Approaching Addiction in Nursing

[BostonTerrierLover, BSN, RN]

Addiction and Chemical Abuse has to be one of the most misunderstood, mis-informed, and most untreated disease process in the world. It saddens me to no end the plight of the addict in healthcare. It is frightening both in its active state and inactive state. This disease is like any other, it has an induction period, all the way to an end stage. Many see drug addicts as weak, criminal, and deviants. It has to be one of the most steriotyped illnesses in the western world. The word "Addiction" itself evokes very negative ideas and reactions. If the Nursing and Medical Profession truly believed it to be a disease, then we could fight it AS ANY OTHER. We would research it, develope more treatment modalities, and educate our patients as it affects not only the addict with this disease.

I truly understand the nurse who immediately has a negative response to a known active addict waiting at triage with a variety of vague pain complaints for the anticipated "Fix," and then off with a prescription for more narcotics if the ER doesn't have a Narcotics Policy. But, I am not angry at the patient following the manifestations of their disease of addiction. They are doing exactly what addicts who need narcotics to prevent withdrawals naturally do! It's the medical and nursing staff who just let a patient with an untreated and probably undiagnosed disease just totally fall through the system.

It is the same as a diabetic patient coming in, displaying all the flagship signs of diabetes acute exacerbations out loud and on paper presenting in with a complaint of dizziness and nausea, and being treated for Vertigo! We have done nothing for the patient, they will get sicker, and if not PROPERLY treated soon, THEY WILL DIE!

To make it even more imperative, it is not just our patients. This disease is present right now in your family, friends, fellow nurses, and doctors as you read this! I have heard it said so many times that if 4 teenagers died of a Virus at their school, the CDC and medical community would be all over it! Where are they now with thousands a year dying or having their lifes completely destroyed? Addiction is no respector of race, wealth and privelage, male/female, age, class, or creed.

I know there has been progress through the years on addiction treatments. I just also know with all my heart, all my being, and all I have seen and heard; We in the medical field have stong feelings about Addiction as a "Valid" disease with "Valid" treatments.

Do you as a healthcare professional believe that Addiction is a disease?

How do you feel about the current social stigmas on Addiction?

How have you been affected personally by Addiction?

Do you agree/disagree with my opinions on Addiction?

[psychRN319]

Hello there. I read your thread and wanted to share my thoughts. I am an RN in Mental and Behavioral Health, specifically on the Chemical Dependency Unit. I have worked in my position since I graduated 3 1/2 years ago. My unit is a detox unit where the pts receive an Ativan taper for about 3 days, depending on which protocol they are on (alcohol, opiates, Benzos). I understand and agree that addiction is a serious problem and very misunderstood and under addressed. Sadly this is the case for all mental health conditions. At our hospital, it is known that Mental Health is the only department that does not make money for the hospital. We remain available to the community because there are very limited resources available to the mentally ill, and chemical Dependency is a mental illness. I see alot of returning pts (frequent fliers) who for whatever reason do not follow up after discharge, most relapse almost immediately. I am blessed that I haven't had to personally struggle with addiction(except nicotine:(......but I also believe I have compassion for the addicts just as I do for my pts with other mental health disorders. Just like any disease process, there are pts who really desire to get better and try to help themselves by following the advice of the treatment team. But it is ultimately their decision to use the resources we provide for them. I get frustrated about the pts that abuse the system (claim they are suicidal to get admitted, come in because they are homeless but have no interest in being clean/sober...etc.) because there are pts who really want help. I hope I helped you and feel free to ask more questions. BTW, what role do you have in addiction? Are you a nurse?

[BostonTerrierLover, BSN, RN]

Hi, my gosh I'm sorry, I wrote this long ago, and I never got a response. After that, I kind of abandoned it, and noticed your response reading over old threads. I'm a recovering nurse of 5 years, Opioids. I am now a FNP who does general practice, but I work very close with the State' Legislature, the Board of Medicine, Pharmacy, and Nursing now in my State to fight this disease. Being in a poor state, it's very hard to get attention for this, and funding was $2,000.00 last year for our recovery projects. I along with 8 other MD's/DO's and one other NP own three halfway houses that charge $200 per month for boarding, daily group, and Utilities/Cable. It is my life's work so far, and currently we house 21 recovering addicts who must follow the rules to maintain up to 24 months residence in the homes. We are trying to purchase another home at current, but money isn't the issue- it's the flack we get from the community when trying to move in. If the current plan works out we can house 48 patients at one time. We are currently 1 over max occupancy, but the one room with 3 guys are all around 19, and enjoy each others company- so it worked out. They must all be full time employed, attend 3 meetings per week (not including daily group which is mandatory 3 nights a week/7 offered), not get any charges, cannot miss a court date, cannot be late for sign in 11 pm, and alas, must volunteer 10 hours per month with community. This is a sweet deal when it cost $1600/mo at cheapest apartments here, and most of their families have discarded them.

[shouse82]

BostonTerrierLoverRN,

Hi and Thank you. It is so refreshing to hear these words of encouragment and see where you are today in your career. Below I have copied and pasted an email I sent to a doctor, it will explain my situation briefly. I am currently attempting to write an argumentative research paper and the topic I chose is Impaired Nurses. I've also attached my outline, any thoughts/suggestions would be greatly appreciated.

