Another Needless Death

During last weeks national meeting of the American Association of Nurse Anesthetists (AANA), we learned of yet another death from propofol. This time it wasn't a famous entertainer. It was an anesthesia provider. No one will read this person's story, and only family and friends will mourn their death. In fact, I even heard one comment by a member of the profession that actually celebrated the death. "One less "F - ing" addict out there!"

Amazing. Someone's parent/child/spouse/friend/colleague dies from a treatable disease, and someone is happy it happened.

I guess it only matters when it's a celebrity.

What in the world is wrong with our society?

Addictions grow deep
http://www.kcnursingnews.com/news/

An interview I had with the Kansas City Nursing News last month.

LaTonia Wright; nurse, attorney, advocate

Nurses in the Greater Cincinnati/Tristate area (Kentucky-Ohio-Indiana) have a real gem in their midst. I'm talking about LaTonia Wright, CEO of the Law Offic of LaTonia Denise Wright, LLC. She's a registered nurse in Ohio, and an attorney licensed to practice law in K-O-I. She specializes in license defense for nurses, but also provides workplace consultations and other services to nurses (in her own words...Representing, Counseling, and Advising Nurses).

What makes her special, at least to this graying, recovering nurse anesthetist, is how she "gets it" when it comes to the disease of chemical dependence. While a majority of our society, including health care providers, believe someone with active addiction is "choosing" to continue using drugs (including alcohol), LaTonia understands they are ill and require effective, evidence based treatment. She also understands the public must be protected from nurses who are not practicing safe nursing, for whatver reason. She wants to be sure the public is protected while assuring the rights of the nurse impaired by this disease are also protected.

In other words, she does her best to assure a win-win situation takes place...the public continues to receive the best care from competent nursing professionals, while the nurse with a chronic, progressive, potentially fatal disease receives the care needed to save their life and possibly their career.

Thank you, LaTonia, for treating nurses struggling with this disease with respect and compassion. And for advocating for their rights...to life (in recovery), liberty, and the pursuit of happiness...which can only happen when the disease is in remission.

Criminal and License Defense

Whenever I'm contacted by a nurse facing criminal charges related to impairment, the first question I ask is;

"Do you have a criminal defense attorney?"

As many of you have most likely answered...Well, duh! Of COURSE I do! Do you think I'm dumb enough to defend myself in court? No, I don't thing so, but there ARE a few who actually consider it.

I receive even more inquires about pending investigations by the board of nursing. Again, the first question I ask the person contacting me is:

"Do you have a LICENSE defense attorney?"

Here are the top three answers I receive to that question:

1. No, it's only the board of nursing. It's not like I'm going to prison or anything.
2. I'm a nurse facing nurses, I know how to defend myself.
3. I can't afford an attorney. Besides, it's the board of nursing, not the judges at Nuremberg.

Let me put it to you this way, there is nothing more serious you'll face in the profession of nursing than an inquiry, investigation, and/or a hearing before the licensure board. If you make a mistake...you may never practice nursing again!

This is why a nurse should purchase professional liability insurance with a licensure defense clause...as soon as you graduate from nursing school! If you don't have one now...GET ONE ASAP!!!! It's cheap compared to all the doo doo you'll face if you need one and don't have it.

I've been charged with a felony, now what?

Need a license defense attorney? Contact the American Association of Nurse Attorneys

Professional Liability for Nurses

Addicts in health professions flock to get peers' help

This article perpetuates many of the most prominent myths associated with the disease of addiction without even realizing that's what they're doing.

Just a few examples:

"Until the late 1970s, drug addiction in the health care industry was largely addressed punitively. Licenses were revoked, careers crushed and addicts jailed. That made doctors, nurses, dentists and pharmacists reluctant to confess addiction or pursue help, further endangering patients. Even now, when addiction is better understood as a disease, health workers fear coming forward."

That's STILL the way many states continue to handle impaired health care providers. They have a "Program on the books", but even if a person meets all the inclusion criteria and also clears the criteria for exclusion from the program, the board can still refuse to admit the provider if they "feel" they might not do well. That's the problem...we need to stop dealing with this disease with feelings and begin using science and evidence based practices. Yes, addicts can do some terrible things as a result of their disease, but if we can remove the stigma, maybe we can intervene and get them into treatment BEFORE they get to the point of committing illegal acts.

"It is extremely difficult to acknowledge because it is admitting to human frailty, and we as health care professionals are held to a higher standard," said Elizabeth Pace, chief executive of Peer Assistance."

Is having cancer a human frailty? Is having diabetes or heart disease a human frailty? This statement is nothing more than being judgmental and assigning blame and lack of willpower to the person with a medical disease that CAUSES the inability to just stop using. This is the very condescending and judgmental attitude that prevents people from seeking help.

Addicts are not bad people trying to become good! They are ill with a chronic, progressive and unnecessarily fatal disease and are trying to become well!

"I didn't understand I had a disease," she said. "I thought I was bad and I had let down my entire profession. I had let the world down. I really thought my punishment should be that I should die."

This is one of the correct things published in this article. Every addict feels this way...not just health care professionals. Society perpetuates this incorrect and unscientific "belief". Once you read the research and the science, looking at it as a lack of will power makes no sense.

"Experts say crushing the stigma of addiction starts with education in medical, dental, nursing and pharmacy schools."

Yes it does. And using scientific terms instead of emotion laden judgment filled words and phrases in the press coverage will also be required to change the cultural acceptance that addiction is NOT a disease.

"That education should also be directed at hospital administrators, who sometimes must choose between quietly firing a pill-plundering employee or calling for help, which can lead to public scrutiny."

There is a great example of using negative emotional words instead of scientific or neutral language. Gee, I wonder what the not so hidden agenda this writer holds when it comes to the disease of addiction in health care providers?

"There are probably people alive right now because some hospital administrators had the guts to say we are going to call in an airstrike on ourselves and fix this problem the right way," said Jeff Sweetin, agent in charge for theDrug Enforcement Administration's Rocky Mountain region."

Typical attitude of a police agency...we have to bring an air-strike in order to eliminate these horrible addicts. We certainly wouldn't want to treat the disease now would we. Of course not, it might cost them their jobs.

"We always ask (the addicted health care worker who just got "busted" instead of diagnosed) what we can tell the hospital to make their system better, and that typically leads to changes in the system."

The biggest change that needs to happen in the system is to start treting this as the disease that it is, not some lack of willpower or moral failing. Until THAT happens, not much is going to change.

Wealth, fame, and addiction

George Carlin (or Robin Williams, depending on the source) said it well,

"Drugs (cocaine) are God's way of telling you that you make too much money."

We are seeing that very thing played out with Michael Jackson. It's one glaring example of the progressive nature of the disease. Mr. Jackson had 2 things that allowed him to continue using mood altering substances until it finally killed him...

• money
• sycophantic enablers (fawning parasite; A servile self-seeker who attempts to win favor by flattering influential people)

By the very nature of the disease, an addict is incapable of stopping by their own force of will. This is why some sort of intervention is required to get them into treatment. Once they detox and their brain begins to recuperate, THEN the education and techniques provided by evidence-based treatment can actually be retained and used to stay "clean".

Intervention takes many forms. The most common type is what we see on the A&E television show "Intervention". It's a technique used to create a "bottom", that magical place and time where the addict will enter treatment. For an addict with unlimited resources and surrounded by people who will give them whatever they want, that bottom is death.

Intervention is difficult. It appears to go against all definitions of love and logic. But continuing to "rescue" the addict from the consequences of their drug misuse allows them to continue to believe they are in control. The longer it takes to get the person into treatment, the more the disease progresses and the tougher it becomes to effectively treat the disease. When you are surrounded by people who want to please you just to be near you, the intervention is unlikely to take place. Or, if someone tries to make it happen, the sycophantic enablers sabotage the very thing designed to help the addict.

Yes, there has been unethical, unprofessional, and undoubtedly criminal activity involved in the death of Mr. Jackson. However, the medical providers aren't the only people to be held accountable (although I have no doubt that's exactly what will happen). Mr. Jackson's family and employees share that responsibility as well.

I hope Mr. Jackson's life is studied closely in order to learn the valuable lessons it holds. While he was an unparalleled entertainer with unlimited talent, his troubled life and premature death could provide the positive move forward when dealing with all apsects of the disease called addiction.

Professional Liability Insurance for Nurses

As a recovery mentor, peer advisor, and consulant, I frequently come in contact with nurses who rely solely on their employer for malpractice/liability insurance. I have to confess, I did the same thing for most of my time as an emergency room nurse and certified registered nurse anesthetist (CRNA). This makes no sense professionally.

An insurance company and the attorneys they provide if there is a claim have the interest of their client(s) first and foremost. If in the process of dealing with the claim it is in the best interest of the employer to hang the nurse out to dry, then that's what's going to happen. Then, the nurse will need to hire their own attorney and pay for them OUT OF POCKET, since the insurance they relied on covers the hospital, not them.

