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When the Nurse is an Addict: Part One

Advice from a real-life Nurse Jackie on burnout, addiction and finding your way back

Nurses don’t plan to become addicts. We often deny our risk, but our profession’s combination of high stress, burnout and access to drugs can make us at least as susceptible to addiction as the general public. I’m living proof.

Crashing and Burning

I clutched two plaques to my chest, beaming with pride as I stood tall with my fellow graduates in a large auditorium. It was 2005, and I was advancing with honors as a registered nurse. I had already won a “Nursing Student of the Year” award for my ability to overcome adversity.

My reputation — hardworking and compassionate — followed me to my first hospital job. Thriving on the fast pace and constant challenges in an acute care telemetry department, I quickly progressed from preceptor to charge nurse and later unit supervisor. I jumped at opportunities to serve on committees and volunteer for community outreach. I was on the fast track to leadership.

What I didn’t forecast was a descent into professional burnout and substance abuse that nearly spelled the the end of my career.

My reality as an esteemed critical care nurse was ripped out from under me on May 17, 2016, when my manager and a human resources representative led me into a back room and confronted me with accusations of diverting narcotics and working under the influence.  I balked at their demands for a urine analysis, but I was stalling. I knew the analysis would glow with a dirty truth: Addicted to opiates and alcohol, I’d broken the vows of integrity I made when I received my degree. Eventually, after giving them their sample, I walked away from the campus and back to my car, alone, terrified and wracked with shame and despair.

Yet, I was also overwhelmed with relief. I no longer had to live a lie. I no longer had to keep up a facade of strength and capability. I could finally admit I was suffering and desperately needed support.

Numbing the Pain

None of us is wholly immune to the danger of addiction. Excellent grades, certifications and professional awards offer little protection if we find ourselves with more stressors than coping mechanisms.

A common theme among nurse addicts is self-medication, and I was no different. Before I ever took daily drinks or habitually popped pills, I had become a burned-out nurse, exhausted and in pain. I had single-parenthood pressures and a second divorce; overreaching overtime hours in the ICU and a part-time clinical instructor role; and the added stress of caring for my terminally ill father at home.

I also had a legitimate Vicodin prescription for migraines. It became a recipe for drug-addiction disaster.

In a 2017 Kronos survey, 93 percent of nurses said work leaves them physically and mentally exhausted, a major risk factor for substance abuse. Sixty-three percent reported suffering job-related burnout.

For me, professional burnout was only one part of the picture. I pushed myself relentlessly in every aspect of my life, neglecting self-care. Internal and external pressure to be the best employee, daughter, mom and partner felt insurmountable. Because I lacked effective coping skills, Vicodin became one of the few tools that relieved tension while synthetically (and temporarily!) boosting my energy.

Silence Keeps Us Sick

The subject of addiction is effectively taboo among nurses, mentioned only in whispers and pejorative terms: “junkie,” “thief,” “unfit to be called a nurse” and worse.  When my opioid use escalated from legit to recreational and then to all-out abuse, I saw no safe place to turn. Although I’d heard of nurses “in the program,” my knowledge of diversion programs was fairly basic. I didn’t trust such programs because I’d heard that shame and stigma follow recovering nurses long after they achieve sobriety.

Instead, I met sporadically with chemical dependency counselors, taking pains to preserve my privacy. Anonymity was paramount to me for reasons of personal pride and job security. I couldn’t acknowledge that my secret was keeping me sick or that I would never be able to manage it on my own, no matter how sharp my nursing skills.

If I had had a better understanding of alternative to discipline (ATD) programs like the one I’m enrolled in with Washington Health Professional Services, I might have sought treatment sooner. An ATD program monitors and supports nurses pursuing sobriety while also taking steps to ensure the safety of the public. These programs don’t prevent an employer from terminating the nurse for substance abuse and they may require the nurse to stop practicing for a time, but they can make it easier to attend treatment, avoid license enforcement action and obtain future employment. [See sidebar for information on the California BRN’s Interventional Program.]

