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Copyright 2004-2006 , Louisiana State Board of Nursing, all rights reserved.

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The Recovering Nurse Program

Louisiana State Board of Nursing17373 Perkins Rd.

Baton Rouge, La. 70810www.lsbn.state.la.us

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Financial Disclosures

* Urhonda Beckwith has no disclosures

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Occupational Hazards of Nursing

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Hazards of PowerPoint Presentations

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Molecular Structures of Narcotics

HYDROCODONE(VICODIN)

www.prescriptionaddictionradio.com

OXYCODONE(OXYCONTIN)

HEROIN

The central molecular structure is identical!DO NOT COPY


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Knowledge of Addiction

Advances in science have revolutionized our knowledge and understanding of substance abuse and addiction

1930’s Study of Addiction▪ Morally flawed▪ Lacking willpower▪ Deserving of PunishmentDO NOT COPY


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Addiction History and Concepts

• Debated since ancient times• Debated in America > 200 years• American Psychiatric Assoc. uses the term disease to describe alcoholism 1965• American Medical Assoc. follows 1966• The 3rd edition (1980) of the APA’s Diagnostic and Statistical Manual of

Mental Disorders (DSM) was the first to recognize substance dependence as a condition separate from substance abuse,

bringing in social and cultural factors

• Primary- genetic predisposition, brain chemistry changes, specific diagnostic criteria and etiology.

• Progressive- ongoing deterioration, marked by early, middle, and late stages

• Chronic- relapsing medical condition (hepatitis, esophageal varices)

• Ultimately fatal- accidental or medical complications (overdoses, MVA’s)

History Concepts

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What does Addiction look like?8

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Known Occupational Hazards

• Back Injuries• Needle sticks• Exposure to virulent

organisms• Combative patients• Lesser known but more

fatal-CHEMICAL DEPENDENCY!

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Prevalence

• 24.6 Million Americans (9.4%) were classified with substance dependence or abuse (2013).

• Prevalence in nursing similar but likely higher due to access.

• Estimated that 250,000 nurses (RN’s & LPN’s) are impaired by substance use disorders. (3.1 million nurses)DO NOT COPY


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Opioid Crisis•The US makes up 5 percent of the world’s population and

consumes approximately 80 percent of the world’s prescription opioid drugs.•Prescription opioid drugs contribute to 40 percent of all US opioid overdose

deaths.•In 2016, more than 46 people died each day from overdoses involving

prescription opioids.•Prescription opioid overdose rates are highest among people ages 25 to 54

years.•Overdose rates were higher among non-Hispanic whites and American Indians

or Alaskan Natives.•Men are more likely to die from prescription opioid overdose, but the gap

between men and women is decreasing.•Because of its cheaper price, heroin has become the drug of choice for many

who are addicted to opioid pain relievers. Approximately three out of four new heroin users misused prescription opioids prior to using heroin.

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Substance Use Disorder (Addiction)DSM-5 criteria for substance use disorder

•The 11 criteria for substance use disorder are divided into four categories of behavior related to the substance use:impaired controlsocial impairmentrisky usepharmacological indicators (tolerance and withdrawal).The severity of the substance use disorder is determined by the number of criteria the person meets:

•Mild: 2 or 3 criteria out of 11•Moderate: 4 or 5 criteria out of 11, •Severe: 6 or more criteria out of 11.

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SUD Characteristic Criteria• Hazardous use-driving, overdose• Social or interpersonal problems related to use• Tolerance• Withdrawal• Taken in larger amounts & over longer period than

intended-loss of control• Persistent desire or unsuccessful efforts to cut down or

control use• Preoccupation in obtaining substance• Neglect of other activities-failure to meet responsibilities• Continued use despite harmful consequences• Physical or psychological problems related to use• Activities given up to useDO NOT COPY


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Disease Concept of Addiction

1. Primary- genetic predisposition, brain chemistry changes, specific diagnostic criteria and etiology.

2. Progressive- ongoing deterioration, marked by early, middle, and late stages

3. Chronic- relapsing medical condition4. Fatal (If untreated)- accidental or

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Substance Use Disorder Severity

• SUD Severity can be difficult to differentiate on the surface

• All can cause problems and have consequences

• All can lead to impairment at work and the need for treatment

• The label of SUD/Addiction implies a stigma which can be a barrier to treatmentDO NOT COPY


