Nurses work hard to take care of patients. Sometimes, they need help, too.

From September through December 2017, 73% of the overall cases reviewed by the Indiana State Board of Nursing involved nurses and substance use. (Photo by Sharon McCutcheon/Unsplash) Download image

WEST LAFAYETTE, Ind. — Substance use isn’t a problem only for patients seeking help from health care providers. It can also be found in the ranks of those providers who are entrusted with helping people put their lives back together.

A new article in the Journal of Nursing Regulation looked at 51 cases from 2014 through 2017 involving substance use at various levels of severity among registered nurses. Each of the cases was handled by the Indiana State Board of Nursing (ISBN).

The ISBN originally received 200 issues involving nurses during the four-month period of September through December 2017. Of those, 145 (73%) involved substance use among registered nurses. Substance use includes but is not limited to alcohol, opioids, cannabis, benzodiazepines, methamphetamines, heroin and cocaine.

Karen Foli, an associate professor of nursing at Purdue University’s School of Nursing, analyzed the data with her research team and described the cases by five general themes:

• Critical junctures of actors in the process, representing the complex interactions between the nurse, nursing board, state nurses’ assistance program and potentially, the legal system.
• Emerging groups that appear before the ISBN or the frequency of having to appear before the nursing board for numerous and separate issues.
• Individual contexts versus standardized discipline, which includes probation versus suspension of the license, and often waiting for legal issues to become resolved.
• Deliberate diversion, deceit and deception, such as when a registered nurse is caught taking medications from a facility, is terminated but law enforcement is not called. It is not until another issue is raised that a nurse could then be summoned before the nursing board.
• Significant threat to public safety and quality care, which includes instances such as harming a patient, dealing or selling narcotics, making errors in patient care that result in life-threatening injuries and withholding pain medications for personal use.

The takeaway from the data is this: Researchers conclude that nursing licensing boards in all states should spend more time with the nurses who have multiple interactions with the board on issues that span several years or decades, as that is the population that is the most dangerous to public safety. The nursing licensing boards should also look at substance use disorder as a medical disease that needs treatment as well.

“The Indiana State Board of Nursing has an incredibly difficult and complex task. On one hand, they need to protect the public and patient safety when nurses are impaired, and on the other, view nurses with substance use disorders as individuals with chronic diseases,” Foli said.

One program the ISBN has in place is the Indiana State Nurses’ Assistance Program (ISNAP), which functions as a recovery monitoring program. A nurse who self-reports may have their license put on probation during a period of time where they are monitored. A nurse can be reported to the state board of nursing through external circumstances such as criminal or non-criminal activities. At that point, they begin a formal discipline process with the board.

Blake Reddick, graduate student; Lingsong Zhang, associate professor in Purdue’s Department of Statistics and a faculty affiliate with the Regenstrief Center for Healthcare Engineering at Purdue; and Nancy Edwards, professor of nursing, were part of the research team.

This study was funded by the National Council of State Boards of Nursing’s Center for Regulatory Excellence. 

Writer: Matthew Oates, 765-496-2571, oatesw@purdue.edu, @mo_oates 

Source: Karen Foli, 765-494-4023, kfoli@purdue.edu

Note to journalists: For a copy of the article, please contact Matthew Oates at oatesw@purdue.edu