Mississippi — Edition 17
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A Story Worth Telling
Paula Davies Scimeca

Everyone has a story worth telling, especially nurses. While some can teach us how to succeed in life or render optimal care to patients, others can provide us with light bulb moments of insight into the dilemmas which confront us, either on or off the job. Some stories may even serve to shield us from making choices we might later regret or prompt us to awareness of a threat we never recognize.<br /> <br /> Such is the case of twenty-nine nurses who entrusted me with their very personal and intimate stories of long term recovery from addiction a few years ago. One story in particular provided mega-watt illumination into an aspect of nursing I had never before considered as possibly leading a nurse towards a diversion of drugs. <br /> <br /> Since nothing happens in a vacuum and other nurses may benefit from her candid remarks, which were uttered more as an aside than as any excuse for taking controlled substances from work, here is what she said: “After working in intensive care for six months, I went to work in another hospital’s ICU. That’s when it happened. I started diverting. I’m not sure why I started, but when I look back I remember what relief I felt when my patients would experience pain relief after I medicated them. I don’t remember if it was physical or emotional pain that I had, but I started medicating myself.” (Scimeca, 2010.) <br /> <br /> Although studies since the terrorist attack on the World Trade Center have illustrated that caregivers are at great risk of selfmedicating in an effort to reduce the stress associated with witnessing human tragedy and suffering (NYC, 2007; Peluso, 2010), the subtle effects of repeatedly witnessing the relief of pain in others over the course of a career has not yet been researched. <br /> <br /> Clearly compassion is an attribute that is valued in the nursing profession. Caring and sensitivity are characteristics that rank high on any patient’s wish-list for a caregiver and appear to be a pre-requisite to any nurse’s ability to deliver quality care. For these reasons, our training as nurses cultivates our ability to readily recognize pain, and pain relief, in our patients. <br /> <br /> Looking back over my own career as a nurse, these finely tuned qualities also served to escalate my stress and anxiety level when caring for patients in severe pain. While I did not divert medication to diminish my distress, I do recall feeling a rush of anxiety relief when I checked medication records and found that potent narcotics could be administered to my patients in pain. The more experience I had medicating patients in excruciating pain, the more accustomed, and the more conditioned, I became to anticipating the relief of patient symptoms which prompted a corresponding drop in my own discomfort. <br /> <br /> Ivan Pavlov proved beyond doubt that repeated exposure to the sound of a bell could become so closely associated with food that the sound of the bell could cause salivation in the absence of food. Similarly, it seems plausible that witnessing the relief of pain countless times a day over the course of a career could condition a nurse’s brain to pair the administration of controlled substances to others with a personal feeling of stress relief, which is clearly what the nurse quoted above was describing. <br /> <br /> Rather than a single cue such as a bell, there is an elaborate and precise protocol of steps that nurses follow in administering controlled substances. Over decades of practice, these highly predictable and sequential activities may ultimately become triggers which provide vicarious symptom relief to some nurses whose brains pair these events as inseparable. Such a conditioned response could explain, at least in part, why nurses who most frequently administer narcotics to patients are more likely to divert medications than nurses who administer narcotics less frequently to patients (Trinkoff, 2000; Dunn 2005). <br /> <br /> Statistics attest to the fact that nurses have a greater tendency to misuse and abuse prescription medications than the general public (Trinkoff, 1999) and that the majority of disciplinary cases brought before any State Board of Nursing in the U.S. are related to a substance use disorder (NCSBN, 2009). In 2012, the Minnesota Controlled Substance Diversion Prevention Coalition released the finding that reports of drug diversion by healthcare professionals more than doubled in that state between 2005 and 2010. (Minnesota Hospital Association, 2012) <br /> <br /> The possibility that a nurse might become conditioned to pair the administration of narcotics to patients with his or her own vicarious stress relief merits study, especially in view of the escalating rate of drug diversion noted in Minnesota. Establishing such a link may help the profession, the healthcare system and other stakeholders enhance nurse narcotic safety in the future. In the meanwhile, it seems wise for all nurses to be vigilant in their own health, wellness, self-care and self-regulation practices so they may have the resilience and coping skills necessary to meet every personal and professional challenge they face. <br /> <br /> REFERENCES: <br /> <br /> Dunn, D. (2005). Home Study Program: Substance abuse among nurses- defining the issue. AORN Journal,82(4), 573-596. <br /> <br /> Minnesota Controlled Substance Diversion Final Report, March 2012. Accessed online on 5-20-2012 at http://www.mnhospitals.org/inc/data/drug-diversiontoolkit/ drug-diversion-final-report-March2012.pdf <br /> <br /> National Council of State Boards of Nursing. (2009). Discipline Data 1996-2006. Chicago: Unpublished. <br /> <br /> New York City Department of Health and Mental Hygiene. (2007). One In Eight WTC Rescue and Recovery Workers Developed Posttramatic Stress Disorder. Accessed online 8-22-2011 at: http://home2.nyc.gov/ html/doh/wtc/html/news/2007-1.shtml <br /> <br /> Peluso, P. (2010). FDNY Was Faced With Alcohol, Drug Abuse Problems Following 9/11. Firehouse. Com News accessed online 8-22-2011 at: http://www. Firehouse.com/stateprovince/new-york/fdny-was-facedalcohol- drug-abuse-problems-following-911 <br /> <br /> Trinkoff, A. M., Storr, C. L., & Wall, M. P. (1999). Prescription-type drug misuse and workplace access among nurses. Journal of Addictive Diseases, 18(1), 9-16. <br /> <br /> Trinkoff, A. M., Zhou, P. Q., Storr, C. L., & Soeken, K. L. (2000) Workplace access, negative proscriptions, job strain, and substance use in registered nurses. Nursing Research, 49(2), 83-90. <br /> <br /> Scimeca, P.D., (2010). “From Unbecoming A Nurse to Overcoming Addiction.” Sea Meca, Inc., N.Y., p. 153.<br /> <br /> This article was written by Paula Davies Scimeca, RN, MS, specifically for the Mississippi Board of Nursing Magazine. Scimeca obtained her baccalaureate degree in nursing from Adelphi University and her graduate degree from SUNY Stony Brook. Her career has spanned over three decades, with the first ten years spent in medical, surgical and critical care nursing. She has over twenty years’ experience in addiction and psychiatric nursing, as well as a background in occupational health, case management and legal nurse consulting. Since 2003, her professional endeavors have been solely devoted to chemical dependency in nurses. As the author of “Unbecoming a Nurse,” http://www.unbecominganurse.org/about.html, Scimeca’s mission is to inform nurses and the public regarding the risk of chemical dependency in the profession, promote efforts which may prevent the development of an issue, and advance endeavors which provide support and advocacy for nurses who are or become chemically dependent.