Whitney Houston and 10 Percent of Nurses: What Do They Have in Common?

February 17th, 2012

By Jennifer Olin, BSN, RN

Celebrities live in the public eye, it is the nature of being famous. They also suffer and die in the public eye. On February 11th singer, actress, Whitney Houston was found dead in her Los Angeles hotel room. While the coroner’s report has yet to be released there is little doubt in most minds that ultimately her much publicized addictions will factor in. She would join the pantheon of celebrities lost to illicit drugs, prescription medications, and alcohol: most recently Amy Winehouse and Heath Ledger, and looking back Jim Belushi, Elvis Presley and Marilyn Monroe, to name a few.

Addiction is a beast. And it doesn’t only bite celebrities. In 2011, the Los Angeles Times reported that after an analysis of government data deaths from drugs have now exceeded deaths in traffic accidents. In 2009 the U.S. Centers for Disease Control and Prevention reported 37,485 people died nationwide from drug overdose.

And, it’s not all illegal drugs. Deaths from prescription pain and anxiety medications, usually combined with one another or with other drugs or alcohol are the most dangerous and commonly abused.

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates more than 22 million people in the United States abuse drugs or alcohol. Now for a truly disturbing statistic, the American Nurses Association (ANA) estimates that six to eight percent of nurses use alcohol or drugs in amounts sufficient to impair professional performance. Other studies say as high as 10 percent of nurses misuse drugs and alcohol. The number of RNs with addiction and abuse problems is about the same as the percentages in the general population.

In other words, of 3.1 million nurses in this country, one in 10, are struggling with some form of abuse or addiction. Look around you, one in 10 is a pretty big number, and that number represents the people most often responsible for the health and well-being of the rest of the population.

Where Do Nurses' Addictions Begin?

Work related stress and easier access to pharmaceuticals are factors that help make nurses particularly vulnerable to drug addiction and abuse. Some of the work related factors attributed to higher levels of drug addiction in RNs include:

• Working a night shift or rotating shifts.
• critical care work.
• Excessive overtime.
• Musculoskeletal injuries and pain.
• Knowledge of medications.

Some nursing specialties, such as anesthesia, critical care, oncology, and psychiatry, are believed to have higher levels of substance abuse because of intense emotional and physical demands, and the availability of controlled substances in these areas, according to "Substance Use Among Nurses: Differences Between Specialties," a landmark study in the in the American Journal of Public Health.

In the March 2007 issue of Hospital Pharmacy a study monitoring the diversion of controlled substances details the typical ways nurses get drugs at work. An RN may ask a physician for a prescription or steal a script and forge one for themselves, the study said. “Nurses have also been known to divert drugs by administering a partial dose to a patient and saving the rest for themselves, or by asking a colleague to cosign a narcotics record saying a drug was wasted without witnessing the drug's disposal. Some nurses have signed out medications for patients who have been transferred to another unit or obtained as-needed medications for patients who have refused or not requested them.”

Nurses who abuse drugs frequently go undetected. Peers and patients may know the symptoms but it’s often like the story of the blind men and the elephant. Each person sees one strange or odd behavior but it takes all the stories to put together a real picture of someone under the influence.

The redirecting of drugs from a legitimate use to illicit channels is called “diversion.” Signs a nurse may be diverting drugs include:

• Arriving early, staying late, and coming to work on scheduled days off.
• Excessive wasting of drugs.
• Regularly signing out large quantities of controlled drugs.
• Volunteering often to give medications to other nurse’s patients.
• Taking frequent bathroom breaks.
• Patients reporting unrelieved pain despite adequate prescription for pain medicine.
• Discrepancies in the documentation of controlled substance administration.
• Medications being signed out for a patient who has been discharged or transferred or who is off the unit for procedures or tests.

It’s almost too easy. Diversion is a crime and when a nurse is accused the police can be called in to investigate and the nurse may be arrested. Add to that forging prescriptions is a crime and practicing while impaired by alcohol or drugs is professional misconduct and grounds for being fired.

Management’s Role

It is the basic role of the nurse manager to recognize and manage nurses who are practicing while impaired. When the manager meets with the nurse under suspicion they must have a basic understanding of a substance use disorder as a primary disease, their 
course and signs or symptoms, and be prepared for all contingencies. Nurses will rarely admit dependency; drug addiction is still often considered morally reprehensible, not an illness, and impaired nurses are always certain they will lose their jobs and have their licenses revoked.

The manager must:

• Know the workplace policies and procedures related to substance use disorder among nurses.
• Know the workplace’s policies and procedures pertaining to medication administration, wastage and inventorying of controlled substances.
• Know who the resources are in-house and externally regarding substance use disorder in any nursing staff.
• Recognize personal attitudes about substance use disorders as supportive or as a barrier to helping a colleague.
• Know how to document a problem properly.
• Feel confident in personal intervention skills (if a problem requires action, know the 
personal reporting responsibilities as they pertain to hospital administration, board of 
nursing and state alternative or peer assistance program).

Back in 2007, unpublished research at Baylor University Medical Center in Dallas, TX estimated the facility saved over four million dollars in turnover cost avoidance involving RNs identified with a substance abuse disorders and certain psychiatric disorders over an eight-year period. Baylor worked to retain nurses whenever possible rather than summarily terminating them. Through the proactive advancement of education, identification, intervention, re-entry to practice and policies and procedures system-wide Baylor administration was able to help save the lives and careers of many employees as well as money.

Empowering nurses to seek treatment, allowing for their insurance to help cover their treatment and making it possible for nurses to return to practice is a win-win for employee and employer alike. There are many resources available both inside and outside the workplace for nurses to find help to beat addiction. We will talk about those options in the next installment of this article.

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