CE FEATURE Alternative Diversion Programs for Nurses with Impaired Practice: Completers and Non-Completers

Abstract

The purpose of this study was to describe, explain, and compare the experiences of nurses who were completers and non-completers of an alternative diversion program for chemically dependent nurses. Risk factors for substance abuse are explored.Sixteen nurses who had participated in an alternative diversion program for chemically dependent nurses were interviewed for this study. Fourteen of these nurses completed second interviews. Qualitative analysis of these interviews was conducted utilizing the constant comparative method.Common issues for the nurses included medical conditions and dual diagnosis for which legal prescriptions were frequently obtained. Most of the nurses worked in critical care, noted stressful work conditions, and diverted medications from the workplace for their own use. They also listed emotional stresses associated with impaired practice and addiction, primarily isolation, depression, shame, and guilt. They noted a culture of stigma and mistreatment of addicts and alcoholics by many professionals.Positive commonalities included improved nursing practice, such as being more patient, tolerant, and compassionate, as a result of their own recovery work. They learned to utilize social support systems, which led them from isolation and hiding to involvement and disclosure. The nurses identified a pivotal event as being the leverage needed to move them into a lifestyle of recovery.Completers were highly motivated to retain their nursing licenses, and they strongly affiliated with other recovering nurses. In retrospect, they viewed the coercion of the program as having positive benefits. They took a brief amount of time off nursing early in their recovery. Most importantly, they had prepared and developed a relapse prevention plan.Non-completers were considering getting out of nursing or combining nursing with another field of endeavor. They did not feel affiliated with other nurses in recovery. They viewed the coercion of the alternative program as punitive and having no positive value. They felt they were forced out of participation in the program for unsupported reasons. In spite of this, seven of eight of the noncompleters remained in recovery.

A critical review of knowledge on nurses with problematic substance use: The need to move from individual blame to awareness of structural factors

“…nurses' easy access to drugs, a structural factor situated in nurses' physical work environments, is commonly posed as a chief contributor toward their use of substances (Darbro, ; Dittman, ; Kenna & Wood, ; Lillibridge et al., ; Trinkoff, Storr, & Wall, ). To support this contention, researchers have frequently cited data showing that the level of nurses' workplace access to drugs correlates with their prevalence of abusing the accessible drugs therein (Bozimowski, Groh, Rouen, & Dosch, ; Bugle, ; Trinkoff & Storr, ; Trinkoff et al., ).…”

“…In our preliminary readings of the works on predisposing factors, however, we found that the literature was almost exclusively centered on the identification and measurement of individual risk factors. These included the following: use of substances, particularly benzodiazepines or opioids prior to entering nursing (Mynatt, ; Rojas, Jeon‐Slaughter, Brand, & Koos, ); comorbid medical (Sullivan, ) or psychiatric (Breslin, ; Darbro, ; Rojas et al., ) illnesses; history of childhood abuse or sexual trauma (Breslin, ; Dittman, ; Strom‐Paikin, ; Sullivan, ,b); socializing with others who abuse substances (Kenna & Lewis, ); absence of proscriptions against substance use (Beamer, ; Trinkoff, Zhou, Storr, & Soeken, ); ‘sensation‐ or thrill‐seeking’ personality (Trinkoff & Storr, ; West, ); family history of addictions (Bugle, ; Kenna & Lewis, ; Kenna & Wood, , ; Stammer, ); use of substances to self‐medicate emotional distress or physical pain (Darbro, ; Dittman, ; Hutchinson, , ; Lillibridge, Cox, & Cross, ; Stammer, ); and male gender (Bugle, ; McNelis et al., ). Multifactorial explanations involving any combination of these individual risk factors have also been offered (West, , ).…”

Treating Nurses and Student Nurses with Chemical Dependency: Revising Policy in the United States for the 21st Century

“…Third, it would appear that alternative programs are more effective in moving quickly to protect the public from unsafe practitioners than are disciplinary programs, since such nurses are removed from the healthcare setting swiftly through early identification and begin treatment within a few weeks, compared to the months or even years before the final adjudication of nurses in disciplinary programs (Sullivan et al 1990;Quinlan 2003). Fourth, those who have successfully completed an alternative program are highly motivated to retain their license, feel an affinity with other recovering nurses, and have a plan to prevent relapse (Darbro 2005). Programs vary from state to state but they are selective about eligibility in order to protect the public.…”

Physician health programmes and malpractice claims: reducing risk through monitoring

“…In particular, they cited being more patient, tolerant and compassionate. Furthermore the monitoring experience helped nurses recognize the need to utilize more social support [28].…”