State-run programs help nurses detox together and stay in their scrubs

“I’m smart, I’m using a clean needle every time, I’m smart and then…I’m in.”

It’s a warm summer evening in New Jersey. About a dozen nurses gather under the hum of fluorescent lights in a church basement. They’re there for their weekly peer support meeting through New Jersey’s “alternative to discipline” program, called RAMP. It’s where addicted nurses go when they want to detox – and keep their jobs.

The nurses huddle on squishy couches pulled into a big circle. Some – straight from work – wearing scrubs. Some come in sweats and have glossy manicures. Mike wears a button-down shirt and keeps his brown hair and beard cropped short. Most of the nurses want to remain anonymous. But Mike – the only man in the room – is happy to share his story.

“I was in charge of a big ER, just directing the traffic in a large ER with three Pyxis machines (or drug dispensing machines)… and one day, it was a slow day, and I stuck a needle in my leg and it was off to the races,” said Mike. He also says his specialized nursing background kept him from recognizing he had a problem. “I’m smart, I’m using a clean needle every time, I’m smart and then…I’m in.”

Between 10 and 15 percent of nurses in the United States have a substance abuse disorder, according to the American Nurses Association. For the general population, that number is around eight percent. Addiction statistics are difficult to pin down, due to under-reporting and stigma. Whether or not nurses use drugs and alcohol at rates significantly higher than the rest of the workforce remains open to debate. But, the access and risks that nurses who use may take on the job, and the kind of stigma they receive for seeking help, make this a special group of people in recovery.

‘I thought I would be able to handle it’

Mike’s story is not unusual. Karolyn Crowley, a nurse and recovery advocate in Boise, Idaho, also battled prescription drug addiction. “I had some pain issues. We had samples in our office – you know this was almost 20 years ago – so I was taking them prescribed by myself.”

“I thought I would be able to handle it, but once those brain changes kick in, you can’t,” said Crowley. She says nurses have to deal with a lot – and the combination of stress and access to drugs can be toxic.

“The access is there, the triggers are there,” said Crowley, referring to triggers like stress and work-related pain. “Say [a nurse] worked three 12-hours shifts in a row, and it’s been incredibly hectic. Mrs. Jones had only wanted one of her pills instead of two and now, [the nurse is] halfway home, there’s a pill in their pocket and they think, ‘Hmm maybe this would help’.”

Crowley got caught stealing pills from her office. She has now been sober for 17 years and wrote a manual for nurses about getting clean and going back to work, called “Re-Entry.” She credits an “alternative to discipline program” for getting her back on her feet – and letting her keep her career.

These state-mandated programs, pioneered by Florida in the 1980s, function under the rationale that if nurses stand to lose their jobs for going into rehab, they won’t seek help. So, a nurse in treatment is safer than one in hiding. And – because the nurse is accountable – the public is safer too. Forty-one states now offer these programs, including New Jersey, Delaware, and Pennsylvania.

The terms of these programs are strict. Nurses sign up for three to five years of drug-testing and mandatory weekly meetings. They also suspend their nursing license and pay a fee to get it back, and this money goes back into paying for the program. Many programs, like the one visited above, require peer support meetings. Some nurses find that peer meetings are more comfortable than regular twelve step meetings, because, in general, other addicts sometimes shame nurses for using while having people’s lives in in their hands.

The big picture

You might be wondering – why give nurses a second chance to practice at all?

Let’s look at the big picture for a minute. There’s been a nation-wide shortage of nurses, of varying severity, since the 1930s. New Jersey recently set aside 22 million dollars to increase the number of training opportunities for new nurses. And nurse turnover is expensive. According to a study in the peer-reviewed Online Journal of Issues in Nursing, losing a single nurse costs hospitals anywhere from $22,000 to $64,000. That means helping nurses get sober and keep their jobs makes sense for hospitals – and for nurses.

Advocates like Crowley also point to studies that show addiction is a brain disease that deserves to be treated with compassion. “We would never turn somebody away because they came in and their sugar was high, because they ate a Snickers bar. Why do we do that with nursing and why do we do that with addiction?”

Compassion – or at least alternatives to unemployment – gets results. Suzanne Kinkle heads up New Jersey’s alternative to discipline program, RAMP. She says accepting that nurses don’t have to be perfect helps them get sober. “Last year we had about 73 percent success rate, remain in RAMP.” That means over 70 percent of people who were in the program at the beginning of the year stuck out the terms of their contract until the end of the year. For conventional twelve-step programs, that number only goes as high as one out of every three people. Florida’s program, the oldest alternative-to-discipline program in the country, boasts retention rates of over 80 percent.

Getting back into their scrubs

In New Jersey’s program, if nurses want to go back to work they have to prove to each other that they’re ready. “Once they’re compliant with their program, they do a presentation to their peer groups and request to go back to work,” said Kinkle. And she says it’s a tough crowd. “They will call them out on their… ‘stuff’ is a nice way of saying it.”

That’s just what Mike, the nurse at the meeting in the beginning, did. He was in the recovery and monitoring program for over six years, and comes back to visit sometimes. He tells the group that he has come a long way. “So, I lost my house, I’ve lost my family because of my own actions. But today, because my house didn’t sell, and I was able to get a job, I then moved back into my house that I own,” said Mike. “And I’ve got a great relationship with my kids.”

One of the other nurses pipes up, “And you got remarried?”

“And I got remarried!” says Mike.

The nurses laugh and the talk shifts to relationships. Kinkle says this extra support – for personal and professional problems that come with addiction – helps nurses get by. “It’s a network for nurses supporting each other. They’re always willing to share where they’re working [and] we have quite a few nurses that are working in the same place.” She says they also help each other find government assistance, like food stamps, for when they are not able to work.

In addition to nurse-specific monitoring programs at the state level, many addiction treatment centers now offer profession-specific programs for nurses and emergency service providers.