Policy statement urges 'alternatives to discipline' for nurses with substance use disorders

A new position statement on substance use by nurses and nursing students emphasizes "alternative-to-discipline" (ATD) approaches—including specialized treatment and a pathway for return to practice, according to a position paper in the April/June issue of Journal of Addictions Nursing (JAN), the official journal of the International Nurses Society on Addictions (IntNSA).

"Health care facilities and schools of nursing [should] adopt ATD approaches to treating nurses and nursing students with substance use disorders, with stated goals of retention, rehabilitation, and re-entry into safe, professional practice," according to the joint statement of the Emergency Nurses Association (ENA) and IntNSA. The authors are Stephen Strobbe, PhD, RN, PMHCNS-BC, CARN-AP, FIAAN, Clinical Associate Professor at the University of Michigan School of Nursing and President of IntNSA; and Melanie Crowley, MSN, RN, CEN of the Emergency Nurses Association. The position paper is available on the JAN website.

As in society at large, substance use is a serious problem among nurses and nursing students. "Alcohol and other substance use by nurses potentially places patients, the public, and nurses themselves at risk for serious injury or death," the authors write.

Traditional disciplinary approaches to nurses with substance use disorders may lead to harsh penalties—especially when diversion of prescription medications is involved.

Nurses may be subject to job termination, loss of their nursing license, and criminal charges. Nursing students may be expelled from school, without appropriate treatment or follow-up.

In contrast to this "moral or criminal model," the ATD approach regards substance use disorders as a "chronic disease leading to biological, psychological, social, and spiritual manifestations."Dr. Strobbe and Ms. Crowley write, "When viewed and treated as a chronic medical illness, treatment outcomes for substance use disorders are comparable to those of other diseases...and can result in lasting benefits."

The position paper urges the use of ATD programs for nurses and nursing students with substance use disorders, "with the stated goals of retention, rehabilitation, and re-entry into safe, professional practice." Drug diversion for personal use "is viewed as a symptom of a serious and treatable disorder, and not exclusively as a crime."

In the ATD approach, nurses with substance use disorders refrain from practice for some time, while undergoing specialized treatment to establish sobriety and a program of recovery. Treatment may include residential or intensive outpatient programs, individual and group therapy, urine drug testing, and support group attendance.

Return-to-work agreements may include restrictions of work hours and assignments, with continued treatment and monitoring for periods of up to three to five years.

The ENA/IntNSA position paper also calls for healthcare facilities to provide education and policies to promote a safe, supportive, and drug-free workplace. Nurses and nursing students should be made aware of the risks associated with substance use, and the responsibility to report suspected concerns.

Dr. Strobbe and Ms. Crowley note that ATD strategies are consistent with the American Nurses Association (ANA) code of ethics, and are recommended by the National Council of State Boards of Nursing. The ANA has officially endorsed the ENA/IntNSA joint position statement, with plans to further promote and disseminate this stance. The position paper concludes: "Professional monitoring programs that employ an ATD approach have been shown to be effective in the treatment of health professionals with substance use disorders, and are considered a standard for recovery, with high rates of completion and return to practice."

Dr. Strobbe adds, "Patient safety is of paramount importance, and one of the best ways to achieve this is through effective prevention, intervention, treatment and recovery, and professional monitoring of nurses and nursing students with substance use disorders."