Substance use and mental illness among nurses: workplace warning signs and barriers to seeking assistance.

BACKGROUND: Although some studies have examined the prevalence of substance use among nurses, few have assessed substance use in the workplace or early cues for identifying these health conditions. Primary data collected as part of a larger program evaluation were examined with the purpose of better understanding (a) the context and perceived consequences of substance use and mental illness among nurses and (b) barriers and opportunities for earlier identification and treatment of these issues among nurses, their colleagues, and employers. METHODS: Anonymous surveys were mailed to 441 active and recent participants of a peer health assistance program in the summer of 2010. The survey examined drug-related behaviors in the workplace; behavioral cues that may permit earlier identification of substance use and mental illness; perceptions of barriers to seeking assistance; and strategies for preventing problems and overcoming barriers to seeking assistance. RESULTS: Responses were received from 302 nurses (69%). Nearly half (48%) reported drug or alcohol use at work, and two fifths (40%) felt that their competency level was affected by their use. More than two thirds of respondents thought their problem could have been recognized earlier. The most highly rated barriers to seeking assistance for substance use and mental illness included fear and embarrassment and concerns about losing one's nursing license. Respondents recommended greater attention be paid to early identification of risk factors during nurses' professional training as a prevention strategy. CONCLUSIONS: Findings from this study provide preliminary data that can be used by schools of nursing and health care employers to improve early identification of nurses' substance use and mental illness treatment needs. These data also suggest a need for more research to explore the prevention and early identification of co-occurring disorders in health care settings where nurses practice.

The prevalence and patterns of substance abuse among nurse anesthesia students.

The purpose of this study was to assess the prevalence, demographic factors, outcomes, and preventative measures for substance abuse among nurse anesthesia students over a 5-year period from 2008 to 2012. An electronic survey was sent to 111 program directors of accredited nurse anesthesia programs in the United States. Twenty-three programs (response rate = 21.7%) reported data related to 2,439 students. Sixteen incidents of substance abuse were reported for a 5-year prevalence of 0.65%. Opioids were the most frequent drug of choice (n = 9). The programs identified no predisposing risk factors in 50% of the incidents. For the students, reported outcomes included voluntary entry into treatment (n = 10), dismissal from the program (n = 7), loss of nursing license (n = 2), and 1 death. Pre-enrollment background checks and drug testing for cause were the most commonly reported screening practices. The most frequently reported prevention strategy was wellness promotion education. The prevalence was lower among student registered nurse anesthetists, as compared with certified registered nurse anesthetists. Although additional studies are necessary to verify this finding, an opportunity might exist for programs to be proactive in assessing risk postgraduation. Future studies evaluating the effectiveness of wellness promotion efforts might lead toward a standardized, best practice approach to risk reduction strategies.

Substance abuse among oral healthcare workers.

The abuse of both licit and illicit substances by the general population affects at least one in ten people. Research shows that the oral healthcare worker has at least the same prevalence of substance abuse, perhaps even higher. The emergence of prescription drug abuse is one of the most worrying and dangerous aspects for the healthcare worker, due to ease of access to such drugs. According to the United Nations, prescription drug abuse is amongst the top three practices of substance abuse. We have an obligation to incorporate the evidence of substance abuse among oral healthcare professionals in our undergraduate dental curricula in order to combat this phenomenon. As the stress of daily survival in single practitioner practices increase, so will the danger of substance abuse. This may lead to impairment of the healthcare worker and ultimately loss of registration. It will take a combined effort from organised dentistry and academic institutions to establish a national strategy to ensure we address this important issue at undergraduate level and provide support at practitioner level. This paper will deal with substance abuse and the implications of impairment it holds for the oral healthcare worker.

Drugs and alcohol found in civil aviation accident pilot fatalities from 2004-2008.

INTRODUCTION: The Federal Aviation Administration (FAA) Office of Aerospace Medicine sets medical standards needed to protect the public and pilots from death or injury due to incapacitation of the pilot. As a part of this process, toxicology testing is performed by the FAA on almost every pilot who is fatally injured in an aviation accident to determine the medical condition of the pilot, medications used by the pilot at the time of the accident, and the extent of impairment, if any. METHOD: The data were extracted from the FAA toxicology database for all pilots who died from 2004 to 2008 in aviation accidents. RESULTS: The laboratory received and tested specimens from 1353 pilots who died in aviation accidents between 2004 and 2008; 507 of these pilots were found to be taking drugs and 92 had ethanol in excess of 0.04 g x dl(-1). DISCUSSION: This study was conducted to determine the extent of drug use in pilots who have died in aviation accidents from 2004 to 2008 and to determine the types of drugs most commonly found. A comparison of previously published reports with this study's report was made to determine trends in drug use by pilots who have died in aviation accidents over the past 20 yr. Factors were discussed that could influence drug trends. Diphenhydramine, an H1 antihistamine with impairing properties, is the most commonly found drug in pilots who died in an aviation accident.

The annual incapacitation rate of commercial pilots.