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General Risk Factors

• Family history• History of physical/sexual abuse• Lack of parental direction or

discipline• Personality traits-impulsive,

perfectionist

• Early & Extensive Substance Use (use before age 15)• Family history of antisocial or criminal behaviorDO NOT COPY


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Occupational Risk Factors

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• Easy access/desensitization*• Positive attitudes towards drugs/drug use• Sleep pattern disturbances (shift-work)• High stress • Back injuries/recent surgery• Problems of daily living • Collusion by colleagues to protect user

(underreported)DO NOT COPY


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• Provider prescribing practices “hallway prescriptions”

• Permissive attitude toward self-diagnosing and self-prescribing (PAIN PILLS, ADDERALL)

• Lack of EDUCATION regarding addictionDO NOT COPY


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What can you do?

• Educate yourself – Be aware it can happen to you and it can happen to a colleague.

• Recommended reading- “Unbecoming a Nurse” by Paula Davies Scimeca

• Periodically take a self-assessment (SHUNT).

• Maintain a healthy respect for all controlled substances

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So what can I do personally?

• Healing the healer – take care of yourself

• Seek non-addicting alternatives for chronic pain

• Seek help for emotional pain• Learn effective strategies for

coping with stress• Similar to high blood

pressure, heart diseaseDO NOT COPY


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The Warning Signs

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• Mood swings, irritable• Illogical/illegible charting• Attendance issues • Calls out after days off, arrives late• Always wears long sleeves• Frequent bathroom breaks• Arrives early, stays late• Asks to give your pain meds

Personality & Behavior Changes

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Personality and Behavior Changes

• Tardies and absences • Performance issues are

usually a late sign• Appearance changes• Signs out more narcotics

than anyone else• Suspicious Activity –

frequent narcotic returns/broken vials

• “Ghosting” disappears from unitDO NOT COPY


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What can I do to help?

• Assure an investigation is done• Provide SPECIFIC evidence and

documentation.• If nothing is done, you can

report to the Board of Nursing• Remember-You may save a life

of a colleague or a patientDO NOT COPY


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Responsibility to Report Self or Others

• RS. 37:921: Grounds for disciplinary proceedings against a Registered Nurse include….

• Is unfit or incompetent by reason of negligence, habit or other causes;

• Has demonstrated actual or potential inability to practice nursing with reasonable skill and safety…because of use of alcohol or drugs; has demonstrated inability to practice nursing with reasonable skill and safety…because of illness or as a result of any mental or physical condition.

• is guilty of aiding or abetting anyone in the violation of any provision of this Part;

• has violated any provision of this Subpart.

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Recovering Nurse Program

• 70% of Disciplinary Actions taken by boards of nursing are related to alcohol or substance abuse

• NCSBN & ANA both called for alternative to discipline programs for nurses in the 1980’s

• Alternative programs were developed to offer rehabilitation prior to discipline

• Approximately 48 states have alternative programs

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Purpose of the RNP

• Identify and assist impaired nurses to seek treatment to remain productive members of the profession without jeopardizing public safety

• Provide statewide identification, referral, and monitoring of impaired Registered Nurses

• Educate health care providers and the public about Substance Use DisorderDO NOT COPY


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Recovering Nurse Program

I. Admission to RNP as an Alternative to Disciplinary Action✔ No Prior Board Action, No Pending Criminal Charges or Conviction❖ Other Criteria such as:

Registered Nurse or Student NurseVoluntarily request admission into RNP

III. Disciplinary StipulationPart of Board Order (ordered into RNP)Required for Reinstatement

Two Paths Lead to the RNP

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RNP Participants

352 Registered Nurses and Student Nurses

• 188 – Confidential*• 164 – Disciplinary*• 42 are APRN’s• 6 participants are in the program for a

medical, mental or physical condition*

*October 2018 statistics

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General Program Requirements

• Refrain from work until cleared by RNP• Minimum of 24 Drug Screens per year• Attend 4 meetings per week- 2 AA/NA,

RNP Support Group, and Aftercare• Five-Year Program Agreement• Complete and total abstinence from all

mood-altering substances• Work restrictions and employer

evaluationsDO NOT COPY


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Conclusion

• Substance Use Disorder is a public health threat and an occupational hazard in nursing

• Educate yourself about the risks• Be proactive – seek help when

needed• Report the suspected impairment

of colleagues to protect the public and yourself

• Know the RNP is availableDO NOT COPY

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