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Working Nurse l WorkingNurse.com 13 February 17–March 23, 2020 Warning Signs B ecause healthcare professionals struggling with substance abuse disorder don't necessarily fit the common stereo- types of addiction, recognizing the signs of their abuse can be a real challenge, especially in the early stages. A nurse suffering active addiction may appear to be a highly functional, knowledgeable, hard-working overachiever whose out- ward demeanor scarcely hints at his or her surreptitious abuse of substances to self-medicate physical and/or emotional pain. Nevertheless, nurses struggling with addiction often demon- strate certain telltale signs. (Keep in mind that these signs alone aren't necessarily evidence of drug or alcohol abuse. However, when they present as a trend over a period of time, they may indi- cate a serious problem.) A NURSE WHO IS ABUSING SUBSTANCES MAY: • Become inexplicably irritable, experience labile moods or have angry outbursts. • Take frequent breaks or leave the department without proper notification. • Suffer numerous illnesses, increasing tardiness and frequent absences, for which he or she may have elaborate excuses. NURSES WHO ARE DIVERTING MEDS for their own use some- times sign up for extensive overtime to ensure easier access to their drug of choice. Where nurses are required to have a witness as they waste narcotics, a nurse who's diverting might come up with various justifications for wasting drugs alone, such as dropping meds on the floor. Diversion often comes at the expense of patients, who might complain that their pain medication isn't working or that they haven't received scheduled doses. Medical administration records indicating that a patient who hadn't previously requested anything for pain or sleep is suddenly and frequently asking for meds can also be a warning sign if all the new medication requests are doc- umented by a single nurse. Time to Intervene N urses suffering from substance abuse will often go to extreme lengths to hide their secret. By the time a nurse resorts to stealing meds or arrives at work visibly under the influence, he or she is undoubtedly desperate — and perhaps even hoping to get caught. That was my experience. I'd been using Vicodin for years, legiti- mately prescribed for migraines. However, my poorly managed stress, job burnout and lack of sleep eventually made the drug an all-encompassing habit. By 2016, I was trapped: physically and psy- chologically dependent on opioids, long past self-regulating rules such as "never take a pill less than eight hours before work." ANY NURSE WHO'S IN THE STATE I was in by then is a danger to themselves and their patients. Such nurses need help before their bad situation ends in tragedy. The good news is that there is hope for them. Almost 70 per- cent of nurses with substance use disorder who seek treatment 1. CONTACT MANAGEMENT Your initial step should be to alert super- visors. However, when deciding whom to approach, consider the managerial struc- ture you're dealing with. You don't want to hand off a problem of this magnitude to a relief charge nurse who is unfamiliar with appropriate procedures or who won't take the matter seriously. If necessary, move up the chain of command, communicating with senior supervisors or administration. Review your workplace's employee handbook and other policy documents to see if there are guidelines for reporting a coworker you suspect of diversion, sub- stance abuse or otherwise posing a risk to patients. Many organizations have an anonymous hotline you can use in these situations. 2. TALK TO THE NURSE Confronting a coworker about a serious problem is awkward and complicated. You may not feel qualified for the dis- cussion. (If you want to expand your skills in this area, check out the courses offered by Mental Health First Aid by visiting www.mentalhealthfirstaid.org). Your coworker might get defensive and lash out. There's also a danger of self-harm as he or she anticipates impending discipline. If you choose to confront your coworker yourself, do so privately, in a compassionate, curious manner. You might say something like, "I notice you seem not yourself — tired, erratic, absent from your patients, red-eyed — and I'm concerned. Do you need help?" This is what happened with one nurse I know who was given an ultima- tum by her friend, a fellow nurse. "I care about you so much that if you don't call and report yourself to get help, I'll need to make the call for you," the friend said. They sat together tearfully as she dialed the phone, her friend's arm wrapped supportively around her shoul- ders. She is now successfully graduated from treatment. 3. NOTIFY THE BRN If you've reported your concern through the appropriate channels and the prob- lem continues, it's time to call the state agency that oversees nursing licensure, which in California is the Board of Registered Nursing. Patient safety is paramount. Steps to Take When You Suspect Substance Abuse or Diversion