Research Proposal on "Substance Abuse in the Medical Profession"

Research Proposal 13 pages (3961 words) Sources: 15

[EXCERPT] . . . .

Substance Abuse in Nursing Puts Patients at Risk

The nursing profession is one that is staunchly backed by advocate organizations and groups, which look out for the rights and well being of their professionals. The American Nurses Association's (ANA) online Journal lists as its primary dictum, "First, do no harm (ANA, 2009)." The dictum is in regard to the numerous patients that enter physician offices, clinics, or hospitals, either by way of a physicians order, or through the Emergency Department (ED) of a hospital (often referred to as "emergency room or ER). Under the strict oversight of managed care today, no patient is admitted to a hospital inpatient setting without having first been assessed for that specific level of care. Patients entering through the ED are often in recent or immediate onset of medical crisis, and must still be certified by managed care for medical necessity to justify admitting the patient to an inpatient level of care. Either way, by a physician's order for a direct admission, or admission through a hospital ED, the oversight by managed care organizations certifies the acute condition suffered by the patient that warrants the care at an inpatient level of care. These patients, and patients at lesser levels of care, place their trust in the physicians and nurses who attend them.

The dictum, "First, do no harm," is one that acknowledges the unspoken trust that patients place in their medical caregivers, especially nurses, who are more than ever before patient care managers. From the nurse perspective, the dictum cautions the nursing professional to be alert, and to be attentive to the patient's medical needs with meticulous and detailed nursing notes to support their actions and the decisions they make about the patient's condition and the care delivered by the nursing professional. When the nursing professional abuses substances like alcohol, prescription drugs, or illicit drugs; the nurse is in violation of the dictum, and patients under his or her care are at risk.

Recent literature on studies of nursing professionals has yielded statistics reflecting ten percent of the nursing population has substance abuse problems, and six percent have problems severe enough to interfere with their performance of their duties and responsibilities of patient care (Talbert, 2009). Abuse of prescription medications has been reported as the most prevalent form of substance abuse among nursing professionals (Dunn, 2005). The potential for harm to the patients under the care of an impaired nurse is obvious. Less obvious is the extent to which individuals have been injured, or, worse, patients who might have died as a result of negligent nurses practices as a result of a nurse under the influence of alcohol or drugs.

It becomes immediately clear when researching the topic of substance abuse by nursing professionals that the healthcare industry and the professional nursing organizations and journals are very protective of the profession, and careful of the ways in which they approach this serious social issue in the information that is written and published on the subject (Dunn, 2005, 82(5)). When putting in the keyword "nursing," literally thousands of newspaper articles, professional organizational journal articles, books, and other published materials on nursing. When the keywords are refined with specificity towards substance abuse in the industry, the search engine return diminishes by the thousands. On the Gale search engine, the results went from over a hundred thousand articles on nursing, to just 49 articles when the keyword "nursing" was modified with specificity to "nurse professional substance abuse among nursing professionals." Of the 49 articles returned on the Gale query, only two articles, Trinkoff and Stor (1998) and West (2002) were peer reviewed studies producing quantitative research and statistical data yield.

The yield of results in the search for professional organizational journals and peer reviewed research on the subject is, at best, guarded; and with good cause. The medical practitioner and provider industries are under the microscope in many ways today: liability insurance for practitioners/providers; fraud, abuse, and waste; quality control and infection control; billing for services vs. services and diagnostically related group (DRG) validity; and, in the public spotlight now, national or public healthcare insurance for the millions of uninsured Americans. From each aspect of scrutiny, the provider and practitioner is under pressure to provide quality care, and to deliver the care with integrity and professionalism. Concerns of widespread professional healthcare provider or practitioner substance abuse could jeopardize Medicare, Medicaid, and even some private reimbursements to the provider/clinic/practitioner; and could ostensibly begin a snowball effect of individual and class action law suit activity which might devastate the industry. From these perspectives alone, we can see the serious impact that widespread substance abuse in the nursing profession could have on the industry.

Also, those places where nurses are employed, hospitals, clinics, physicians' offices, as well as the professional oversight organizations, and especially the registered nurses licensing boards all take substance abuse very seriously. State agencies are responsible for licensing nurses (Dunn, 2005). The agencies are responsible for ensuring that licensed nurses possess the skills and abilities to perform their duties (Dunn, 2005). If the nurse is found incompetent, unable to perform his or her duties, or puts the patient at risk, then, ". . . The license is not earned or is suspended or revoked (p. 775). Thirty-nine states have intervention programs and work to help the nurse find an appropriate rehabilitation program, but allow for return to work with review and supervision (p. 775). The issue of licensing, license suspension, or revocation rests with the licensing board (p. 775). Therefore, the subject of substance abuse among nurses is not a subject to be approached carelessly, but approached with an eye towards addressing the issue and resolving problems quickly when they are identified.

This essay will seek to answer the questions:

In what circumstances have patients been found to be harmed or found to have been at risk of harm by nurses with substance abuse problems?

Is the industry minimizing the extent of the problem, and putting patients at risk?

Do nursing professionals have a professional ethical and moral responsibility to report their peers in instances where they suspect or know substance abuse is putting patients at risk; and are they reporting?

Is the response to substance abuse by nurses responsive to patient safety?

What does the nursing industry and nursing professional oversight agencies recommend as the action to be taken when a nurse is found to be abusing alcohol, prescription drugs, or illicit drugs?

This essay is based on a study of existing literature and studies on substance abuse among nursing professionals. The review is to gain an understanding of the information that exists on substance abuse among nursing professionals, and to understand how, when, and where patients are most at risk when under the care of a nurse who is a substance abuser. An annotated literature review provides an at glance look at the materials selected in support of this essay thesis: patients are at risk as a result of nursing professionals who abuse alcohol, prescription drugs, and illicit drugs.

Literature Review

Introduction

The prevalence of substance abuse among nurses is a problem, and has been the source of peer reviewed studies and research in order to gain a better understanding of how to address the problem within the industry. Research from both quantitative and qualitative studies indicate that industry-wide, ten percent of nursing professionals providing patient care suffer from substance abuse, and six percent are impaired by their substance abuse as to cause the patients they attend to be at risk of harm. Patient safety and care must be the primary focus of the medical industry, and when substance abuse poses a risk to patients, action must be taken as quickly as possible to circumvent that problem.

This literature review examines the existing literature to understand how substance abuse is perceived by the professionals in the medical and nursing industries.

Review

Unlike many other web sites, the professional nursing organizations' online journals provide industry information that is written, reviewed, and approved nursing professionals for posting on their professional organization web. The American Nurses Association online Journal (ANAJ) is one such professional organization web site. The web site updates nursing professionals on important events, legislation, and industry-related discussions that the profession might find interesting and useful in their continuing education and work. The web site reiterates on its home page, found online at http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/environmentalhealth.aspx, information, including the nursing dictum, "First, do no harm (2009)." A review of the site shows that it is a professional tool, intended to keep the nursing professional aware and updated on points of interest to a nursing professional. It is, for the lay person, revealing about the hard work and dedication that nursing professionals expend in preparing their selves to become nurses, and to maintain their skills and expertise as they work in their profession. The site is professionally maintained, and the reader of the information gains a sense of the pride and cohesiveness that is shared by nursing industry professionals. It… READ MORE

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