Professional liability insurance (which should include a license defense clause!) for nurses is extremely reasonable. The claim that "it's too expensive" is lame at best. The American Nurses Association (ANA) states ont their web site; "A must have for every nurse. Protect your career by purchasing your own coverage at a reasonable price. Every nurse today should carry their own professional liability insurance to protect themselves from the costs of legal and board of nursing action -- even if they are covered by their employer."

So why is it most nurses DON'T have their own insurance, and don't seem to understand the importance of having this insurance? Read the opinion of a nurse who is also a license defense attorney.

What do you think?

Brilliant, Free Marketing (and a little revenge)

This man is a genius! AND! Look at the free marketing while also taking on a huge airline! Anyone who has traveled extensively for business would love to do this to an airline who overbooked a flight (never could figure that one out), lost luggage, or had a body cavity search because you DON'T fit the terrorist (dare I say it?) PROFILE?

Several years ago I flew to Brownsville, Texas to provide a day long program at a hospital there. I had a layover in Dallas. I arrived in Brownsville while my luggage traveled to Oakland. My lecture material was in my checked luggage along with my suit and tie. I was assured the luggage would arrive at my hotel by 11:00pm.

It didn't. When my wake up call arrived at 5:00am, my luggage had not arrived from it's junket to the west coast. The hospital educator arrived at 6:30am to escort me to the hospital. When I met her in my polo shirt, jeans (yes, they were clean, but I had worn them the day before), and tennis shoes, she surmised something wasn't quite right. We stopped at a Kroger and picked up a razor, shave cream, and some deodorant (cheap hotel).

I did the presentation with 2 white boards and red, black, and green dry markers. It went OK. When I arrived at my hotel at 4:30pm, my luggage had JUST arrived! The airline said they would cover up to loss of $250.00. My speakers fee was significantly above that mark (not too significantly above). The airline informed me they wouldn't cover that loss if the client decided not to pay the full fee, even though it was their mistake that could have cost me a significant amount of money.

I wish You-Tube would have been around at the time. It would have been fun to extract some justice (and maybe even $$) as a result of the free marketing.

Michael Jackson, Addiction, the Media, and the Medical Profession

I've been following the Michael Jackson saga since the first news alert of his "possible" death. The first thing that went through my mind was he died from an accidental overdose. Little did I realize it would take us to the "propofol" thing. And while his death is tragic, so are the deaths of all addicts. They are tragic because many, many, MANY of them don't have to happen.

So why DO they continue to happen? And why do they appear to be increasing? Because our culture continues to follow the same failed ways of "dealing" with this "issue".

First of all, it's NOT an issue...it's a disease. Until we treat it that way, this kind of crap will keep happening more and more. "Dealing" with a disease in a punitive way...i.e., with the police department and jail instead of with interventions and treatment leads to continued progression of the disease and ultimately death.

"BUT TREATMENT DOESN'T WORK!"

Of course it does, when it's started as early as possible, is evidence based, and is ongoing. Currently, that doesn't happen in too many cases.

Why not? Because we approach this disease with what I call the "3 Ms" of addiction: Myth, Misbelief, and Misinformation. One of the predominant myths is known as "hitting rock bottom".

"Treatment doesn't work until the addict HITS ROCK BOTTOM!"

What is rock bottom? I'm sure there are numerous definitions. I think the most accepted one is this...the addict has to lose most (if not all) of the things that are important to them....job, marriage, family, money, car, etc. before they will be willing to enter treatment. But without an intervention of some kind...the bottom for all too many addicts is death.

Mr. Jackson is just one example of what happens when treatment is withheld until the addict "hits bottom".

Goodness, he even had a physician with him at the time of his death! It will be interesting to see what happened leading up to his death that day (if we ever really find out). But there are some clear things that DID happen.

First, Michael Jackson was surrounded by sycophants (self-seeking, servile flatterers; fawning parasites...according to dictionary.com). Some of these people were health care providers, some even (gasp) physicians! As you can see, doctors, nurses, pharmacists, etc. are not immune from all of this. There are star struck individuals in all walks of life, just as there are unethical people in all areas of business and government. When someone told Mr. Jackson no...he found someone who would say yes. My guess is the physician with Mr. Jackson at the time of his death thought he was skilled enough to prevent what happened. Guess what...MD doesn't automatically endow the person with the ability to manage an airway or prevent them from making a mistake in administering a medication they have no business administering. Combine that with administering this medication in a place where it should never be administered and you have the very situation on June 25th in his rented home.

Second, let's compare how we (meaning society and the medical community) approach other chronic, progressive, potentially fatal diseases.

Diabetes. We teach about the disease, that if there is a family history, the risk increases. We teach early signs and symptoms. We suggest early EARLY treatment, aggressive treatment, and evidence based treatment.

Cardiovascular disease. Early recognition of signs and symptoms. Immediate intervention at the first sign of possible heart attack or stroke. Get to the ER now! Education about prevention (family history, diet, exercise, check ups, etc.).

Cancer. Education about the disease, causes, risk factors...like family history (where have we heard that before?), early signs and symptoms, and early, aggressive treatment.

Addiction. How do we handle it? Don't talk about it. Ignore family history...hell, don't even THINK about talking about it! Ignore the early signs and symptoms (it's a phase, it's part of "growing up", they're in the "wrong crowd", they made "bad decisions" or "mistakes"), cover up the consequences for their "bad decisions" (called co-dependent behavior), and WAIT UNTIL THEY HIT BOTTOM. Does anyone see how completely crazy this is? Does anyone see how it makes absolutely no sense from a medical stand point? And yet we keep doing the same stupid stuff over and over hoping the outcome will be different. Didn't Einstein say that was INSANITY!?

If you don't see the idiocy, you're part of the problem. If you do see the idiocy and do nothing, you're part of the problem.

Several family members and friends have said over and over, "We tried to save Michael but we just couldn't. We did everything we could and it just wasn't enough."

BALONEY! Did they hire an interventionist? Did they require him to enter treatment and refuse to provide him with drugs? Did they hire recovering addicts to keep the sycophants away? Did they fire the doctors who were unethically and unprofessionally supplying him with addictive drugs?

Let's stop the insanity and actually start doing what needs to happen. Education, early recognition, intervention, aggressive treatment, and long term follow up...just like we do for other chronic, progressive, potentially fatal disease.

I hope Michael Jackson's death won't be in vain.

American Association of Nurse Anesthetists Warned of Propofol Dangers 3 Days Before Jackson's Death

Thank you to a good friend and colleague for writing this for publication on my blog.

PARKRIDGE, IL. The American Association of Nurse Anesthetists published a statement on June 22 warning of potentially fatal results when the anesthetic agent propofol (Diprivan) is abused, just 3 days before Michael Jackson died of a possible overdose of the drug. The association also warned that propofol has properties which make it a potential drug of abuse and addiction, Indeed reports of propofol abuse and fatal, accidental self administered overdose have been reported since 1992 and are on the increase. The majority of incidents of abuse are among health care providers since propofol is an intravenous medication which is use only inside hospitals, outpatient surgery centers and clinics. "Our concern has been growing over the ease of access to propofol within hospitals compared to other drugs of abuse like morphine. Most disturbing is a 30-50% incidence of fatal outcomes when this dangerous drug is abused. Propofol stops breathing, followed in 4-5 minutes with cardiac arrest due to lack of oxygen" says Greg Stocks CRNA, a peer assistance advisor at the association.

Propofol has no approved clinical use outside of health care institutions and is not available by prescription. It is never indicated for treatment of insomnia. Despite the potential for propofol abuse, it is not a drug controlled or restricted by the DEA and is treated no differently than antibiotics. Some hospitals and anesthesia departments have taken their own steps in securing and accounting for their supplies of propofol after it became clear to them that a high incidence of fatal overdose results from abuse.

See the AANA propofol Position Statement at www.aana.com

Propofol, Michael jackson, and ethics (or lack thereof)

More "mess" regarding propofol and Michael Jackson................

Michael Jackson: Aliases, Painkillers, Propofol & a "Mini-Clinic"

I don't think I'd want to be the folks involved in all of this "mess". Talk about unethical, unprofessional, unlawful, and any othe "un-" you can invent.

Video of Nurse Discussing Propofol Use by Michael Jackson

Video is at the end of the article at this link:

Jackson Begged for Sedative, Nurse Said.

http://www.cbsnews.com/stories/2009/06/30/entertainment/main5126529.shtml

Michael Jackson's Death Might Change the Status of Propofol

Propofol (also known as a Diprivan) is a medication used to induce anesthesia for a variety of procedures. It's also not a controlled substance.

What does that mean?

It means it's not considered "dangerous". It means it has a "low abuse potential".