Every situation is unique, but in my case, admitting that I needed help and accepting treatment wasn’t the end of my career, as I’d feared. Instead, it was the beginning of the end of my addiction. At times, the journey has been humiliating, nerve-wracking, exhausting and expensive. However, the well-being and personal growth I’ve cultivated in sobriety have been more than worth it.

What I Wish I’d Known

Reflecting on my circumstances and the choices I made, there are things I wish I’d done very differently.

I wish I hadn’t bought into the fallacy that working more overtime hours in a busier department would earn me extra points as a nurse or elevate me to some hypothetical pinnacle of the nursing profession.

I wish I’d known how and when to ask for help, and that asking for help didn’t necessarily mean compulsory expulsion from the nursing profession.

I wish I’d known that fighting to hide my stress and “keep it all together” would just lead to my falling apart.

There’s no changing the past, but I can use it to demonstrate to others that overcoming addiction is a strength, not a weakness diminishing your worth as a nurse. In that way, I can transform a shame-filled story into an example of empowerment and hope.

Nursing Education

If you’re struggling as I did, know that prevention and recovery are possible. However, the nursing profession needs more early education and better self-care promotion. We in the healthcare industry need to have candid, compassionate conversations about addiction so that we can eradicate shame and stigma. Above all, we need to empower ourselves and our colleagues to seek help long before drug diversion occurs while supporting nurses on the road to recovery.

 


Sidebar:

An Ounce of Prevention

For nurses, burnout and addiction often go hand in hand. Here are some steps you can take to protect yourself:


Recognize the indicators of job burnout:
  • Depersonalization of patients or yourself
  • Physical/emotional exhaustion
  • Feeling a lack of accomplishment.

Understand your risk factors:
  • Personal or family history of substance or alcohol use disorder
  • Tendency to want to be everything to everyone
  • Night shift or rotating shifts
  • Perfectionism
  • Lack of work-life balance
  • High-stress environment and/or frequently facing trauma or death (e.g., ICU or emergency department).

Integrate meaningful self-care into your daily routine:
  • Physical exercise
  • Meditation
  • Yoga
  • Adequate sleep
  • Quality nutrition
  • Spirituality
  • Music
  • Connecting with nature

Sidebar: 

Seek Help

If you recognize that your problem can’t be addressed on your own, it’s time to reach out for help.

  • Your workplace’s employee assistance program (EAP) may offer a variety of free or reduced-cost services, including financial planning advice, legal help and individual or family counseling. Insurance benefits may cover treatment, counseling, massage or acupuncture. Also, research what support groups may be available in your community.
  • If you suspect or know you abuse drugs or alcohol, seek help immediately. Call the national crisis line (1-800-662-HELP) or talk to your doctor, a trusted colleague or your supervisor.
  • Look into the BRN’s Intervention Program (www.rn.ca.gov/intervention), an ATD program that offers confidential help for nurses with substance abuse problems. Entering the Intervention Program is a big step because you will have to stop practicing for a time, and you will have practice restrictions until you complete the program. However, the alternative could be losing your license or worse!

Sidebar:

Anonymous Recovery Support Groups

Here are several options:

  • Recovery Dharma (recoverydharma.org): Buddhist-inspired, mindfulness-based recovery (a personal favorite of mine!).
  • SMART Recovery (www.smartrecovery.com): Free support groups based on the principles of cognitive behavioral therapy.
  • Alcoholics Anonymous (www.aa.org): The venerable organization offers a Meeting Guide app to help you find meetings in your area.
  • In the Rooms (www.intherooms.com):  Weekly online support group meetings for people struggling with addiction. The meetings are also open to friends, loved ones and allies.

Read Part 2 of this story: Colleagues Under the Influence


Tiffany Swedeen, RN, BSN, CPRC/CPC, works in critical care and as a clinical instructor. She is a mom, writer, meditator and VW van road-tripper. She proudly lives “sober out loud.” Follow her on Instagram @scrubbedcleanrn or www.recoverandrise.com.

Jasmin Mora is a Los Angeles-based Illustrator who contributes frequently to Working Nurse.


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