Confronting Jane- From the Perspective of an Impaired Nurse (Part One)

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    I am Jane and a recovering alcoholic. In the darkest day of my nursing career, I was confronted at work for appearing impaired. I would like to share my experience to bring insight into addressing the impaired nurse. The day I was confronted was shameful, but I now believe for my workplace to confront my behavior was an act of compassion.

    Confronting Jane- From the Perspective of an Impaired Nurse (Part One)

    I never dreamed I would be an impaired nurse. There have been times over my twenty-year nursing career I would think "how could that nurse ever come to work altered?" But I did clock in to work impaired and another nurse was faced with the dilemma of "if" and "how" to confront me, Nurse Jane. The disease of addiction knows no bounds when it comes to who it affects - regardless of age, race, sex, financial status and even occupation. If you are like me, you too have had in-services and possibly CEUs on the issue of substance abuse among nurses. I would like to share parts of my lived experience to hopefully bring new insight to previous training.

    The American Nurses Association (ANA) estimates the prevalence of addiction among nurses is consistent with the U.S. population at ten percent. The stigma of addiction as moral failure instead of a disease flows against the high moral and ethical standard set for nurses. As a person, I felt unbearable shame and guilt and feared losing my family. As a healthcare professional, my disease progressed to a point I unethically continued to practice and place patients at risk.

    I think many of us could identify at least 5-10 signs of impairment caused by a chemical substance in the workplace. As an alcoholic (I will focus on alcoholism), most of my signs were caused by withdrawal. As my drinking progressed, evidence of my alcoholism became more noticeable. It is easy to read a list of signs, but I would like to share the experience behind the behavior.

    1. Arriving late, leaving work early or calling out sick.

    I used to never call out sick and would just "work through it". As my drinking progressed, so did my tardiness and absence from work. It is easy to assume I was out all night on a bender and I just did not want to stop the party for work. In reality, I would drink in isolation on my days off and when I would sober up for work- withdrawal kicked in. Early in my alcoholism, I would be nauseated with diarrhea. Getting ready for work in the morning was miserable and once I made it to work, I spent a lot of time in the bathroom. Some days, I came up with an excuse to leave early. As my disease progressed, I had profound nausea, loss of balance, difficulty concentrating and withdrawal so severe, only more alcohol could ease the physical suffering.

    2. Unkempt physical appearance.

    Initially, I had fine hand tremors in the mornings and because of sickness, spent little time getting ready for work. I was always red-faced, flushed and sweating. Again, my appearance was symptoms of withdrawal. I was quick with an explanation for my embarrassing appearance- hormones, taking steroids, medication causing sweating. I no longer cared enough to maintain my usual professional appearance.

    3. Declining work performance.

    It is actually difficult at times to type this article. I had always taken pride in my work performance and the care I provided. I had worked hard over my twenty-year nursing career to obtain my BSN, MSN degree and 60 hours into a doctorate program. My job as a nursing instructor was one of my most rewarding career tracks, but the disease steered me away from what I valued most. Initially, I would be slow to document, forget documentation details and difficulty concentrating. I became easily emotional, tearful and frequently had labile mood swings while working. Withdrawal caused my thinking to be less clear and slowed.

    I am sure my co-workers noticed I was struggling and conversations took place to hypothesize what was going on with me. My peers may have thought I couldn't get any worse, but I could, and this is the progressive nature of addiction.

    I look forward to sharing what lead up to a co-worker confronting me, Nurse Jane, in the next Confronting Jane article.

    Would you like more information on substance abuse in the nursing profession?

    Drug addiction among nurses: Confronting a quiet epidemic | Modern medicine

    Nursing Continuing Education- Addressing Chemically Dependent Colleagues, available at
    Last edit by Joe V on Jun 14
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    About J.Adderton, BSN, MSN Pro

    Stepper (Jane) is a nurse with 22 years of experience. Stepper worked in home health/hospice and earned her master's degree in nursing. Stepper worked as Director of Education at a large home health and hospice company for 8 years prior to accepting a position teaching in an ADN program. Stepper is in active recovery and participates in an alternative to discipline program offered by her state's board of nursing.