Those of us in the anesthesia profession, especially those of us who deal with professionals who are dealing with substance abuse and chemical dependence, have been trying to get propfol's status elevated to a controlled substance. This means it would be more difficult to obtain and misuse. The FDA and the DEA have continued to resist this change in status. The American Association of Nurse Anesthetists (AANA found at www.aana.com) has just published (to their credit) Position Statement 2.14, "Securing Propofol".

Apparently, the deaths of anesthesia professionals aren't enough to change the minds of the FDA or DEA. Perhaps the death of Michael Jackson from a possible propofol overdose will change their minds. If so, his death will not have been in vain.

"Dangerous Drug Found in Jackson Home"
http://www.tmz.com/2009/07/01/michael-jackson-propofol-lidocaine-overdose-criminal/

A New Alliance

I am so excited to be able to announce the formation of an alliance that will help the nurse struggling with substance abuse and chemical dependency in Kentucky, Indiana, and Ohio. I'm joining forces with a good friend and colleague, LaTonia Denise Wright, RN, BSN, JD. She is the owner and CEO of The Law Office of LaTonia Denise Wright, in Blue Ash...a suburb of Cincinnati, Ohio. LaTonia is a Registered Nurse in Ohio and a License Defense Attorney in Ohio, Kentucky, and Indiana. I'll be assisting her with nurses facing board actions as a result of substance abuse and chemical dependence.

Check back for updates.


Law Office of LaTonia Denise Wright, LLC
11427 Reed Hartman Highway, Suite 205
Cincinnati, Ohio 45241
513-771-7266 local
888-571-1110 toll free
888-580-1119 fax

Thank You Samantha and Mt. St. Joe's School of Nursing!

Sam and her classmates at Mt. St. Joe's Nursing Program did an outstanding job in their debate last Tuesday. They were debating whether a nurse with chemical dependency should receive treatment or discipline from the board of nursing. I have to say that Samantha did a great job (she had a little help from someone who has an inside view and experience with addiction).

I wanted to thank them and their professor, Dr. Susan Johnson, for making me feel at ease and welcomed. Hopefully this will start an continuing relationship for the students at "The Mount". Learning as much as they can about this deadly disease can only help themselves, their colleagues, and the patients they will care for during their careers.

Thank you all!!!!!

Punishment vs. Treatment

I'm speaking tomorrow (Tuesday June 9, 2009) at the College of Mt. St. Joe here in Cincinnati. A student had the courage to contact a complete stranger to discuss this highly charged, extremely unpopular topic. Her class is having a debate between disciplinary measures to deal with an impaired nurse vs. "alternative to discipline" methods of dealing with the disease and the nurse who suffers with it.

I'll post the results tomorrow. It should be an interesting day.

Thanks for having the guts to take the less than popular stance, Samantha!

Casey's Law

I met an amazing woman last Friday. Her name, Charlotte Wethington.

How do you recover from the death of your son, your only child? As if his death isn't bad enough, it came from a disease that is treatable. The disease of chemical dependence. Her 23 year old son Casey died of an overdose of heroin. And the sad thing is this, she had taken her son to the emergency room for an overdose...2 previous times! After his first ER visit...for an overdose of heroin...he was discharged because he refused to enter treatment. Why? Because there was no law that allowed the parents of a child over the age of 18 to mandate treatment. Even though an addict is incapable of making a rational decision when it comes to the use of drugs, they still can't have him admitted. And consider this. Casey was "recovering" from an overdose. Common sense tells you this person is OBVIOUSLY incapable of making a rational decision regarding treatment for drug addiction!

Ahhhh yes...this is the land where a land owner can lose control over what they do with their land if an endangered flea is found on their property. But intervene when a human is suffering from a treatable disease that renders them incapable of making a rational decision. Ohhhh no.....we wouldn't want to do that!

This country has lost it's mind!

The second ER visit within less than a year was for another heroin overdose. OK. Second OD in less than a year. Doesn't it seem "logical" that the person has demonstrated an inability to make rational decisions regarding the use of a potentially fatal drug? But again, we can't interfere with an irrational decision that might cause a death, but we WILL interfere with a terminally ill person's right to die with dignity. We WILL intervene if someone with severe, chronic, unrelenting pain that can't be cured seems to be taking "too much" pain medication. Even though it has been prescribed by a board certified pain specialist. Oh my! We wouldn't want this person who has no hope of a cure for their pain to become addicted! But it IS OK to let an already addicted individual die from their disease once it's already happened because we can't mandate them to treatment which is life saving!

What the hell is wrong with this picture?

When they were getting ready to discharge Casey, a nurse in the ER told his mother that her son hadn't lived long enough yet, he was too young to have "hit bottom" yet. He hadn't "lost enough". She said to the nurse, "What happens if never grows "old enough"? What happens if his "bottom" is death?" She had no idea she was predicting the future. Her son died several weeks later from one last overdose.

Charlotte, not willing to simply grieve the loss of her son, decided to make a difference. She began to research how to get a law passed. When she was told she would never succeed, she kept on plugging away. When more people told her it would take nothing less than 5 years to accomplish the passage of a bill. She did it in 2 years! As she told me in our discussion, rather than give up when a door would close in her face, she would find another and walk through that one.

I told her she was my hero for having the guts to do what needed to be done regardless of who it ticked off and who didn't like it.

I guess that's the power that a wounded mother is capable of, even if the wound was a fatal one...for her only child.

The Unethical and Unprofessional Response by the Health Care Community in Lebanon, Ohio

"Two Caretakers Indicted for Allegedly Stealing Drugs in a Warren County, Ohio Nursing Home"

That was the headline in Cincinnati newspapers and on TV and radio news in the tristate area. As I read the story, I thought back to my experiences over the past 19 years.

The first thing that jumped out at me was the comment by the executive director of the nursing home. He stated they contacted the police who then watched the nurses over the next 2 years.

Excuse me? WATCHED them for TWO YEARS!?

Why? To gather evidence in order to make an arrest and seek a successful prosecution. Why would you not intervene sooner? If these nurses were addicted to opioids, why would you allow the disease to continue to progress, risk the well being of those entrusted to their care, and possibly allow the nurse...your employee and colleague...to possibly cause a potential auto accident or die from an accidental overdose?

Would they watch an employee with signs of tuberculosis, swine flu, MRSA, or other illness to see if they would steal antibiotics or other medications to deal with their illness? Would they put the residents at risk for infection or harm to catch the nurse steeling medications or other hospital equipment? Of course not. So why is it permissible to allow them to continue diverting opioids in order to get enough evidence for an arrest and conviction?

Easy answer. Few people, including doctors and nurses, believe addiction is a disease. They receive little education regarding the disease during training. Few nurses recognize the signs and symptoms in a colleague. Even if they do they rarely intervene for fear of being wrong, or harming the nurse's career. They wait until they can no longer ignore the signs and then they terminate them, report them to the police or both. Instead of intervening in order to get them out of the clinical area and into treatment, they eliminate the "problem" by firing them. This allows the disease to continue to progress. It also allows an impaired professional to go to another facility where they may harm clients or themselves.

The Code of Ethics for Nurses is very specific about the impaired nurse. Statement 3.6 says the colleagues of an impaired nurse are ethically required to intervene in order to protect the patients and to advocate for the appropriate treatment and rehabilitation of the impaired nurse. This advocacy also includes appropriate and fair legal response.

None of this happened in the incident in Lebanon, Ohio. They placed residents at risk in order to gather evidence for prosecution. They allowed a chronic, progressive, potentially fatal disease to progress. They placed the lives of innocent bystanders AND the lives of the nurses in jeopardy in order to look tough in the "war on drugs".

There are no winners when this happens...only losers. he biggest losers are the nurse, their family, and society at large.

The only real casualty in the war on drugs are those unlucky enough to have the disease.

Ending Nurse's Week by Facing the Hidden Epidemic of Impaired Nurses.

FOR IMMEDIATE RELEASE

Contact:
Jack Stem
Peer Advocacy for Impaired Nurses, LLC
513-833-4584 (Cell)
513-231-4280 (Home)
jack@jackstem.com
http://www.peeradvocacyforimpairednurses.com


Ending Nurse's Week by Facing the Hidden Epidemic of Impaired Nurses.


Dateline: Cincinnati, Ohio May 14, 2009 – How can a nurse, doctor, dentist, or any other health care professional fall prey to substance abuse and addiction? Their training should decrease the risk of becoming an addict, right? RN Magazine tackled this topic in their April issue with the article, “Drug Addiction Among Nurses: Confronting a Quiet Epidemic. Many RNs fall prey to this hidden, potentially deadly disease. (April 2009 issue of RN Magazine)

Cincinnati's own Jack Stem was one of professionals interviewed for this article. He, along with Patricia Holloran, RN, author of “Impaired: A Nurse's Story of Addiction and Recovery” (Kaplan Publishing, 2009), and Marilyn Clark Pellett, RN, JD, an attorney who has represented nurses in disciplinary hearings before the Connecticut Board of Nursing for many years, were contacted because of the number of nurses struggling with this chronic, potentially deadly disease. Stem is a recovering addict and former emergency room nurse and certified registered nurse anesthetist. He has been a peer advisor since 2005, and is the chair of the Peer Advocacy for Practitioner Wellness Committee of the Ohio State Association of Nurse Anesthetists.

