Misuse of drugs: One nurse’s nightmare

A health professional’s misuse of drugs or alcohol can be a nightmare for the provider, the facility, and even the community. One anesthetist’s story is a testimony:

A certified registered nurse anesthetist (CRNA) had been one of two anesthesia providers at a small community hospital for 30 years. Her anesthetic partner contracted cancer and had to leave his job, so she handled the practice by herself for two years without asking for a vacation or an extra day off. In the meantime, her husband became disabled and required $10,000 for his monthly treatment. He was dependent on her health insurance for his treatment. Also during a two-year period in which these events occurred, her father died.

One day at work, when the end of the shift was long away, she developed a migraine headache. Although she had never misused drugs, she self-administered 25 mg of Demerol subcutaneously. Afterward, she was anguished that she had misused the drug, so she reported herself to her supervisor. Her supervisor’s response was that she was required to report her to the state board of nursing.

The first major mistake’

"That was the first major mistake," says Diana Quinlan, CRNA, MA, chairwoman of the Peer Assistance Advisors Committee at the American Association of Nurse Anesthetists, Park Ridge, IL. "If someone comes to you for help, then you help him or her," she says.

If your state doesn’t have a program for impaired nurses, call the state medical society’s peer assistance program for advice, suggests Eric B. Hedberg, MD, associate medical director of the Talbott Recovery Campus in Atlanta, which specializes in chemical dependency treatment of medical professionals.

In the case of the CRNA who had misused drugs once, the sheriff took her away in handcuffs within 24 hours and charged her with diverting narcotics in the workplace. The CRNA’s name appeared on the front page of her newspaper; she was fired from her job; she lost her license; and she faces the possibility of five years in prison and a $5,000 fine. She and her husband have had to declare bankruptcy. They lost their home of 30 years, although they had not previously missed a mortgage payment. The CRNA is currently working three minimum-wage jobs in an attempt to keep her health insurance to pay for her husband’s treatment. "Now tell me where the justice was in all of that," Quinlan says. "This was nursing’s response to a nurse in need."

The CRNA lived in a state in which the board of nursing doesn’t understand that addiction and misuse of substances is a professional hazard, she says. Instead, its response was to be maximally punitive, says Quinlan, who declined a request to identify the state. "[The board] thought [it was] doing the right thing to protect public by disciplining the nurse, but [it] disabled a community and destroyed a nurse and her life," she says. "All of this was for want of someone who knew what to do appropriately and a mechanism in place in that state to help a nurse who asked for help."

Discrepancy between doctors and nurses

Physicians in that state are escorted to treatment and allowed to re-enter the workplace, Quinlan points out. State medical societies have physician health programs that refer addicted physicians to approved treatment facilities. In comparison, only 34 states have diversion programs for nurses, and some of those programs are more disciplinary than helpful, she says.

If you are a nurse, be familiar with the law in your state, she advises. "If nurses ask for help because [they have] abused a substance, depending on the state [in which they work], they are helped to treatment and re-entry into the workplace, or they are sent to jail," Quinlan says. It’s purely a geographical determination, she adds.

When there’s no alternative to a discipline process with a state’s board of nursing, all nurses in that state are at risk, Quinlan adds. "Anyone of us, at any time, can become addicted," she says.