NURSES NOW HAVE GUIDE ON HOW TO DEAL WITH SUBSTANCE ABUSE

The numbers are small but substance abuse is an issue in Nova
Scotia's nursing profession.

And the College of Registered Nurses of Nova Scotia, the regulating
body, is so concerned with the few cases it has seen that it recently
launched a resource guide on what nurses and employers should do when
faced with problematic substance use in the workplace.

"It's not a big problem," college executive director Linda Hamilton
said in an interview. "Nurses, just like any other member of our
general society, are prone to having problems with substance use,
both alcohol and drugs."

There is no data on how many nurses in this province or across Canada
are substance abusers. But of the 138 complaints received by the
college over the past five years, 12 per cent, or 17 cases, were
related to problematic substance use.

The college acknowledges this may not accurately reflect the actual
number of nurses in Nova Scotia experiencing problems because some
situations are never reported to the body.

Ms. Hamilton said it is not a widespread problem but "nonetheless
when you get it, it's a big problem" because it affects patient care.
"And also they affect the health of nurses."

The college's records indicate nurses have had problems with alcohol,
narcotics such as Demerol, morphine, MS Contin and Dilaudid, other
controlled drugs like Tylenol 3, Darvon and Ativan and street drugs
including crack cocaine, cannabis marijuana, LSD and hashish.

The resource guide is intended to educate nurses and employers about
substance use, provide practical steps to address related issues in a
caring and supportive manner, encourage nurses who admit they have a
problem to seek help and to inform nurses of their professional
responsibilities in situations where there is a risk or potential
risk to patient safety as a result of a colleague's problem with
drugs or alcohol.

"Prior to reporting a situation to your manager, it is essential you
accurately document your observations of your colleague's
behaviours," the guide advises. "This documentation should be
objective/factual and contain times, dates, locations, what occurred,
names of witnesses, identification of any patients involved, and
actions taken."

Once a nurse has provided his or her manager with those observations,
it is "the manager's responsibility, professionally, ethically and
morally to intervene," the guide states.

"If a nurse is obviously impaired while working, the manager must
immediately remove the nurse from the work area. Two people should
determine whether a nurse is fit to continue working or if she/he
should leave the workplace."

Last year, the college received funding from Health Canada to develop
the resource guide and an education module for use by nursing schools.

"What we're hoping is the earlier we're able to identify nurses who
are at risk of going down the path of problem use that we would be
able to help them," Ms. Hamilton said.

Some nurses who have come before the college started using drugs
because they initially had chronic back pain, could not sleep or were stressed.

"So it's a combination of physical problems, emotional problems and
they start very benignly in terms of just taking some Gravol to get
to sleep or taking some valium and so on. And, that progresses into
other kinds of drugs."

Accessible drugs in the workplace make it easier for some nurses to
develop problems.

"Participants in one study said they were surprised at how easy it
was to take discarded doses, steal patient's doses, and take
medications that patients brought in from home," the 32-page resource
guide states.

"When policies related to the administration and documentation of
narcotics are followed, it is difficult for nurses to divert drugs,
and easier to identify when a nurse is attempting to divert drugs."

In 2005, one patient sued a nurse whose earlier drug use came to
light in a decision by the college.

Lindsay Meredith Brown, a Halifax freelance journalist, sued the
Capital district health authority and Colleen Taylor, a Dartmouth
nurse suspended for stealing and using drugs while working in the
recovery room of a Halifax hospital.

Ms. Brown alleges Ms. Taylor, her recovery-unit nurse for six hours,
failed to give her narcotics when she knew Ms. Brown was in pain
after surgery; misappropriated and used narcotics intended to relieve
Ms. Brown's pain; and administered intravenous saline to Ms. Brown
without consent.

Ms. Taylor was first suspended from the hospital in June 2003.

In October 2003, the college temporarily suspended her licence to
practise. She remains on suspension.

Ms. Taylor, a recovery-room nurse since 1980, admitted to the college
that she stole and used narcotics while on duty at the Queen
Elizabeth II Health Sciences Centre from March to June 2003. She also
said she made numerous charting errors during the period.

But in a defence filed against the lawsuit, she denied withholding
narcotics from Ms. Brown.

In a separate defence, the authority has also denied liability. The
case is still before the courts.