“This disease still carries a heavy stigma for those unlucky enough to find they have it. Despite the amazing growth in the knowledge and understanding of this disease, that knowledge hasn't made it to the front line care giver. Nurses and doctors still make decisions based on what I call the 3 Ms; Myth, Misbelief, and Misinformation. As a peer advisor for Ohio's nurse anesthetists, my job is to educate all practitioners and incoming students about the risk of substance abuse and addiction. This disease is the number one health risk associated with the practice of anesthesia, yet many anesthesia providers are unaware of that fact, or choose to ignore it. Denial about the disease isn't exclusive to those who have it. Friends, family and colleagues also fall victim to denial.”

Mr. Stem started his consulting and educational company, Peer Advocacy for Impaired Nurses, LLC, last October (2008) when it became clear he was receiving more and more calls from non-anesthesia nurses looking for help. The Ohio board of nursing developed an alternative to discipline program in the mid to late 1980's for nurses who voluntarily sought help for their impairment. The Ohio Nurses Association provided the monitoring service for Ohio nurses enrolled in the program. The alternative to discipline program is currently under review and the ONA is no longer involved. “As a result, nurses are caught between a rock and a hard place. They fear for their license, their ability to return to nursing after successful treatment for their disease. But their biggest fear is the stigma they will face from their family, the public, and their nursing colleagues”, says Stem. “Despite the acknowledgement by the AMA, ANA, and other professional organizations, that addiction is a disease, the attitude of health care providers continues to be negative, especially toward impaired professionals. If we ever hope to change the way addicts are treated personally and medically, we must first educate the health care providers about the disease of addiction. If health care professionals don't get it, how can we ever expect the average Joe and Jane to change their view?

We have over 25 million people in this country struggling with substance abuse and addiction. The average age where a person first tries a mood altering substance is under 12. The most common place they obtain drugs is the medicine cabinet. Why are we continuing to do things the way we always have when it clearly hasn't been successful? I'm just one individual who has experienced the shame and guilt associated with this disease. I was lucky to have people who love me enough to refuse to give up or let me give up. I'm just trying to pay that love and respect forward. No one should have to fight their own colleagues to get the treatment they need and deserve. Especially when their colleagues are health care professionals.”

Mr. Stem has joined forces with LaTonia Denise Wright, RN, BSN, JD, and a leading attorney dealing with nursing and licensure issues in Ohio, Kentucky, and Indiana. Wright and Stem have developed a series of workshops for nurses in the Greater Cincinnati area. These workshops will focus on the disease of chemical dependence, recognizing an impaired colleague, and taking steps designed to safely remove the impaired nurse from practice while helping them enter treatment programs designed to deal with the unique needs of addicted health care professionals. Ms. Wright discusses the legal and licensure issues facing the nurse dealing with substance abuse and addiction. She also provides valuable information covering a wide variety of legal issues many nurses are unaware they face on a daily basis in their practice. The workshops begin on March 30, 2009 and will be offered throughout the remainder of the year.

About Peer Advocacy for Impaired Nurses, LLC

Founded by Jack Stem in 2008 to improve patient care and safety and to assist nurses in achieving long-term recovery. These goals are accomplished by assisting the nursing profession in early recognition and intervention of the impaired nurse. A variety of services are provided, including educational programs and workshops, assisting organizations in developing effective policies and procedures for preventing substance abuse and dealing with impaired nursing staff. Additional services are designed to assist the impaired nurse in obtaining appropriate, evidence based treatment for substance abuse and chemical dependence, relapse prevention, and recovery “coaching”.

For information on these and other services, a copy of the titles and dates of the workshops for nurses, or to make a reservation, contact:

Jack Stem
Peer Advocacy for Impaired Nurses, LLC
513-833-4584 (Cell)
513-231-4280 (Home)
Email: jack@jackstem.com
Web Site: http://www.peeradvocacyforimpairednurses.com
Seminar dates: http://peeradvocacyforimpairednurses.com/workshops.html
Blog: http://advocacyforimpairednurses.blogspot.com/

For information on the programs and services provided by The Law Offices of LaTonia Denise Wright, LLC, contact:

LaTonia Denise Wright, RN, BSN, JD
The Law Offices of LaTonia Denise Wright, LLC
11427 Reed Hartman Highway, Suite 205
Cincinnati, Ohio 45241
Phone: 513-771-7266
Email: ldw@nursing-jurisprudence.com
Web Site: http://www.nursing-jurisprudence.com/
Blog: http://www.advocatefornurses.typepad.com/
Representing, Counseling, and Advising Nurses.

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Treatment program for public safety officers

If you or someone you know is a public safety professional (police officer, firefighter, paramedic, or EMT) struggling with substance abuse and addiction, Treatment Solutions Network has a program specifically for these professionals.

Follow this link for more information: http://www.treatmentsolutionsnetwork.com/power/

Workshops

I have teamed with LaTonia Denise Wright, RN, BSN, JD to provide a series of workshops for nurses in the Greater Cincinnati area. There are 2 one hour presentations at each workshop. The first hour deals with addiction/impaired nursing practice. The second hour deals with legal issues facing nurses in their practice. The size has been limited to 25 participants. For information on the dates, topics, and to register follow this link:

http://peeradvocacyforimpairednurses.com/workshops.html

You can now register and make your payment online through PayPal. Even if you don't have a PayPal account you can pay with your credit card. Follow this link to register and pay online.

You may contact me by email at jack@jackstem.com or by phone: 513-833-4584

Hear we go again.

I had a most interesting and frustrating telephone conversation today. A representative of a local nursing program contacted me with questions about the workshops I'm providing with LaTonia Wright, RN, BSN, JD. Our topics focus on substance abuse/chemical dependence and legal issues (related to addiction as well as other legal issues) facing the nurse and nursing profession. Since we've just started these workshops, attendance hasn't been what we hoped for, but we realize it takes time to get the word out. I digress...back to the phone call.

As I explained why I started my company and my mission, I discussed the obstacles we face when dealing with the disease of chemical dependence, such as:
- addiction isn't accepted as a disease (it's a lack of willpower or lack of morals)
- "they" did this to themselves
- if they loved their family, they would stop doing this
- how could they let this happen? After all, they are health care professionals, they should know better!
- treatment doesn't work, so why bother

The caller's response was almost textbook, as if reading from a script or a "FAQ" brochure.

Caller: Nurses receive education about the disease in training, don't they?
Me: Yes, but the focus is mainly on "caring" for the addict (talk about an oxymoron!). Even more likely is a focus on the consequences of the actions of the addict's use of an addictive chemical or participating in an addictive behavior. Things like cirrhosis, gastritis, gastric ulcers, pancreatitis, infections (including sexually transmitted diseases, hepatitis, etc.), accidents, crime, violence (domestic and otherwise), loss of job, income, divorce, etc.

Caller: Nurses know this is a disease.
Me: No they don't. They may pay lip service to the disease concept, but their attitudes and actions speak loudly...gossip, rejection, hostility, etc.

Caller: The incidence of addiction in nurses and doctors is less than the general public. After all, they are trained health care providers.

Me: Actually, the incidence is the same in health care professionals, even higher if you practice in certain specialties such as anesthesia, emergency room and other critical care areas. Training about addiction provides no more "resistance" than training in oncology prevents cancer, or training in endocrinology prevents diabetes. Education MAY help early recognition and treatment, but it doesn't prevent the possibility of disease.

Caller: The relapse rate is so high. Doesn't this mean treatment isn't as successful as treating other diseases?

Me: No, because we don't approach addiction in the same manner we approach other chronic diseases. For all chronic, potentially fatal diseases we all know early recognition, treatment, and continued follow-up provides the best chance for remission. Is that the approach used for addiction? No. We wait until the addict hits "rock bottom", treat them with outpatient therapy (when research clearly shows increased effectiveness of long term inpatient/residential treatment), with little, if any, follow up.

If we waited until the person with cancer had signs that could no longer be ignored, provided treatment with inadequate doses of chemotherapy for too short a time, with little or no follow-up, how many remissions would we see? Not many!

