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Out From Under the Bus

Posted on by CDC's Safe Healthcare Blog

Paula Davies Scimeca, RN, MS, CARN
Paula Davies Scimeca, RN, MS, CARN
Guest Author: Paula Davies Scimeca, RN, MS, CARN
Many health professionals believe that reporting a colleague’s alcohol or other drug problem is “throwing them under the bus.” However, most professionals in recovery from a substance use disorder agree that they were already under the bus that was going to run over and kill them. Most experts in peer assistance, including myself, concur that without responsible reporting, the professional may not only die, but harm patients. Yet there is another gallery of voices that must be heard to truly see the impact of this dilemma.

Several years ago, I received an email from a man I never met. He recounted a story I’ve heard too many times. The tale was of a nurse, his 35-year-old fiancée, who was found dead of an accidental overdose at the hospital where she worked. Although the man was still grieving one year after her death, what troubled him most was that co-workers saw signs of her substance problem at work and did nothing.

Moved by these stories, I conducted an on-line survey to capture the experience of those left behind after a nurse dies of an overdose. One survey participant shed some light on the issue, stating, “Behavior that I would be alerted to in a patient I was blind to in a colleague.” However, the total sample of nearly eighty respondents almost unanimously reported that there was awareness of a substance problem in the workplace that was not reported or individuals intentionally turned away from signs of the problem. Indeed, the experience of silence and denial is so pervasive that Monroe and Kenaga wrote an article in 2010 titled, “Don’t Ask, Don’t Tell.”1

Drug Diversion: A growing risk to patient safety
Drug Diversion: A growing risk to patient safety
This denial has very real implications for patient safety. Countless patients are put at risk of receiving substandard care by impaired nurses including potential exposure to life-threatening infections, such as when a nurse reuses a syringe while diverting injectable narcotics. Intentional blindness to a colleague’s condition clearly violates the American Nurses’ Association’s (ANA) Code of Ethics.2 By following this code, we not only protect colleagues and patients, but also honor the plea of the man who lost his fiancée – that her life not be in vain.

  1. Monroe, T. and Kenaga, H. (2010) “Don’t ask, don’t tell: Substance abuse and addiction among nurses.” Journal of Clinical Nursing, 20, 504-509.

  2. American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Retrieved on 8/18/2016 from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html

Paula Davies Scimeca, RN, MS, CARN, is a recognized expert on addiction and recovery in nurses. Author of “Unbecoming A Nurse,” she sits on the Nurse Advisory Panel for the New York State Office of Alcohol and Substance Abuse Services and various committees focused on education and prevention of substance use disorders.

Posted on by CDC's Safe Healthcare Blog

4 comments on “Out From Under the Bus”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    As a peer assistance advisor for OSANA I have had the opportunity to help many nurse anesthetists and nurse anesthesia students face this disease. We’ve had overwhelming successes and underwhelming outcomes, including death. What Ms. Davies has published here is absolutely true…punitive regulatory boards prevent the impaired professional from seeking help until there is no other alternative. As with any chronic, progressive disease, early recognition and treatment provides the best hope for a positive outcome. As a former CRNA, recovering addict with over 21 years of sobriety, and now as a chemical dependency counselor, I see the negative outcomes of continuing to treat all addicts with punitive measures instead of treatment. We can’t treat a disease with punishment and expect positive outcomes. We are currently discovering the results of failed political and legal policies. Time to end the stigma and reach out with effective treatment protocols.

    Paula, nice article. Short and right to the point about healthcare worker’s responsibility to “see something, say something.” I want to use your thoughts and experiences, in your article for potential trainings of our nurses and the stigma of “snitching” that is often cited by nursing staff. I have not read your book yet, but intend to, with the hopes it can assist in our training processes.

    I worked with a nurse in the 1980’s she was always offering to give my narcotic injections to my patients on the floor. When she was not working my patients said the pain shot I gave worked better than hers. It turned out she was using. She did go through rehab and is still working in a” no access to narcotic” role.

    Just a reminder that OSHA requires annual retraining of all employees with potential exposure to “blood and other potentially infectious materials.”

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