Stress and easy access to drugs - a dangerous mix

Monday, Aug. 21, 2006 | 7:19 a.m.

While complaints of all kinds are filed against less than 2 percent of Nevada's more than 24,000 nurses, licensing officials are concerned about what they consider an unacceptable number of violations related to substance abuse, both nationally and statewide.

For the 12-month period that ended in May, about 11 percent of the disciplinary and licensing actions against Nevada's nurses were for such violations.

That's slightly higher than the 10 percent national rate, according to officials at the National Council of State Boards of Nursing.

Vickie Sheets, director of practice and regulation for the board's national council, says such abuse is partly due to nurses' easy access to drugs.

"They already have their hands in the cookie jar, so to speak," she says. "It's an occupational risk for these professions."

This point is borne out in statistics that show certified nurse's aides, who don't have access to prescription drugs, consistently have a much lower rate of substance abuse.

Other contributing factors Sheets cites are the overall increase in drug abuse nationally and stresses resulting from the nationwide shortage of nurses.

Despite the numbers, Nevada's Board of Nursing gets high marks from Sheets and other national nursing officials for a 20-year diversion program that offers help to the state's chemically dependent nurses.

It allows nurses who report their substance abuse to get help and then resume practicing after completing the program.

Before the advent of the program, a nurse with a substance abuse problem was likely to keep it hidden for fear of losing his or her livelihood. The public was at risk from impaired nurses who continued to work, experts say, and without professional help the grip of addiction became even stronger.

Debra Scott, executive director of the state nursing board, says the program has been a success: "The average relapse rate for people who try to get sober is about 50 percent, and our relapse rate for nurses in the alternative program is less than 5 percent."

About 30 nurses are currently in treatment, and more than 100 have completed the program but are still on probation. During the probationary period, nurses agree to be monitored and randomly tested to ensure compliance.

Officials emphasize that the drug violations represent only a small portion of overall disciplinary actions and a minuscule segment of the nursing population.

"The great majority of nurses do their jobs very well, without the need for disciplinary action," Scott says.

The numbers seem to bear her out.

In the fiscal year that ended June 2005, 460 complaints were filed against Nevada's 24,125 registered and licensed practical nurses. During that period, 63 percent of complaints were closed after investigation and resulted in no disciplinary action.

The overwhelming majority of complaints that required action involved fraudulent applications.

The application includes questions regarding previous criminal history, substance abuse, medical or psychiatric conditions that limit the ability to practice nursing and actions against a nursing license in another state.

Applicants sometimes omit information that might jeopardize their ability to get a license, which can come to light in a subsequent investigation. The fraud can also be revealed by a colleague, as nurses are required to report unprofessional or dangerous behavior from a colleague .

An applicant who gives false or misleading information on the application is subject to disciplinary action even if the initial offense might not have resulted in denial of a license.

In addition to substance abuse, the remaining complaints comprised mainly practicing beyond the scope of certification, negligence, incompetence and criminal convictions.

Scott says Nevada's board investigates each complaint to ensure that the rights of both patients and nurses are protected. In 1999 the board took this a step further when it commissioned a project that looked at every nurse disciplined over two years. The study verified that each nurse disciplined was afforded due process.

Tracy Singh, vice president of the Nevada Nursing Association, says that overall her group has a good relationship with the board.

"They have a thorough process. They seem to investigate more than some other boards and they try to be fair. I think opinions sometimes play a bigger role than maybe they should," Singh says.

Scott acknowledges the board has considerable latitude when it comes to decisions: "We try to look at each case individually and things such as prior history, and how we perceive the facts are certainly a factor."

Sheets, of the national council, says state boards' jobs are made even more difficult by the nursing shortage.

"This is probably when you need to maintain standards more than ever," Sheets says. "The temptation is there to look the other way because you need people, but you can't do that and put patients at risk. It's a balancing act."