There-in lies the problem. Addiction is not accepted as a "legitimate" disease. Research has identified the areas of the brain where addiction takes place. It has determined the brain chemicals (neurotransmitters) involved, how "cues" can trigger activity in those areas of the brain even after documented decades of abstinence. There is a very specific set of signs and symptoms associated with addiction. It occurs in all cultures and all socio-economic classes. Yet we continue to approach the person with addiction in the same ineffective manner used since addiction was described thousands of years ago (China and Middle East cultures have described substance abuse as early as 5,000 years ago). We continue to base our decisions on the three "M's" of addiction...Myth, Misbelief, and Misinformation. This the way we approach any situation where we have no factual understanding. Look at diseases such as Hansen's Disease (Leprosy), congenital blindness, seizure disorders and HIV. The first three were almost universally accepted as a punishment from God (in the case of congenital blindness the punishement was a result of the parent's sin), or demon possession. Then, when science began to discover the pathology of disease(s), those misbeliefs were eliminated. Yes, there are still some who continue to believe the myths, but generally it's from a lack of education. Because the topic is skirted or ignored, there has been little progress in treating addiction.

No one wants to talk about it. Ignore it and it will go away. The disease won't go away, but the addict will...either to prison, or to the morgue. Certainly not an acceptable outcome in the 21st century.

The Power of Recovery and the 12 Steps

I received a surprising email today, although, as someone who has experienced the power of the 12 Steps in my own life, I shouldn't be surprised.

The email was from a relative who has experienced the power of addiction and the even stronger power of recovery. This relative spent a fair amount of time incarcerated for several activities conducted while under the influence. I hadn't heard from him in over 20 years! I received the email today, making amends for some of the things that had occurred over the years. Yes, I accepted his amends, How could I not? I made those same amends to the people I've hurt over the years as a result of my using days.

The 12 Steps can work miracles in the lives of those who choose to truly follow them. Will we never make mistakes again? Of course not...after all, we are only human. But when we do mess up, we have the opportunity to make those amends. Recovery is a program of progress, not perfection. As with any other chronic disease, the risk of relapse...re-activation of the active form of the disease is always possible. That's exactly why we take things one day at a time.

A Tribute to Bill Wilson, Co-Founder of AA

(Author Unknown)

We died of pneumonia in furnished rooms where they found us three days after when somebody complained about the smell.

We died against bridge abutments and nobody knew if it was suicide and we probably didn't know either except in the sense that it was always suicide.

We died in hospitals, our stomachs huge, distended and there was nothing they could do.

We died in cells, never knowing whether we were guilty or not. We went to priests, they gave us pledges, they told us to pray, they told us to go and sin no more, but go. We tried and we died.

We died of overdoses, we died in bed (but usually not the Big Bed). We died in straitjackets, in the DT's seeing God knows what, creeping, skittering, slithering, and shuffling things. And you know what the worst thing was? The worst thing was that nobody ever believed how hard we tried.

We went to doctors and they gave us stuff to take that would make us sick when we drank on the principle of "so crazy, it just might work," I guess, or maybe they just shook their heads and sent us to places like Drop kick Murphy's. And when we got out we were hooked on paraldehyde or maybe we lied too. And the doctors and they told us not to drink so much, just drink like me. And we tried, and we died.

We drowned in our own vomit or choked on it, our broken jaws wired shut. We died playing Russian roulette and people thought we'd lost, but we knew better. We died under the hoofs of horses, under the wheels of vehicles, under the knives and boot heels of our brother drunks. We died in shame. And you know what was even worse was that we couldn't believe it ourselves, that we had tried. We figured we just thought we tried and we died believing that we hadn't tried, believing that we didn't know what it meant to try.

When we were desperate enough or hopeful or deluded or embattled enough to go for help, we went to people with letters after their names and prayed that they might have read the right books, that had the right words in them, never suspecting the terrifying truth, that the right words, as simple as they were, had not been written yet.

We died falling off girders on high buildings, because of course ironworkers drink, of course they do. We died with a shotgun in our mouth, or jumping off a bridge, and everybody knew it was suicide.

We died under the Southeast Expressway, with our hands tied behind us and a bullet in the back of our head, because this time the people that we disappointed were the wrong people.

We died in convulsions, or of "insult to the brain," we died incontinent, and in disgrace, abandoned. If we were women, we died degraded, because women have so much more to live up to. We tried and we died and nobody cried.

And the very worst thing was that for every one of us that died, there were another hundred of us, or another thousand, who wished that we could die, who went to sleep praying we would not have to wake up because what we were enduring was intolerable and we knew in our hearts it wasn't ever going to change.

One day in a hospital room in New York City, one of us had what the books call a transforming spiritual experience, and he said to himself "I've got it" (no, you haven't, you've only got part of it) "and I have to share it." (Now you've ALMOST got it) and he kept trying to give it away, but we couldn't hear it.We tried and we died.

We died of one last cigarette, the comfort of its glowing in the dark. We passed out and the bed caught fire. They said we suffocated before our body burned, they said we never felt a thing, that was the best way maybe hat we died, except sometimes we took our family with us.

And the man in New York was so sure he had it, he tried to love us into sobriety, but that didn't work either, love confuses drunks and he tried and we still died.

One after another we got his hopes up and we broke his heart, because that's what we do. And the worst thing was that every time we thought we knew what the worst thing was something happened that was worse.

Until a day came in a hotel lobby and it wasn't in Rome, or Jerusalem, or Mecca or even Dublin, or South Boston, it was in Akron, Ohio, for Christ's sake.

A day came when the man said I have to find a drunk because I need him as much as he needs me (NOW you've got it).And the transmission line, after all those years, was open, the transmission line was open. And now we don't go to priests, and we don't go to doctors and people with letters after their names.

We come to people who have been there, we come to each other. And we try. And we don't have to die.

Treatment Failure or Inappropriate Treatment Paradigm?

Report: David Hasselhoff Hospitalized for Alcohol Poisoning

Monday, May 04, 2009

AP

David Hasselhoff

Actor David Hasselhoff was rushed to a Los Angeles hospital Saturday after his teenage daughter reportedly found him unconscious on the floor of his Encino California home as a result of alcohol poisoning.


The former “Baywatch” star reportedly registered a staggering .39 blood alcohol level. The legal limit in California is .08 percent.

A rep for Hasselhoff later said the actor regretted drinking too much Saturday, but is otherwise doing fine.

I wasn't surprised to read this story. And the comment by the Baywatch star is a perfect example of the pathological denial that is a part of this disease. "He
regrets drinking too much, but is otherwise doing fine." Excuse me? Fine?

Mr. Hasselhoff has been to treatment in the past and had a famous video filmed by his daughter when he was so drunk he couldn't get off the floor. This latest story is a good indication of how far his disease has progressed. Without intensive long term, residential treatment, Mr. Hassellhoff will undoubtedly be found dead in the next 5 to 10 years.

Many will point to this incident as proof that drug treatment doesn't work. On the surface that appears to be a logical conclusion. That would be an incorrect conclusion.

Condemning ALL addiction treatment modalities as failures because Mr. Hasselhoff relapsed is the same as saying when a person with cancer dies it proves ALL cancer treatments don't work, or that antibiotics don't work because someone died of overwhelming sepsis.

The scientific and medical approach to "legitimate" diseases such as cancer, cardiovascular disease, diabetes, etc. is based on one simple principle...recognize the signs and symptoms of the disease as early as possible and then begin the evidence based treatment protocols as soon as possible. The longer we wait to seek medical assessment and treatment, the more difficult treatment becomes, and the chance of a full recovery decreases.

Yet this is exactly what happens in almost all cases of addiction, regardless of the chemical abused. Most individuals don't recognize the early signs of substance abuse and addiction, especially if it's a family member or a colleague. When the disease progresses and signs become more pronounced, the family and colleagues may refuse to believe that the person is developing the disease of addiction. When the signs of addiction can no longer be ignored, they might tell the person to seek help. The addict isn't capable of recognizing the disease in themselves (pathological denial) and generally reacts in anger, telling everyone they don't have a problem and they can handle it themselves. Finally, someone will spout one of myths associated with this disease: "He hasn't hit bottom yet. Treatment won't work until the addict hits bottom.

Bottom for the disease of addiction (this includes alcohol) is death. The last time I checked, death can't be treated successfully.

In order to get the addict into treatment, an artificial bottom is created through a planned and rehearsed intervention. Once the addict accepts the gift of treatment, the protocols must be evidence based (that means they can show evidence of successful treatment outcomes) and of sufficient time and intensity to achieve the desired results...abstinence from mood altering drugs and a change in the way they approach life's situations. Recovery breaks through the wall of denial of the addict, the family and colleagues while providing safe detoxification from the drugs of abuse. It provides a safe environment and the addict is taught to recognize stressors and cues that lead to drug use, and then develop skills to deal with those triggers in order to remain clean and sober.

Returning to old places and the people we used drugs with is one of the major risk factors involved in returning to drug use. Moving back home with a family who received no counseling about their issues and inappropriate behaviors developed while trying to deal with the addict is like throwing an endangered species right back into the polluted lake that was killing them in the first place.

This is a family disease, both genetically and environmentally. If the addict is treated and the family is not, relapse is likely. It's time to change the paradigm of this disease and the treatment methods from an acute model (wait until there is a crisis and send them to short term treatment) to a chronic disease model (recognize it early, intervene, and treat it aggressively for longer periods of time, and then have appropriate followup care and support). Until that happens, there will be more tragedies like Mr. Hasselhoff.

