PUT PATIENT BEFORE THE ADDICT

The Manitoba Nurses Union's concern and compassion for the welfare of
their members with addictions is understandable, abundantly so for
the thousands of Manitobans who struggle with substance abuse and
have seen their jobs threatened by the addiction. Limiting the damage
that addictions can wreak upon lives must be the primary concern of
employers, unions and community members.

No one could argue with the position that it is best for nurses --
doctors, lawyers, teachers or bakers, for that matter -- abusing
substances to be encouraged to report themselves to their regulators
or employers in order that the appropriate steps be taken to deal
with the addiction, safeguard patients and return the worker to
health. Where the agreement ends, it appears, is where hard lines
should be drawn. The Manitoba Nurses Union, not the College of
Registered Nurses, is drawing that line, in insisting that nurses
with addictions never be named, publicly, even upon discipline for
their behaviour. There may be some room for negotiation in current
practice, but prohibiting the naming of nurses, period, is probably
not the solution.

The college has the responsibility of ensuring those who hold a
licence to nurse are capable, competent and trustworthy, that the
work they do is up to standard and the care delivered is in the
interest of the patient. Addictions can imperil patients if they are
not managed before they progress so far as to impinge upon the work
life of a nurse. And if that is the case, then there is work to be
done in encouraging nurses to report themselves, something that
relies heavily upon convincing nurses their best interests, too, are
at stake. Last year, four nurses were disciplined and named in the
college's journal for their substance abuse problems.

The disciplining came about after it was found that the nurses had
repeatedly failed or refused treatment; that discipline was a last
resort. This indicates that the college works to assist nurses in
need, but also draws a line when it appears that the addiction is not
under control and, if it goes unchecked, will endanger others.

The alternative to making a nurse's continued practice conditional --
restricting the scope of practice, demanding treatment and proof of
improvement -- is to cancel a nurse's registration, an extreme
measure as it affects the person's livelihood and future and can
compound the problem of addiction. In Ontario, when a nurse is
incapacitated by mental illness or addiction, his or her practice can
be restricted and the public can see that limitation but not the
reason for it. This can protect patients, while avoiding the stigma
that is attached to mental and physical conditions that render a
nurse incapable of meeting standards of care, and of being judged
untrustworthy with the lives of patients.

Ultimately, the college as regulator must strike the delicate balance
between risks and benefits of playing out sufficient rope to a nurse
in need of help, and keeping it taut enough that he or she can be
reined in before someone is hurt.

Not every nurse struggling with an addiction need be named, but
similarly, the college should be able to make public identification a
condition of continued practice where it is felt warranted.
Ultimately, a conditional registration is the nurse's choice.