The best way to manage substance abuse in nurses — and safeguard patients — is to help them beat addiction rather than punishing them for it, according to researchers.

Recent estimates put the rate of drug and alcohol abuse among nurses at 10-20 percent, yet few seek help for themselves or colleagues due to fear of the consequences.

To determine whether disciplinary action is the best approach to the problem from a staff-retention and patient-safety standpoint, Vanderbilt University School of Nursing researchers Todd Monroe, PhD, and Heidi Kenaga, PhD, synthesized 30 years of the literature on punitive versus alternative-to-discipline (ATD) responses from healthcare providers and regulators around the globe.

Results showed that ATD programs were safer for patients because managers could remove addicted nurses from the floor immediately, while disciplinary removal can drag on for years. Further, ATD programs not only helped nurses recover from addiction, they also reduced dismissal rates at a time when nurses are in short supply by allowing them to return to work under strict monitoring and drug-testing protocols.

On a practical note, ATDs also reduced the costs associated with disciplinary action, such as obtaining liability insurance.

“Poor or ineffective policies that mandate punitive action are more likely to endanger the public, as they make it more difficult for impaired nurses or students to seek help,” said Monroe.

“ATD programs appear to be the best way to protect patients and retain nurses at a time when the profession is facing serious shortages of experienced professionals.”

In their paper, Monroe and Kenaga offered six key guidelines for incorporating a successful ATD program:

1. Promote open communication by discussing substance abuse in healthcare and nursing-education settings.
2. Encourage an atmosphere where people feel they can report problems confidentially.
3. Provide information about the signs and symptoms of impairment.
4. Conduct mock interventions to help people feel less fearful or uncomfortable about approaching a colleague or fellow student about suspected chemical dependency.
5. Invite ATD experts to speak to hospital or school administrators.
6. Participate in scholarly forums about addiction among healthcare providers.

“We believe that these key points will help to transform perceptions of substance abuse among nurses, so that they are seen as a medical disorder requiring treatment, rather than a moral failing,” concluded Monroe.

The article appeared in the February 2011 issue of the Journal of Clinical Nursing.