Carrying the Message of Recovery to the Nursing Community

Our society still sees addiction as a self induced disease characterized by a lack of willpower and a desire to keep using. Nothing is further from the truth. Research has shed a great deal of light on the biology of this disease, including the mapping of the areas of the brain affected by substance misuse.

I can understand how a non-health care professional would continue to believe the stereotypical view of addiction and the addict. I find it baffling that a trained health care provider would continue to believe it. Professionals are supposed to keep up with current research and published literature in order to maintain their level of expertise. With substance abuse and chemical dependence the number one public health issue, not staying current is unprofessional and unethical. Fortunately, more professional journals are beginning to publish articles dealing with this disease.

RN Magazine has published an article in the April issue. They interviewed me and Patricia Holloran (author of Impaired: A nurses story of addiction and recovery. This is a good start. Those of us in recovery must speak out if we are ever going to change the way this disease is treated.

If nurses don't accept addiction as a disease, how can we ever expect society to accept it?

Treating Addiction as a Chronic Disease

"Treatment doesn't work!" "The addict has to hit bottom for treatment to work."

Two of the most common myths held as "gospel" by a majority of the population. While it would seem to be true, nothing could be further from the truth. Imagine any other chronic disease...diabetes, hypertension, coronary artery disease. Now imagine the response if we said the same things about the disease of your choice.

"The diabetic has to hit bottom before they will seek treatment. Besides, treatment doesn't work."

Well, if we waited until the diabetic was in a coma with a leg infected and gangrenous, we would definitely think treatment doesn't work.

"The person with coronary artery disease has to hit bottom before they seek treatment. Besides, treatment doesn't really work."

If we wait until the person has a massive heart attack or stroke, we would think treatment was a joke.

This is exactly what most folks do when it comes to addiction. They wait until they can't ignore the "problem" anymore and then wonder why treatment "doesn't work". If there is to be any significant success in treating the disease of addiction, then we need to approach it in the same way we approach other chronic, progressive, potentially fatal diseases...increased education about the disease, early recognition, intervention, treatment, and long term follow up.

In other words...treat it scientifically, not emotionally.

Common Genes Tied To Alcohol, Nicotine, Cocaine Addictions

Treatment professionals have know this for at least the 19 years I've been dealing with addiction. We have more and more science to prove this is a disease and yet no one seems to want to accept it. Is hating addicts preferable to treating a deadly disease that destroys the addict and everyone around them before it finally kills the addict and others around them? It makes no sense to me.

"ScienceDaily (2009-03-16) -- For decades, finding clues to substance addiction has been much like searching for a needle in a haystack. But researchers may finally be honing in on specific genes tied to all types of addictions - and finding that some of the same genes associated with alcohol dependence are also closely linked with addictions to nicotine, cocaine, opoids, heroin and other substances."
http://www.sciencedaily.com/releases/2009/03/090310142912.htm#

Should the Board of Nursing Investigate a nurse with a DUI?

An interesting comment about a nurse receiving a DUI conviction:

"I am writing this because I am irritated that in the nursing field if you receive a DUI during your off duty time it can (and usually will) seriously affect your career. I have a colleague who has been nursing for over 40 years, they have never put patients in danger, and have never been intoxicated on shift. Yet this person receives a DUI and the BON immediately treats this person as if they are the scum of the earth."

First, with all of the ads about drinking and driving it's pretty tough to say "I didn't know..."

Second, anytime a person drives while under the influence of a mood altering chemical, whether it's alcohol, prescription medications (opioids, sedatives, tranquilizers, muscle relaxants, etc.), or illegal drugs (marijuana, cocaine/crack, amphetamines/methamphetamines, heroin, etc.) it's a sign of poor judgment. Not the type of judgment I want to see in a health care professional caring for me or my loved ones.

More importantly, a DUI is an overt sign of a serious problem with substance abuse or chemical dependence and should be referred or court ordered to treatment.

According to the website "DUI Foundation" (http://www.duifoundation.org/):

On average, the first time drunk driving offender has driven drunk 87 times prior to being arrested.

According to Rebekka S. Palmer, Ph.D., Yale University School of Medicine, and Mary E. Larimer, Ph.D.,University of Washington: in a press release on March 26, 2007:

Most first-time offenders for driving while intoxicated need help for more than just alcohol

* Driving while intoxicated (DWI) is a significant public-health problem in the US.
* New findings indicate that many first-time DWI offenders also have high rates of other substance-use disorders as well as other psychiatric disorders.
* Intervention programs may need to provide enhanced services to help this more severe subtype of DWI offenders.

Also in that press release:

"We found that 42 percent of first-time DUI offenders reported a lifetime history of drug abuse or dependence," Palmer said in a news release. "Marijuana abuse or dependence was the most prevalent, followed by hallucinogen abuse or dependence, and then cocaine abuse or dependence. Approximately 30 percent of the participants also indicated a lifetime history of anxiety or mood disorder. Social phobia was the most frequent anxiety diagnosis, and major depression was the most common mood disorder."

It always makes me shake my head when I hear the "what you do in your private life shouldn't affect your license" argument. When the things you do in your personal life are illegal or show poor judgment, the licensing agency has a duty to investigate. Their job is to protect the public from professionals who are unsafe. A professional who drives under the influence is declaring loud and clear "I make poor decisions regarding controlled substances and the welfare of others" (not to mention their own welfare).

Chemical dependence is a disease that alters the brain which alters perception, learning, and decision making. Active alcoholics/addicts are incapable of seeing they have the disease...it's called pathological denial. There are very few truly recovering individuals who would agree with the argument that a DUI should be ignored by the licensing boards. We've been there and know exactly how out of control we were before we entered treatment, and we don't want to see others go through the same living hell we've been through. While we aren't responsible for having the disease of dependence, we all MUST accept full responsibility for our recovery.

The person who struggles with substance abuse or chemical dependence usually faces an intervention before they will seek treatment. That intervention can take one of the following forms:

- Planned by family, friends or colleagues.

- An arrest and/or conviction for a DUI or diversion from work.

- Accidental overdose or trauma as a result of an accident, domestic violence or other criminal activity.

- Or death

Hopefully someone will love and respect the addict enough to perform an intervention.

If you know of someone who may be dealing with substance abuse or addiction, contact me for assistance in obtaining help before a consequence occurs that can't be remedied.

jack@jackstem.com or call me at 513-833-4584. All contact is confidential.

Don't forget to attend the nursing workshops on Nursing Law (by LaTonia Denise Wright, RN, BSN, JD) and The Impaired Nurse by yours truly. They begin next Monday March 30, at 6:00 PM. Seating is limited, so call to reserve your seat. Fee is $20.00 at the door (cash only please...receipt provided). Contact me at the resources listed above.

MARCH 30, 2009

Substance Abuse and Addiction in Nursing: The Profession’s Response
6pm-7pm

2009 RN Renewal Application and the Ohio Board of Nursing
7pm-8pm

Location:
Panera Bread
405 East Kemper Road
Springdale, Ohio 45246

Should a nurse with a DUI be reported and disciplined by the board of nursing?

I'll have more to say about this topic in the next few days. For right now, here's a blog from a nurse attorney in Texas.

DWI & Nursing License Discipline by the Texas Board of Nurse Examiners

What are YOUR thoughts about this article?

Jack

Workshop for Nurses in Greater Cincinnati, Monday March 30, 2009

Just a reminder to nurses in the Greater Cincinnati Area.

There is a workshop being presented in Cincinnati on Monday evening March 30, 2009 from 6 - 8PM.

The first presentation is from 6 - 7 PM by me. The topic: "Substance Abuse and Addiction in Nursing: The Profession’s Response".

The second presentation is from 7 - 8 PM by LaTonia Denise Wright, RN, BSN, JD of The Law Office of LaTonia Denise Wright. The topic, "2009 RN Renewal Application and the Ohio Board of Nursing".

The setting will allow for interaction with both myself and LaTonia. We are limiting the seating to 25 attendees. The price is $20.00/person. Payment is cash with receipts available. Refreshments will be provided. To make reservations, contact me at: jack@jackstem.com or call 513-833-4584.

Location: Panera Bread
405 East Kemper Road
Springdale, Ohio 45246

"Can I run this by you?".

Keep your ears open for a new recovery based radio program in Cincinnati, Ohio called, “Can I run this by you?" TM. Cynthia B. is the creator and high energy producer behind the idea. I spoke with her today by phone and she is currently seeking individuals and corporations interested in becoming involved in promoting the message of recovery. Cynthia describes the idea behind the program like this:

“Can I run this by you?" TM is a 1-hour call-in talk radio program hosted by Cynthia B. featuring interviews with individuals in, and experts of, addiction and recovery communicated through engaging and meaningful exchange of ideas. The featured radio program covers news updates and interviews around the topics of addiction, treatment, research and recovery whilst probing the spiritual components of sustained recovery. As well, this is a public affairs program with callers from the listening audience phoning in to “run something by” the host and/or guests. Maximizing your customer equity is developed using Can I run this by you? on your station or network as it provides a means for developing processes that identify, attract, and retain high value customers."