    Joined: Nov '17; Posts: 100; Likes: 242

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  3. by   not.done.yet
    Brave, brave, brave nurse. I am absolutely looking forward to your next installment and would like to toss my hat in the ring of admiration and support, both for your continued sobriety and for your ability to rebuild your life. Thank you so much for sharing this with us. It may save a life.
  4. by   J.Adderton
    I appreciate your comments and support. I hope this article reaches someone that may be at the same crossroad.
  5. by   Daisy4RN
    Thank-you for sharing your story! This is such a struggle for so many people and just consumes their lives. I am glad that you were able to break free and wish you well in this new chapter of your life. Looking forward to the next post. Godspeed!
  6. by   FineAgain
    I applaud your honesty and am looking forward to reading your next installment. I truly believe that alcohol is harder to give up than other addictions. Opiates do not call from the shelves of every store you walk into, silently screaming "buy me! You know you want me!". For those of us who do not understand the lure of alcohol...I hope you can teach us how it feels. Maybe it will help us to understand the power that alcohol holds. Thank you for this article.
  7. by   hppygr8ful
    Thanks so much for writing this. I have been in recovery for 15 years. Stone cold sober since 2004. I participated I an alternative to discipline program and came back from the depths of suicidal depression to regain a life I love. I admire your bravery. My life is pretty much an open book and I share my experience, strength and hope often. I like people to know that they can be in recovery and be practicing nurses once again. Keep on Stepping.

  8. by   J.Adderton
    I appreciate your feedback. Alcohol was a way for me to escape, a flawed coping mechanism, for underlying past trauma. A glass of wine at night made it easier to go to sleep and since alcoholism is progressive- it advanced from there. I hope the articles do help shed some light on addiction.
  9. by   J.Adderton
    hppygr8ful- Congratulations on your 15 years! What a great testimony for those reading that may fee there is no hope. I remember being told early in my recovery that there are people/groups who believe nurses in recovery from substance abuse should never work in nursing again. This hit me like a ton of bricks- that is stigma of recovery. Fortunately, there is hope and the joy in life you have found.
  10. by   subee
    The best revenge for all the skeptics, regarding recovering nurses coming back to work, is coming back in better form than when you left! The stigma is lessening - one generation at a time.
  11. by   SobreRN
    Loved your column. 'Tis progressive, alcohol was my drug of choice but I did not slowly progress. I jumped in the boozy waters with both feet such that it mystified me how I could progress.
    I was a barely function waitress in 1989 when I got clean and sober, I am grateful in retrospection that it was so bad as it made denial difficult. I was so shaky when I 'came to' that I had to drink before work to carry a tray of cocktails. I'd either be still shaky or overshoot the mark and show up to work a tad tipsy. Given my co-worker (the bartender) was my drinking buddy we would drink vodka tonics throughout our shift and snort lines off the CD player in the storage area at end of the bar.
    I still attend and love 12-step, I do not ever want to forget the gutter I crawled out of. I was quite fortunate in having a boss who demanded I get sober or get fired. I was also fortunate in avoiding arrest, not taking on any responsibilities such as college, marriage or parenthood until I had minimum couple of years sober.
    You serve to remind me I am not the only sober RN :-)
  12. by   wannabeny
    Oh, thank your for sharing your story, and all the best with your recovery! Honored to have read it. And as someone who has had loved ones in the throes of addiction, it helps to understand that journey better then before.

    I had to leave a man I loved very much because they never found that road to recovery..glad to see you were able to.
  13. by   J.Adderton
    I am grateful for the road I am on, but also know how fragile it can be. Thank you for support.
  14. by   ChryssyD
    Thank you so much for your honesty. Such shame is attached to substance abuse--I am so proud of you for ignoring the prevailing view. There is so much ignorance and misunderstanding in the world. I admire you so much, and you should be so proud of yourself for your honesty and strength. I believe in you!