Substance abuse among nurses is an increasingly common problem. Work-related stress and inadequate support mean nurses are susceptible to substance abuse to cope.
In a 2020 report, over 40 percent of all alleged conduct violations had some connection to substance abuse issues. Anecdotal evidence suggests this number increased following the COVID-19 pandemic and the stress it placed on medical personnel, especially nurses.
Substance abuse is a serious concern. It can increase the risk of workplace-related accidents and the risk to patient safety. These are not minor issues, and patient care and safety should be a primary concern of any healthcare organization.
Concerns for patient safety, however, shouldn't reduce the need to effectively treat and prevent substance abuse issues in nurses. Rather than treating and supporting nurses dealing with addiction and other substance abuse issues, the current stance is punishment. Michigan, for example, publishes the names of all health professionals who have faced disciplinary issues.
The risk of disciplinary action and damage to their careers are just two of the reasons why nurses may fail to seek help. Fear of hurting their professional reputation or being disciplined without being provided with the resources to overcome substance abuse makes it difficult for many nurses to come forward until the problem becomes severe or after they make mistakes with patients.
If you're dealing with substance abuse and potential disciplinary issues, the Professional License Defense Team at the Lento Law Firm can help. We understand the issues facing nurses and the challenges in seeking help. We advocate for our clients and their careers, helping them get the assistance they need. Call us at 888-535-3686 or fill out our online form.
Nurses: Overworked and Burned Out
Substance abuse has been an increased issue for medical staff in recent years. A 2010 paper stated that up to 20 percent of nurses dealt with substance abuse issues. Medical professionals also potentially have easier access to certain drugs.
The COVID-19 pandemic further increased substance abuse and stress among medical personnel. A 2020 study of Michigan healthcare professionals found that nurses were the hardest hit by the pandemic. Another study reported that up to half of nurses and non-physician medical personnel suffer from PTSD, partially compounded by the cyclical nature of the pandemic.
The 2020 study of Michigan healthcare workers found medical personnel facing the following issues related to workplace stress:
- Depression
- Anxiety
- Insomnia
- Psychological distress
- Post-traumatic stress
- Burnout
These issues not only increase the likelihood of mistakes in the workplace, they also increase the risk of substance abuse. Conducted in the early months of the pandemic, the 2020 study painted a rosier picture of the issues facing nursing than more recent reports.
A 2022 federal study found that approximately half of all healthcare professionals report that they often feel burnt out. Other research shows that, of healthcare professionals, nurses suffer the most. The suicide rate among female nurses is double that of the rate among the general population.
Nurses throughout the United States deal with staffing shortages, a profit-driven healthcare system that de-emphasizes patient care, and a general lack of support. Less than one-third of nurses report receiving any mental health support. As one nurse pointed out, even when there are resources, many are only available during traditional business hours, and nurses work nontraditional, 24/7 hours.
Another factor is the type of personality attracted to nursing: Empathic individuals who want to help other people. Compassion, the very quality that makes some individuals excellent nurses, also opens them up to be more susceptible to stress and burnout, which, in turn, makes them more susceptible to substance abuse issues.
In short, the question becomes, who cares for the caregivers? Unfortunately, for too many nurses, there's no support system.
Nurses may not report issues for fear of hurting their careers or facing punishment. The current system, which focuses on discipline, only heightens the fear that acknowledging a problem may permanently damage a nurse's career and future.
Lack of Support
One issue highlighted by recent studies is that nurses often bear the financial cost of therapy and treatment. They may also worry about how confidential therapy and other mental health services are. While some healthcare systems have established free, confidential mental health services for medical staff, they're the exception.
This underlines a second issue, which is whether nurses trust and have faith in their employer's administration and leadership, which can influence their willingness to seek help or rely on employer-provided support. If a nurse believes that using these services will potentially reflect negatively on them, such services don't help.
Some employer-provided services seem more lip service to support than actual support. For example, mental health apps raise major privacy concerns. Not all mental health apps fall under HIPAA, and almost half of these companies are reported to have shared patient information with third parties, including advertisers. As of 2024, the United States doesn't have a federal consumer data privacy law, and Michigan also doesn't have a comprehensive law on protecting data privacy.
In other words, employer-provided or recommended mental health apps aren't adequate support. They potentially risk patient privacy.
Concerns about being caught and not having adequate support can only compound feelings of stress and burnout. This can, in turn, feed into substance abuse and related issues.
This lack of a support system leaves nurses as not only the victims but also the people most likely to be punished for these problems. On a broader scale, this lack of support hurts patient care over the long term and increases the stress of the nursing profession as a whole. Nurses shouldn't be the ones left holding the bag, but that's how the current system too often works.
Treatment, Not Punishment
Dr. Stephen Strobbe, Clinical Professor Emeritus at the University of Michigan School of Nursing, is one of the nation's leading experts on substance abuse and nursing. Much of his research focuses on how to address, prevent, and treat substance abuse issues with medical staff.