If you or someone you know would be interested in becoming a sponsor for "Can I run this by you?", you may contact me by email: jack@jackstem.com or call 513-833-4584, or you may contact Cynthia at cynthiasueblock111@yahoo.com or by calling 859-801-9461.

Updates as they become available.

"One day at a time!"

FOR IMMEDIATE RELEASE

Contact:
Jack Stem
Peer Advocacy for Impaired Nurses, LLC
513-833-4584 (Cell)
513-231-4280 (Home)
Email: jack@jackstem.com
http://www.peeradvocacyforimpairednurses.com


Helping the Helpers: Substance Abuse and Addiction in Nurses

Dateline: Cincinnati, Ohio March 07, 2009 – Nurses aren't supposed to become addicts. Their education and training should prevent this from happening, shouldn't it? Nurses who become addicts must be morally bankrupt with a lack of willpower, right?

"Hogwash!", says Jack Stem, founder and CEO of Peer Advocacy for Impaired Nurses, LLC. "Nurses develop the disease of addiction at least at the same rate as the general public. Some researchers have found a higher rate for health care professionals in certain specialties, including anesthesia, ER, and ICU. "Providing care for critically ill patients, long hours, under staffing, the expectation of perfection when caring for these patients, and the lack of respect from physicians, administrators, and even their own colleagues can cause intense pressure. Mix in sleep disturbances, lack of understanding from family members, growing up in a family with a parent who abuses alcohol or drugs, and a genetic predisposition for chemical dependence and you have the makings for "the perfect storm", says Stem.

Despite a rapidly increasing level of understanding about this chronic, progressive, fatal if untreated disease, there remains an astounding gap in getting this information to the practicing health care professional. Substance abuse and addiction continue to be seen as a lack of willpower moral corruption. “Addicts are seen as moral degenerates who have done this to themselves. They could stop if the wanted too, they just don't want to”, says Stem, a former ER nurse and certified registered nurse anesthetist (CRNA). Mr. Stem is also a recovering addict and founded Peer Advocacy for Impaired Nurses, LLC, as consulting firm focused on educating the nursing profession about the disease among it's members and advocating for appropriate treatment and monitoring. “It took quite awhile for me to finally come to grips with this disease. It cost me the most important things in my life. My marriage, the relationships with my children and family, and ultimately my career as a nurse anesthetist. I don't want to see other professionals go through the living hell I experienced due to the lack of knowledge so pervasive throughout society and the health care community. How can we expect to help the health care consumer to change their view of this disease if we can't help our colleagues? We have a professional and ethical obligation to change the way substance abuse is treated in this country. Unfortunately we aren't doing a very good job of that, are we?”

Mr. Stem has joined forces with LaTonia Denise Wright, RN, BSN, JD, a leading attorney dealing with nursing and licensure issues in Ohio,Kentucky, and Indiana. Wright and Stem have developed a series of workshops for nurses in the Greater Cincinnati area. These workshops will focus on the disease of chemical dependence, recognizing an impaired colleague, and taking steps designed to safely remove the impaired nurse from practice while helping them enter treatment programs designed to deal with the unique needs of addicted health care professionals. Ms. Wright discusses the legal and licensure issues facing the nurse dealing with substance abuse and addiction. She also provides valuable information covering a wide variety of legal issues many nurses are unaware they face on a daily basis in their practice.

The workshops begin on March 30, 2009 and will be offered throughout the remainder of the year. The first workshop is scheduled for March 30, 2009 at Panera Bread, 405 East Kemper Road, Springdale, Ohio, 45246. Mr. Stem's topic: "Substance Abuse and Addiction in Nursing: The Profession’s Response" begins at 6:00 pm. Ms. Wright will discuss "2009 RN Renewal Application and the Ohio Board of Nursing" at 7:00 pm. Fee is $20.00 at the door (receipts provided). Each workshop is limited to 25 participants.

For additional information or a copy of the titles and dates of the workshops, or to make a reservation, contact:

Jack Stem
Peer Advocacy for Impaired Nurses, LLC
513-833-4584 (Cell)
513-231-4280 (Home)
Email: jack@jackstem.com
Web Site: http://www.peeradvocacyforimpairednurses.com
Seminar dates: http://peeradvocacyforimpairednurses.com/workshops.html
Blog: http://advocacyforimpairednurses.blogspot.com/
Providing assistance for nurses dealing with substance abuse and chemical dependence. Educational programs, policy development, and assistance with interventions.

or

LaTonia Denise Wright, RN, BSN, JD
The Law Offices of LaTonia Denise Wright, LLC
11427 Reed Hartman Highway Suite 205
Cincinnati, Ohio 45241
Phone: 513-771-7266
Fax:
Email: ldw@nursing-jurisprudence.com
Web Site: http://www.nursing-jurisprudence.com/
Blog: http://www.advocatefornurses.typepad.com/
Representing, Counseling, and Advising Nurses.

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Nursing Workshops

LaTonia and I are are looking forward to providing these workshops for the nursing community in the Greater Cincinnati Area. Substance abuse and chemical dependence are a growing problem, not only in nursing, but in all areas of our society. With the current economic downturn and no end anytime soon, we can expect to see an increase. Using alcohol and prescription medications to "cope" with stress can start off as a short term remedy until the crisis is over, but for a percentage of individuals, this can turn into chemical dependence. It's an unintended consequence of genetics, exposure, and inadequate or innapropriate coping skills. This is a disease that creeps up on you. NO ONE decides to become addicted to mood altering substances. As health care professionals, it's our responsibility to assist our patients AND our colleagues when faced with a chronic, progressive, unnecessarily fatal disease. Come and learn more about the medical, professional, and legal consequences of turning a blind eye to this major public health problem. If you're interested in attending, contact me at jack@jacksem.com to ask questions or reserve your seat. Space is limited.

Nursing Workshops for 2009

LaTonia Denise Wright, RN, JD and I are providing a series of workshops for nurses in the Greater Cincinnati area. The workshops focus on Substance Abuse and Addiction in Nursing and Nursing Law and Order. These workshops will be intimate and focused in order to allow a relaxed atmosphere and encourage interaction with all who attend.

Nurses and other health care professionals are at risk to develop substance abuse and chemical dependency. Education and training does not provide immunity for health care professionals. The stigma associated with this disease prevents early recognition and intervention, allowing the disease to progress and making successful treatment with long term recovery difficult. Continuing to deal with this public health crisis by sending non-violent addicts to prison instead of sending them to treatment, will only assure failure and hopelessness for the addict and those who care abut them.

Here are the first 2 workshop dates, times, and places. Be sure to check back for the remaining schedule.

Monday, March 30, 2009

Substance Abuse and Addiction in Nursing
The Profession’s Response
6pm-7pm
presented by Jack Stem, Peer Advocacy for Impaired Nurses, LLC

2009 RN Renewal Application and the Ohio Board of Nursing
7pm-8pm
This is workshop with no CE credit provided.
presented by LaTonia Denise Wright, RN, BSN, JD

Panera Bread
405 East Kemper Road
Springdale, Ohio 45246

Monday, April 27, 2009

Is Addiction Really a Disease?
The Biology and Pathophysiology of Addiction
6pm- 7pm
presented by Jack Stem, Peer Advocacy for Impaired Nurses, LLC

What is Nursing Board Discipline and How Does It Impact A Nurse’s Employability?
7pm-8pm
This is a workshop with no CE credit provided
presented by LaTonia Denise Wright, RN, BSN, JD

Panera Bread
8420 Winton Road
Cincinnati, Ohio 45231

Workshops for Nurses

LaTonia and I are are looking forward to providing these workshops for the nursing community in the Greater Cincinnati Area. Substance abuse and chemical dependence are a growing problem, not only in nursing, but in all areas of our society. With the current economic downturn and no end anytime soon, we can expect to see an increase. Using alcohol and prescription medications to "cope" with stress can start off as a short term remedy until the crisis is over, but for a percentage of individuals, this can turn into chemical dependence. It's an unintended consequence of genetics, exposure, and inadequate or innapropriate coping skills. This is a disease that creeps up on you. NO ONE decides to become addicted to mood altering substances. As health care professionals, it's our responsibility to assist our patients AND our colleagues when faced with a chronic, progressive, unnecessarily fatal disease. Come and leaarrn more about the medical, professional, and legal consequences of turning a blind ye to this major public health problem. If you're interested in attending, contact me at jack@jacksem.com to ask questions or reserve your seat. Space is limited.

Thank you Glenbeigh!

Gary, Pat, et al.....

