LWW Journals - Beginning with A



Dr. Susan HenlyMay 30, 2013EditorNursing ResearchSchool of Nursing, University of Minnesota5-140 WDH, 308 Harvard St. SEMinneapolis, MN 55455Dear Dr. Henly, Thank you for asking us to respond to the thoughtful letter from Ms. Morrissey provided to Nursing Research regarding our article, “The Prevalence of Employed Nurses Identified or Enrolled in Substance Abuse Monitoring Programs”(Monroe, Kenaga, Dietrich, Carter, & Cowan, 2012). We concur with Ms. Morrissey that substance use disorders (SUDs) in nurses and nursing students has become the topic of a long over-due discussion (Hamilton & Taylor, 2011; Monroe, & Kenaga, 2011). Ms. Morrissey makes two salient points that we would like to address. First, we agree that in general, education and prevention efforts regarding SUDs in the nursing are lacking. For example, a seminal study conducted in 1987 found that the total number of hours of educational content related to alcohol and substance use in nursing schools was between 1 and 5 hours (Hoffman & Heinemann, 1987). Unfortunately, we believe that 25 years later the amount of educational content in nursing education programs has not changed. In fact, student nurses seem to be at a heightened risk for SUDs and we have argued that more preventative measures, education, and access to non-punitive treatment should occur at this level (Monroe, 2009). SUDs are certainly not limited to student nurses. We have noted that nurse leaders may be faced with the issue of SUDs in employees yet may lack the resources to help guide decisions. We have identified critical gaps in the policy literature and we have suggested key elements for nursing leaders to use when addressing substance abuse with employees. Specifically, during each hospital orientation, a pointed discussion about access to confidential and supportive assistance should be discussed. We believe that leaders who remain silent and/or support “zero-tolerance” policies only place both nurses struggling with SUDs and their patients at risk (Monroe, Hamza, Stocks, Davies Scimeca, & Cowan, 2011; Monroe, Vandoren, Smith, Cole, & Kenaga, 2011).A second point by Ms. Morrissey requires some clarification. To our knowledge, nurses with identified SUDs are not commonly “permitted the option of choosing between disciplinary and ATD programs”. We have extensively discussed elsewhere the programmatic and philosophical differences between the two types of paradigms (Monroe, Pearson, & Kenaga, 2008; Monroe, Pearson, & Kenaga, 2009). In general, nurses who have been identified with an SUD in a disciplinary state have the choice to enter the discipline program or to surrender their license. Nurses identified with an SUD in states with ATD programs generally have the choice to enter the ATD program or to face disciplinary action by the board of nursing. An important point we want to emphasize is that the nursing profession heavily regulates all monitoring programs for nurses with SUDs. ATD programs are not places for nurses to hide and avoid professional discipline but are specifically structured to identify and swiftly remove the nurse with an SUD from direct patient care.We are in agreement with Ms. Morrissey that the nursing profession should continue to educate nurses on the existence of, and the basic philosophy of, the ATD paradigm which is that ATD programs exist to improve public protection by offering a swift and confidential avenue for nurses to receive assistance with SUDs. Importantly, we have shown that ATD programs may better protect the public as they remove nearly 75% more nurses with substance use problems from direct patient care (Monroe et al., 2012). Also nurses who complete ATD programs have fewer legal problems and have fewer restrictions on their license to practice (Haack & Yocom, 2002). Thus, for most nurses with SUDs, we believe that ATD programs are the obvious first “choice” for the both the safety of the public and the treatment and rehabilitation of nurses with SUDs. Regards,Todd MonroeReferencesHaack, M. R., & Yocom, C. J. (2002). State policies and nurses with substance use disorders. Journal of Nursing Scholarship, 34, 89-94. doi: 10.1111/j.1547-5069.2002.00089.xHamilton, B., & Taylor, G. (2011). On our way with alternatives-to-discipline for nurses with addictions? Commentary on Monroe T & Kenaga H (2011) Don’t ask don’t tell: Substance abuse and addiction among nurses. Journal of Clinical Nursing 20, 504–509. Journal of Clinical Nursing, 20, 2083-2084. doi: 10.1111/j.1365-2702.2011.03791.xHoffman, A. L., & Heinemann, M. E. (1987). Substance abuse education in schools of nursing: A national survey. The Journal of Nursing Education, 26, 282-287. Monroe, T. (2009). Educational innovations. Addressing substance abuse among nursing students: Development of a prototype alternative-to-dismissal policy. Journal of Nursing Education, 48, 272-278. Monroe, T., & Kenaga H. (2011). Don’t ask don’t tell: Substance abuse and addiction among nurses. Journal of Clinical Nursing, 20, 504-509. doi: doi: 10.1111/j.1365-2702.2010.03518.x Monroe, T., Hamza, H., Stocks, G., Davies Scimeca, P., & Cowan, R. (2011). The misuse and abuse of propofol. Substance Use and Misuse, 46, 1199-1205. Monroe, T., Pearson, F., & Kenaga, H. (2008). Procedures for handling cases of substance abuse among nurses: A comparison of disciplinary and alternative programs. Journal of Addictions Nursing, 19, 156-161. Monroe, T., Pearson, F., & Kenaga, H. (2009). Treating nurses and student nurses with chemical dependency: Revising policy in the United States for the 21st century. International Journal of Mental Health and Addiction, 7, 530-540. doi: 10.1007/s11469-009-9208-2Monroe, T., Vandoren, M., Smith, L., Cole, J., & Kenaga, H. (2011). Nurses recovering from substance use disorders: A review of policies and position statements. Journal of Nursing Administration, 41, 415-421. 410.1097/NNA.1090b1013e31822edd31825f. Monroe, T. B., Kenaga, H., Dietrich, M. S., Carter, M. A., & Cowan, R. L. (2013). The prevalence of employed nurses identified or enrolled in substance use monitoring programs. Nursing Research. 62, 10-15. doi:?10.1097/NNR.0b013e31826ba3ca ................
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