He was part of a 2017 joint statement on prevention, treatment, and recovery for substance abuse rather than punishment. The current forms of discipline may lead to more stress, with nurses focused on losing their livelihoods, salaries, and health insurance, which can exacerbate substance abuse. The statement emphasized the need for alternative-to-discipline approaches.
The 2017 statement highlights that substance abuse treatment should be viewed as treating a chronic medical illness. When viewed through this lens, the outcome of treating substance abuse is more successful in both the short- and long-term.
Michigan Disciplinary Actions
Despite joint statements and research on why punishment doesn't work, disciplinary action continues to be front and center when addressing substance abuse issues with nurses. Substance abuse can also tie into other disciplinary issues, which can make receiving treatment more complicated.
A nurse could be charged and convicted of a DUI. They may make mistakes in patient care. Substance abuse may be an indirect reason for actions that could lead to disciplinary action.
If you're facing disciplinary action and substance abuse is a contributing factor, you should contact the Professional License Defense Team at the Lento Law Firm. We will advocate for you and help you fight for an alternative-to-discipline treatment plan.
Disciplinary Action Steps
Michigan's Department of Licensing and Regulatory Affairs (LARA) handles professional licensing within the state, including for nurses and other healthcare professionals. When someone files a complaint against a nurse, the I&I Division and Complaint Intake Section investigate the initial complaint to see if it has merit.
The process for investigating complaints is as follows:
- Review the complaint
- Investigate the complaint
- Complete the investigation, at which point an investigator recommends one of three actions:
- Close the investigation
- Refer the case for expert review
- Begin an administrative complaint, which is the formal charging document
- If a case proceeds, file an administrative complaint
In situations when Michigan believes a nurse poses an imminent threat to the public's health and safety, they may issue a summary suspension. This will remove a nurse from their workplace almost immediately. Until the case is resolved, the nurse will be unable to return to work.
For nurses who receive an administrative complaint, the next step will be a compliance conference.
Compliance Conferences
During the conference, a nurse can negotiate a settlement. If a complaint isn't dismissed, the following disciplinary actions may be taken:
- Reprimand
- Monetary fines
- Probation
- Restrictions on a nurse's ability to practice
- Conditional return to practice, such as requiring training while a nurse continues to work
- Suspension or revocation of a nurse's ability to practice in Michigan
In general, a nurse's inability to practice in Michigan will make it difficult for them to practice in other states. They may also need to report any disciplinary action to other state boards of nursing.
When a complaint centers on potential substance abuse issues, the Complaint Intake Section may refer the case to the Health Professional Recovery Program (HPRP). In some situations, nurses may be able to negotiate entering the HPRP as a non-regulatory referral. The goal throughout the process is to defend your license and your livelihood.
Health Professional Recovery Program
For over three decades, Michigan has funded the Health Professional Recovery Program (HPRP). An alternative-to-discipline approach, HPRP's goal is to support medical personnel as they recover from substance abuse. It's a voluntary program.
HPRP allows nurses to receive support as they seek treatment. Private contractors provide the monitoring services. This includes monitoring and providing caseworkers. Ideally, each participant's support should be tailored to them rather than following a cookie-cutter program.
Types of Referrals
Referrals fall into two general categories: non-regulatory and regulatory. Non-regulatory referrals occur when a nurse self-reports to HPRP and asks for support in dealing with any substance abuse issues. Regulatory referrals usually come from disciplinary actions or other health care professionals, the state of Michigan, or from a licensing board.
Non-regulatory referrals will generally be allowed to participate in a monitored recovery program and return to work without any disciplinary action. If they follow program requirements, their names will not be publicized or available via a subpoena or Freedom of Information Act request.
Regulatory referrals are public information. Nurses who enter HPRP's program as a regulatory referral may still face disciplinary action or be unable to return to work for a period of time.
Ideally, Michigan nurses dealing with substance abuse should opt for a non-regulatory referral. It provides more confidentiality and will minimize the effect on their career. Addiction and substance abuse issues are not that simple, however, and even a self-report may still become public knowledge if they violate the program requirements or face other disciplinary action while in the program.
Intake Process
HPRP uses the same general intake process for all referrals. The first steps will usually be:
- Referral
- Initial Discussion
- Intake Interview
- Provider Referral
- Evaluation
The process can go in several directions once it reaches the completed evaluation stage. Regardless of how you were referred to HPRP, you should make sure that the treatment and support program best supports you.
While many medical personnel dealing with substance abuse issues may face similar challenges, every person and situation is unique. A generic treatment plan or one that isn't tailored to you is less likely to be successful. An unsuccessful treatment plan makes relapses more likely and may open you up to disciplinary action.
Continuing to Practice
During the intake process, one of the considerations will be whether you're fit to continue working as a nurse during treatment and recovery. HPRP, once they receive a referral, will determine if a nurse is a danger to the public as part of the intake process. If you're found to have an impairment, you'll be considered unsafe to practice and restricted from returning to work.