Email:

Dr. ******,

Good morning! My name is ********* and I am in desperate need of your services, I respectfully request your time to visit with me as a new patient to discuss possible treatment options. Long story short, I am a RN who knows just enough to do some pretty significant damage, joke but not funny. Developed chronic back pain d/t MVA in 1999 at age 17, rehab ~8 mo, developed opiate dependency but able to stop off and on through out early 20's. Year into my nursing career on surgical oncology floor re injured back. Saw dr.******** and have MRI report from which point went to dr. ******** for pain management for L4-s1 deg disc disease, synovial cyst, dissemination, protrusion/herniation, and bilateral facet hypertrophy. from here. Unsuccessful Relief from multiple ESI's, prescribed 240 norco 10's per month. My disease of addiction reared it's ugly head. From here diverted dilaudid, morphine, and Demerol. Subsequently voluntarily checked into treatment and self referred to TPAPN. Due to bouts of acute pain was unable to complete 2 years and recently surrendered my license for one year. I am hoping my honesty will compel your assistance. I am currently on Northstar for mental ( psych is dr **********) and Amerigroup for medical (pcp plano clinic alma and spring creek). Northstar has given me your contact info as per request of my physicians. Need updated MRI but ins won't pay per pcp until X-ray and PT are done. Dr. ******* recommended suboxone since I took it after treatment with great pain relief results in 2011 prescribed by dr. ********* at ******** psych who no longer takes either of the ins I currently have. My goal is to get some relief and be better functioning until I can obtain a more permanent solution (surgery prev recommended)? Northstar stated would cover treatment services and meds from you. I have my ADN and currently taking classes online to obtain my BS in healthcare admin in hopes of finding a solution over the next year before I reapply for my RN license at which point either began that career or hopefully get my RN back and with BS in health admin pursue my MSN. I sincerely hope you will consider seeing me as many doctors won't take on patients for pain control that have prev opiate dependency /addiction, but I just need someone to help me get some relief until I can find a solution versus just a bandaid.

With great hope and expectations.

Sincerely ,

****** ********

Attached below is the outline for my paper:

Outline for Research Paper

I. Introduction

a. Introduce topic and thesis statement

b. Thesis statement: Addiction in nursing has known prevalence higher than any other career field outside of healthcare and has insufficient processes for consistency in dealing with the issue.

c. Insight into personal reason of topic to hook the reader

d. It can happen to anyone

II. Nursing as a Career Field

a. Personality type that might choose nursing as a career

b. Obstacles getting into nursing school

c. Issues in nursing today

d. Physical demand/injury/illnesses that req. medication ie: mental/behavioral health

III. Addiction

a. Disease of addiction, how one becomes addicted, genetics, etc

b. Pain and addiction? How to distinguish need of medication vs. drug seeking

c. Prevalence of addiction in average American vs. healthcare field

d. “an occupational hazard” article

IV. Recovery

a. Punishment and discipline

b. Obstacles of recovering/ difficulty / relapse rates

c. Peer review programs for nurses

d. Fairness, consistency, rules of peer review program for Nurses

V. Ethical issues

a. Nurses duty to “do no harm”

b. Safety of public if nurses are practicing impaired

c. Governments responsibility to protect public

d. TPAPN and fairness – why do we try so hard to help others but not our own (NO narcotics policy PERIOD???)

e. LIVELY HOOD OF LOSING LISCENSE: WHY IS THERE NOT ALT. TO NURSES WORKING NOT IN THE PUBLIC SEGMENT ( For example, for someone like me who NEEDS pain medication to function due to back injury but failing out of peer program due to need for medication, why couldn’t I keep my license and continue to work in QA or admin side not dealing with public)

VI. Conclusion

a. Restate thesis

b. Sum up body of paper restating pertinent info

c. Close argument

[EnergyHeals]

Being sick from intentional poisoning from a past relationship, left me in a tough situation. I was in debilitating pain while for over a year no etiology was found. When in was identified it was so unbelievable that my peers, friends, co-workers and associates didn't understand it or have a base point to gage my illness. It was then perceived as I was crazy or hypochondriac. In which the fight to stay healthy was in gear and searching wellness by many MD, DO and holistic approaches. However, in the mean time a bogus and I mean completely BOGUS complaint was filed by a spiteful nurse supervisor. Even though I was under a MD for pain management with as few as possible medications it was looked at as wrong. I have never had a desire and still don't to be on medications. I've been a personal trainer and health nut longer than being a nurse. I have never drank, smoked or done anything that could be damaging to my body, for religious and personal beliefs and values. I don't even drink soda, eat junk food or city water. My health is too valuable. For the board to look at the small slice of my life regarding medications, but ignore the fact I have refused more prescriptions than handed out is like being accosted. When was too ill to even take a shower, going to work or dealing with the Board of Nursing was impossible. Before the censure I had moved and not been compliant with the terms. My license was suspended and I didn't care, at that point I thought I would never be well and able to work. I was also grieving over a boyfriend that had committed suicide while I was in the next room and other unfortunate family tragedies that left me with PTSD. The PTSD was diagnosed a year later. I had already applied for disability. Why is it the Board of Nursing has no compassion for sick nurses? They have a program if your a substance abuser, but not one for other illness. I am now better after years of strict healthy eating, off many prescriptions and less stress life. My option is to surrender my license, I want to eventually get it back for the principle of clearing my name. If later it looks like I can work then wonderful. Has anyone faced this issue? Being completely misjudged and not heard? I thought the truth would overcome the allegations, I was wrong. The effects of the poisoning is the issue not the medications! IS THERE HOPE?

[SIMPLE28403]

Hi I'm a nurse in recovery with 5yrs clean. I'm looking for work with restrictions from the board. Can any of you give me any advice about getting back into nursing? Grateful M.