Help for the helper. Confronting a chemically-impaired colleague.

Abstract

She's a nurse-she can't be an alcoholic. That was my thought when, as a new clinical nurse specialist in alcoholism and drug abuse, I found that one of my first patients was a woman who had been a nurse for many years. Nurses are somehow supposed to be above that kind of thing. They should know better. Through contact with that nurse/patient and others, I learned that nurses are human too. One of the most demanding and sensitive professional problems that you can face in your nursing career is dealing with a nurse colleague who is impaired by alcoholism or drug addiction. The actual incidence of addiction to alcohol or drugs is very difficult to determine. LeClair Bissell, MD, nationally known for her expertise and research on addicted health care professionals, estimates that there are about 40,000 alcoholic nurses in the United States. It has been stated that the rate of narcotic addiction among nurses closely parallels that of physicians, and the estimate is that narcotic addiction among physicians is 30 to 100 times greater than it is in the general population (1-3). It has been suggested that the populations of three medical schools and 10 nursing schools are lost to narcotic addiction alone each year(4). Even though figures on the incidence of alcoholism and narcotic addiction are estimates, it is clear that the problem is significant. And, the figures stated do not include nurses who may be experiencing problems with such non-narcotic drugs as tranquilizers, barbiturates, or amphetamines. Despite the frequency of the problem, incidence is only a secondary concern. The main reason for concern over impaired nurses is the impact of this problem on the entire health care delivery system. On the personal level, the tragedy is that nurses suffer from illnesses that go undetected and untreated for years, while they work among providers of health care services. On a professional level, the danger is that patient care will be jeopardized by nurses whose judgment and skills are impaired. Within the work unit, the entire system can be adversely affected by one nurse's impairment. Continui y of care and teamwork are compromised as other nurses attempt to pick up the slack for the impaired nurse. Frustrations and resentment build as peers cover for latenesses, absences, and unfinished assignments. As job performance deteriorates, supervisors try everything to keep the system functioning, but nothing seems to work. At this point, each person involved can become a victim of stress, and job performance can suffer as a result. The impaired nurse is often given chance after chance. She may be protected, blamed, promoted, transferred, or ignored. But the problem remains. Indeed, the higher up the system the nurse moves, the greater her responsibilities and the less chance she has of being identified, confronted, and coerced into receiving the help she needs. By covering for the impaired nurse, her peers and supervisors may indeed be killing her with kindness. If nursing is caring, then nurses must care enough to learn how to help nurses who struggle with the devastating disease of addiction. Addiction is an insidious process that occurs as the result of (a) prolonged intake of a chemical, (b) processes going on within the individual (including genetic, psychological, and chemical), and (c) processes external to the individual (that is, the actions and reactions of family, friends, coworkers, supervisors, and society). On a p actical level, addiction is present any time a chemical interferes with any aspect of a person's life and that person keeps using the chemical. The focus here will be on occupational interferences, even though by the time the addiction affects job performance, it may already be having a negative impact on the person's family, social, financial, psychological, legal, physical, or spiritual life. By detecting the problem early, the supervisor may help to stop the process before permanent damage is done in any sphere of the nurse's life. However, the supervisor's major concern must be with job performance.