences while on the unit;
- volunteers for overtime or night shifts in areas with less supervision;
- volunteers to work with patients with excessive pain medication;
One of those changes probably doesn’t mean there’s a substance use problem, but a pattern should trigger concern, Furman says.
Emphasize treatment over punishment: Again, the goal should be to help the nurse return to health so she can return to work and productivity, he says. Hiring and training new employees is expensive. While helping an employee recover from substance use also is costly, much of the cost is borne by the employee, Furman says.
"The basic costs for initial evaluation and treatment can range from $5,000 to $50,000 in some high-end facilities. Then there are ongoing costs —random urine drug screens at $75 to $100 each," he says.
Most programs require the employee to participate in a self-help group like Alcoholics Anonymous or Narcotics Anonymous.
Providing employees with the option of going through a treatment and monitoring program — where they attend regular meetings and are monitored for substance use over a long period — is also a way to encourage employees to self-report, Furman adds.
"A nurse might come in and report to the manager that she has an alcohol problem," he says.