If it's determined that you aren't safe to practice, failure to abide by this restriction may result in the following:
- Referral to the Department of Licensing and Regulatory Affairs (LARA), Bureau of Professional Licensing
- Potential disciplinary action
- Closing your file with HPRP and your ability to seek help through HPRP
In addition, anyone referred to HPRP who refuses to enter into monitoring may be reported to LARA. Once reported to LARA, individuals may face disciplinary action.
While each nurse will have a different treatment and monitoring program, some of the commonly used practices include:
- Drug screening
- Counseling
- Group meetings
The University of Michigan Addiction Center, for example, has a dedicated therapy group for health professionals. The center has several programs and resources for healthcare professionals with substance abuse problems, such as how to recognize addiction in healthcare workers.
Costs
While the HPRP doesn't charge for its services, those who participate will have to cover costs and fees for required treatment, therapy, and drug screening. Medical personnel referred to HPRP are responsible for any costs not covered by their employer or health insurance.
Such requirements can put a burden on nurses, especially those who are considered unsafe to practice and, therefore, unable to work. They're potentially not earning a salary while required to pay for services and support to enable them to return to work.
Treating substance abuse isn't cheap. One of the common refrains about the cost of treatment is that, in the long term, it's cheaper than the cost of addiction. While that may be true, it doesn't lessen the severe financial burden treating substance abuse can put on individuals and families.
There's no single way to treat substance abuse, and effective recovery programs should be tailored to the individual, including what substances they were abusing. This means that costs can be radically different between two people.
One estimate pins treatment for substance abuse at between $15,000 to $27,000 as of 2022. The average salary for an RN working in Michigan in 2022 was approximately $75,000. If a nurse isn't cleared to work, they're suddenly expected to pay thousands of dollars in treatment or risk disciplinary action.
FMLA
Some nurses may qualify for time away from work under the Family and Medical Leave (FMLA) to treat their substance abuse. Nurses qualify for FMLA and its job protection when:
- Their employer has more than 50 employees or is a government agency
- They've worked for their employer for at least one year
- They've worked at least 1250 hours in the past year for that employer (the equivalent of working 40 hours a week for 31 weeks)
- The employer has at least 50 employees within 75 miles of your workplace
Nurses who meet the above requirements may qualify for FMLA for treatment of their substance abuse. The treatment must be through either a healthcare provider or a referral from a healthcare provider. Nurses may also take FMLA to care for a family member undergoing treatment for substance abuse.
Employees who fall under FMLA can generally not be fired or face any retaliation. The exception is if an employer has an established policy on when employees can be fired for substance abuse. This policy must be communicated to employees and applied in a non-discriminatory manner to be an exception to FMLA.
FMLA is for unpaid leave. While individual employers may have provisions for paid leave, FMLA does not require that an employee continue to receive their salary.
If you're eligible for protection under FMLA or any other laws about medical leave, you need to contact the Professional License Defense Team at the Lento Law Firm. We'll protect your right to seek treatment without risk to your job.
Long-Term Monitoring
HPRP states that it has procedures in place for long-term support and monitoring. One of the challenges with substance abuse and addiction is that recovery is an ongoing process. Life happens, and stress and other events may trigger relapses. It's difficult to break habits, as evidenced by approximately half of the individuals relapsing during their first year of treatment.
For nurses who continue in their previous jobs and whose jobs contributed to their substance abuse, finding new avenues to cope and break habits can be especially challenging. Stress and exposure to the environment that caused the initial substance abuse are both high-risk situations that can increase the risk of relapse.
It's important to have guardrails in place that can minimize the risk of relapse. At the same time, employers or others, even if well-meaning, may put too many restrictions or limitations on you as you recover. They may claim to be doing this for your well-being or patient safety.
Alternatively, they may place burdensome restrictions on you that are difficult to meet. An employer may put benchmarks into place that are difficult to meet and maintain, all with the unstated goal of forcing you out of your position.
Addition isn't like a common cold that, once you recover, is entirely in the rearview window. Part of your recovery may be switching to a different position to avoid stress, but these decisions are yours to make. Addiction is similar to a disability in that it doesn't mean someone isn't capable of doing a job or succeeding. It often just means they have to go about things a different way than the status quo.
Protect Your Career
Nurses face increasing sources of stress at work. Even ignoring the pandemic and staffing shortages, they also face violent attacks by patients. That a majority of nurses feel burnt out and have considered leaving the profession is sadly not surprising.
Medical staff, especially nurses, often deal with PTSD and other stress-related health problems with minimal support. That some end up abusing drugs and alcohol is a symptom of these problems. What might begin as a recreational hobby or a way to unwind can unknowingly creep up on a person, and seeking help can seem challenging or a risk to your career.
When nurses face disciplinary action due to substance abuse issues, including those indirectly related to addiction, the Professional License Defense Team at the Lento Law Firm can help. We assist our clients in seeking alternative-to-discipline approaches that focus on treatment, protecting their careers, and preserving their long-term health. Call us at 888-535-3686 or fill out our online form.