Thank you so much for the hospitality! You guys are AWESOME!!

Excellent dinner as well! I look forward to our next meeting.

Jack

For more information about Glenbeigh treatment facilities, visit www.glenbeigh.com

Tell them Jack sent you.

On the road to Glenbeigh!

After a wild weather day here in Cincinnati (thunderstorms, winds up to 60 MPH) I'm driving 5 hours to Glenbeigh Hospital to give a presentation on the treatment guidelines for impaired nurses and nurse anesthesia providers.

Glenbeigh has an excellent treatment facility and a top-notch treatment team with an excellent program for impaired health care professionals. With the board of nursing steering fewer and fewer nurses into treatment, focusing mainly on discipline, it's imperative for intervention as early as possible. This protects the patients while providing the intense treatment required to arrest the progress of this deadly disease.

How can nursing ever hope to provide compassionate care to the chemically dependent in society when they can't provide that care to their own colleagues?

Lack of Education About the Disease of Addiction in Nursing Programs

Below is a post from a nursing web site followed by my response. The nurse who wrote the post has graciously allowed me to reprint her question here (Thank you!)

“I see that this category has been slow moving lately and I wanted to start a new thread with a different direction. I would like to get everyone's opinion (even the people that have never suffered with addiction). What do you think about your state's peer assistance/recovery program? Do you think it is too harsh or not harsh enough? What state are you in, and do you know the rules or guidelines of your states recovering nurses program?

I just want to get a general view of nurses' education on the matter. I have noticed lately in my hospital that the nurses do not know that there is a recovery program out there. They don't know that there are options and many are scared to report someone, especially if it is their friend. They are scared to report themselves if they need help.

I know that there are more impaired nurses out there than any of us want to admit. I think that if we were educated more on the matter, we could get a better grasp on the situation.”

When I attended nursing school back in the 70's (ancient, I know), no one discussed this issue. In fact, the only real education I received about substance abuse/addiction discussed the physical effects of the different substances with the main focus on ETOH. The actual DISEASE of addiction was never discussed...ever. Working in the ER, first as an orderly and then as an RN, my attitude was these people did this to themselves and if they loved their family they would stop, or at least get help!

My education in anesthesia didn't touch on the disease, it focused on how to manage the addict while under anesthesia and postoperatively. The fact that substance abuse and addiction are the number one health risk associated with the practice of anesthesia was never mentioned, even in passing! NEVER!

A little over 8 years after graduating from anesthesia training I found myself addicted to opioids (spondylolisthesis and an eventual spinal fusion AFTER my addiction was triggered). My disease progressed rapidly as a result of access to the most potent opioids in clinical use on the planet (fentanyl and sufentanil). I went from my first IM injection to IV injection to almost dead and an interrupted suicide attempt (my Angel story) in less than 6 months.

I entered treatment "voluntarily" after an accidental OD. At the time (October 1990), there were very few programs with a focus on the addicted health care professional. Since that time numerous programs have developed for those of us unlucky enough to have this disease and be healthcare pros. In general, these programs are longer and more intense than the "standard" 28 day program. Our intelligence, access, and comfort with administering these powerful medications to our patients make us an even tougher nut to crack than the "average" addict. Because of denial (in ourselves AND our colleagues) and professional co-dependence (our tendency to make excuses and/or cover-up for an impaired colleague), the disease is allowed to progress and flourish. This means by the time a nurse gets "caught" (instead of diagnosed) the disease will be even tougher to treat, and sustained recovery is less likely. Combined with insurance companies paying for less than appropriate treatment, employers who want to "eliminate" high risk employees, and our society's desire for "justice" rather than treatment, we have the settings for exactly what most of us have experienced...total mismanagement of a chronic, progressive, unnecessarily fatal disease that destroys families, our colleagues and profession, and society, before it finally destroys the addict who "doesn't get it".

Can you imagine the outrage that would occur if cancer, diabetes, cardiovascular disease, or any OTHER chronic disease were managed the way addiction is managed? What would happen if a nurse who was also a "brittle" diabetic was fired after an episode of hypoglycemia and everyone thought she was an alcoholic? Justifiable outrage! This DOESN'T happen because diabetes is seen as a "legitimate" disease that can be managed. Even if the nurse with difficult to manage diabetes does have an occasional "relapse" no one is calling for their dismissal because it's known and accepted that this can happen with diabetics. In fact, everyone jumps in to lend a hand, cover their work schedule, and generally do whatever they can to make "recovery" happen as quickly as possible.

The above response doesn't happen for the addicted nurse because there is an appalling lack of knowledge about addiction by a majority of the profession. Read the posts here and on other nursing sites and its clear many RECOVERING NURSES don't really understand the disease. They still believe they are evil people who should have known better. When a relapse happens because of inadequate treatment and inappropriate continuing care combined with poor monitoring services and a thorough return to work contract...the nurse says "I really screwed up. How could I let this happen?" Would they say that if they had cancer, received an inadequate course of chemotherapy, little or no follow-up, and didn't know the early signs that the cancer might be active again?

People say, "Well THAT would NEVER happen!" That's probably true. Why? Because of the appropriate education nurses receive about the "real disease" of cancer.

None of this will change until our profession begins looking at the DISEASE and the risks inherent in the profession. That won't happen until the educational system governing the establishment and certification of nursing programs faces the reality of this DISEASE and the totally inept manner in which it has been dealt with to this day. That change won't happen until recovering nurses begin to step out of the shadow of the stigma associated with the disease and begin to demand change at all levels of our profession. Once that happens (and it WILL happen), society will begin to change as well.

As Bernadette Higgins Roche, CRNA, EdD states in her book, "Substance Abuse Policies in Anesthesia";

"Anesthesiologists and CRNAs must establish a culture of courage within the anesthesia community; advocating for a chemically impaired colleague requires tremendous courage and a strong commitment to integrity."

As recovering nurses WE need to be the people who make that change happen in the nursing community.

Jack

Myths of Addiction (Part 1)

I have a Google “news alert” set up for the keyword 'addiction'. It sends me a daily a email with links to a variety of news articles, blogs, etc. containing that word. As you can imagine many of the links lead to some pretty crazy things. At the same time they can give a great overall view of how society “sees” this chronic, progressive, unnecessarily fatal disease. Too many of these news stories have one thing in common, they perpetuate many of the myths associated with addiction. Let's look at some of the major myths about this lousy disease.

Myth #1: “They did this to themselves.”

This myth is partially correct. All addicts have to have that first exposure to get things rolling. No exposure, no addiction. (ALCOHOL IS A DRUG!)

Unfortunately, our culture has used mood altering substances for hundreds of years. We celebrate life (the birth of a child, birthdays, promotions, new businesses, art, etc.) and death, with alcohol. (ALCOHOL IS A DRUG!)

“It's Mary and Johnny's 21^st birthday next week. Let's take them out for their first “legal” drink!” This can be heard in businesses, colleges, and homes around the country every day. When I was practicing anesthesia, the sales-reps would show us their newest piece of equipment and then tell everyone, “When you get off, stop over at the XYZ pub/restaurant/hotel for “Happy Hour”...the drinks are on me!” For 80 – 85% of the people who drink alcohol it's no big deal. They “know when to say when”. For someone with a genetic predisposition to addiction, it can be the first exposure that begins the process of the disease of addiction. (ALCOHOL IS A DRUG!)

It is no different for people who try any other mood altering substances. Those with the genetic “wiring” to develop the disease of addiction run the risk of becoming addicted. It's genetics/exposure/chemistry/evolution. Exposure alone doesn't cause addiction. Exposure plus genetics does. A strong family history of addiction (ALCOHOLISM IS ADDICTION!) is the best “predictor” we have today. If one of your parents has a history of addiction...BE CAREFUL! You could be next. Willpower won't prevent addiction...not using mood altering substances can.

The disconnect about the disease of addiction happens because the 85% who “know when to say when” find it hard to believe the 15% who become addicts ((ALCOHOL IS ADDICTION!) can't “just say no”. Once the disease has been triggered, the ability to control use goes away. The longer the disease is ignored the worse it gets. The worse it gets, the harder it is to treat successfully and the less likely long term recovery will be achieved. We don't wait until the cancer is so advanced it can no longer be ignored. If we do, no one is surprised when treatment only provides a short period of remission before it returns with a vengeance! EVERYONE is surprised and disgusted when an addict relapses after treatment.

I have never met an addict who said, “When I was growing up, I KNEW I wanted to be the best addict I could be!” Just like no one who smokes cigarettes or uses other tobacco products wants to end up with oral cancer, lung cancer, cardiovascular disease, cerebrovascular disease, etc. These nicotine addicts (NICOTINE IS A DRUG!) “did it to themselves”, yet we don't berate them or ignore them when they end up with a horrible disease. We treat them! Treatment DOES work. Recovery IS possible. But neither will happen as long as we believe the myth that they “did this to themselves and they deserve what they get.”