While all fifty states have treatment programs that protect a doctor’s license, only forty-one have nondisciplinary alternative programs for nurses. Nurses with substance abuse issues have fewer resources than doctors, report more problems following treatment, and receive more frequent and more severe professional sanctions. The Journal of Advanced Nursing reported, “The rate at which nurses were placed on probation was not only higher than physicians prior to treatment, but was also disproportionately higher than doctors after treatment. . . . Therefore, the group who can least afford to miss work appears to be most likely to be reprimanded and may be least likely to seek costly legal representation.”

Despite high numbers of addicted nurses, fewer than 1.5 percent of nurses are enrolled in substance abuse monitoring programs. Massachusetts, for example, has approximately 140,000 nurses, about 200 of whom are enrolled in the state program at any given time. “If you go by national statistics for drug abuse, you’re talking eight to ten percent,” said Douglas McLellan, RN coordinator for Massachusetts’ Substance Abuse Rehabilitation Program. “If you apply those numbers to nurses in the state, there should be twelve to fifteen thousand nurses in our program. God only knows what they’re doing.”

Nurses can nudge coworkers to self-report by compassionately mentioning the topic. “The best recommendation is to know how to identify an impaired colleague and get them safely into treatment. Once the brain is hijacked by addiction, it’s deeply in denial. Usually, an individual will not seek help. It’s up to others,” said Julie Rice, who manages the AANA Health, Wellness, and Peer Assistance Programs. (See here, for additional resources for nurses with substance abuse issues.)

Loyalty is admirable, and one of the bonds that make this subculture so strong. The sisterhood is more powerful, though, when nurses can ask their peers for aid, and when colleagues, unbidden, can reach out to help. Overlooking an addicted nurse’s transgressions protects neither the nurse nor her patients. The ANA has stated that “it is every nurse’s responsibility to acknowledge the needs of an impaired nurse and to help him or her regain full professional capacities.”

In fact, experts warn that a nurse is legally responsible to turn in an impaired coworker; if a patient suffers, some states can bring charges against the nurse who didn’t report her colleague. Reporting an impaired colleague can save her life—and her patients. There should be no stigma when, as one nursing administration journal phrased it, “the nurse becomes [the] nursed.”

Nurses’ patient advocacy can extend toward their fellow nurses when it is clear they need treatment. Getting them help may break the “don’t talk rule,” but ultimately, the code of ethics outweighs the code of silence.

SAM

  CITYCENTER MEDICAL, April

At 3:00 a.m., Sam was documenting at the nurses station when she received a text from William. She hadn’t seen him much since her schedule had shifted. She’d been surprised how much she had missed him. She glanced at her phone. He had texted, “Didn’t know you went on a date w/ McCrary.”

“What?” Sam yelped, and slammed down the phone. From Citycenter, Sam had gone out only with Dr. Spiros. Certainly not McCrary, an intern. Where do people come up with this stuff? she wondered. Rumors of promiscuity had followed her at Pines Memorial, too. How did people not see that she was too awkward to be a slut?

She texted him back. “I didn’t! Where is this coming from?”

When he replied, she learned that he was at a bar with several people from work, including CeeCee and Dr. Spiros.

She did not have time to stew about it. Medics brought in a trauma patient who had been shot in the leg. With no pulse in his foot, the staff assumed that the bullet had severed an artery. When the OR called down to say that the team was ready, the ER doctor told Sam to hurry the patient upstairs for surgery. Once Sam wheeled the patient upstairs, however, the OR nurse refused to take her report. “I don’t know anything about this patient,” the nurse huffed. “Just go in there. They’ll take report.” The nurse pointed toward the operating theater, the area bordering the operating rooms.

The patient, a young man in his twenties, was whimpering in pain. His bleeding was well controlled and his family was on the way. There was little that Sam could do for him because he was in a limbo between the ER and OR. Sam found two anesthesiologists in the operating theater. “Do you know who I can give report to?” Sam asked. She had to thoroughly update a nurse from the admitting department on the patient’s condition before she left.

“No,” said the more senior doctor. The doctor turned to the patient. “Have you ever had surgery? Did you have any problems with it? Okay, open your mouth.” Anesthesiologists checked patients’ mouths before surgery because if the patient had a large tongue or the roof of the mouth hung low over the throat, then intubation would be more challenging.

Sam wasn’t allowed to return to her other patients until she gave report on this one. After several minutes of waiting around, she asked the male anesthesiologist about the delay.

“We’re still waiting for the on-call vascular attending to get here,” he answered.

“Can I get fentanyl for him while you’re figuring this out?” she asked. Her patient desperately needed pain medication.

“No,” the doctor said, and resumed doing paperwork.

Sam, exponentially more confident than she had been in August, stared down the more senior anesthesiologist. “Really? You want him to sit here in pain when you guys were the ones who wanted him to come upstairs and I could have gotten him pain medicine downstairs, so he’s up here in pain because of you?”

The doctor sighed. “Fine,” she said, and wrote the orders.

By the time Sam retrieved the fentanyl and administered it to the patient, there was still no news on the surgery status. Sam was frustrated: She had nowhere else to take him, and she had five other patients downstairs who needed her, including a woman in bad shape and bound for the ICU.

Typically, taking a patient to the OR was a quick and easy trip. If Sam had known this visit would have been so complicated, she would have asked a less busy nurse to escort the patient. Sam circled the floor, asking the anesthesiologists and the PACU nurses for the name of the person who had given the okay for the patient to come upstairs, so she could finally give report.

“Here,” the senior anesthesiologist said, handing her a piece of paper. “Call this number. It’s the senior surgical resident.”

Sam had a feeling the doctor was giving her a task just to shut her up. Reluctantly, she dialed. “Who gave you this number?” the surgeon barked when Sam reached him.

Sam realized that the anesthesiologist had given her the doctor’s personal cell phone number rather than his hospital cell. (“That was completely inappropriate! It was a doctors’ pissing match,” she said later.)

The surgeon ranted to her about the anesthesiologist. “Anesthesia had no right to give you this number,” he fumed. “No one is on their game tonight. The OR has had problems all week.”

Sam fidgeted with her glasses. The ultimate goal is taking care of the patient, not seeing whose stethoscope is longer, she thought. She didn’t care about interdepartmental politics; and she had heard that tension between surgeons and anesthesiologists was common. Sam just wanted to get back to her patients.

“I need to go. I’ll just leave the patient in the PACU with the nurses.”

“That’s fine,” the surgeon said.

When Sam wheeled the patient to the PACU, she found a nurse surfing the Internet. “The surgeon says to leave the patient here. I have five other patients to get back to.”