INTRODUCTION: Scant data are available on the annual incapacitation rate of aircrew. This study analyzes all incapacitations occurring among UK commercial pilots, in flight and off duty, in 2004 to derive a baseline minimum annual incapacitation rate for the UK commercial pilot population. METHOD: The study cohort was all professional pilots holding a valid UK/JAR (Joint Aviation Requirements) Class 1 medical certificate and license in 2004. Three data sources were used to identify episodes of incapacitation: the statutory notification of prolonged illness, personal injury, or pregnancy to the UK Civil Aviation Authority; Mandatory Occurrence Reports (MORs) for in-flight medical incidents; and death certificates. The total number of incapacitations was expressed as a proportion of the number of professional pilots to give an incapacitation rate. RESULTS: In 2004 there were 16,145 UK/JAR professional pilot license holders. Of the notified medical events, 36 presented as incapacitations; half were cardiac or cerebrovascular. In-flight incapacitations were predominantly of psychiatric cause. There were four sudden deaths. The type of incapacitation varied with age. A male pilot in his 60s had 5 times the risk of incapacitation of a male pilot in his 40s. The annual incapacitation rate was 40/16,145 = 0.25%. DISCUSSION: Aeromedical emphasis on minimizing cardiovascular risk and monitoring the mental health of pilots remains appropriate. Age should influence the content and periodicity of regulatory aeromedical assessments. The demonstrated annual incapacitation rate of 0.25% may provide a basis for quantifying the acceptable risk for a pilot undertaking single pilot commercial air transport operations.

Opioid abuse among nurse anesthetists and anesthesiologists.

Abuse and dependency on potent opioids have long been recognized as problems among nurse anesthetists and anesthesiologists. Research has provided insight into the incidence of abuse, risk factors associated with this type of dependency, identification of an impaired provider, treatment for abuse and dependency, and prevention strategies. Although several factors influence the development of abuse and dependency, access to potent opioids likely has a large role. This access also makes returning to practice while in recovery extremely difficult because the temptation for relapse continually surrounds a recovering anesthesia provider. There is research supporting successful reentry of anesthesia providers into the practice of anesthesia; however, research also reveals high relapse rates among anesthesia providers who return to the practice of anesthesia. This article reviews the literature regarding opioid abuse and dependency among nurse anesthetists and anesthesiologists and offers implications for future research.

Professional boundary violations and mentalizing in the clergy.

Increasing attention has been focused on mental health problems of clergy in light of long work hours, extraordinary demands, and diversity of tasks. In this communication we report findings from the psychiatric evaluation of 70 Episcopal priests. We describe psychiatric diagnoses, but our focus is on two common themes that emerged: difficulties maintaining professional boundaries and problems with mentalizing, i.e., imagining the impact of their behavior and words on others. Recommendations for education and prevention are addressed.

Physician wellness: a missing quality indicator.

When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

Superficial supervision: are we placing clinicians and clients at risk?

Mental heath nurses recognise the importance of professional boundaries and therapeutic relationships and understand that clinical supervision is an important component to good clinical practice and their ongoing professional development. This qualitative constructivist grounded theory research has uncovered a potential risk in contemporary mental health clinical practice, where the desire for expedient answers may compromise the outcome of formal structured supervision. The notion of a new concept 'superficial supervision' and its implications for formal structured supervision are explored.

Civilian aviation fatalities involving pilot ethanol and a previous record of substance abuse.

INTRODUCTION: Pilots are subject to the same temptations as the general population, but due to the demands of flying, the use of ethanol or other impairing substances are more likely to have severe consequences. The Federal Aviation Administration (FAA) requires pilots to report all adverse legal actions involving their use of ethanol and/or other drugs. The purpose of this study was to evaluate fatal civil aviation accidents between the years 2000 and 2007 in which ethanol was present in the pilot and the pilot had a record of previous drug and/or alcohol offenses. METHODS: Case histories and accident information for the period under study were obtained from the National Transportation Safety Board (NTSB). Toxicological information was obtained from the Civil Aerospace Medical Institute's Forensic Toxicology Research Laboratory. RESULTS: During the examined period 215 of the 2391 pilot specimens received for toxicological analysis had documented alcohol or drug related offenses. Of the 215 pilot specimens received, 23 showed evidence of ethanol consumption prior to the fatal incident and 16 of those had ethanol concentrations above the FAA's legal limit of 40 mg x dl(-1). DISCUSSION: These results confirm earlier reports that pilots with previous alcohol and/or drug offenses are more likely than others to engage in repeated substance abuse in association with flying with resultant fatal accidents. These findings support the NTSB's recommendation that the FAA implement more thorough verification of alcohol and drug offenses as a means of identifying pilots at increased risk of causing accidents.

A Retrospective Descriptive Study of Nurses With Substance Use Disorders in Texas.

There are approximately 3.1 million nurses in the Unites States (U.S. Census Bureau, 2016), and approximately 8% of them experience substance use disorders (Kunyk, 2015). Nurses with impaired practice are referred to peer assistance programs as they seek rehabilitation. As of 2016, 348 nurses in Texas Peer Assistance Program for Nurses were actively participating in the program for substance-abuse-related offenses. Over the last 6 years (2010-2016), 1,553 nurses were referred to Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. These represent 2% of the population of nurses in Texas. The average age of participants was 40.1 years. Women represented 75% of participants, and 76% were registered nurses. About 41% successfully completed the program without relapsing, and 32% reported at least one relapse. Varieties of drugs were abused including prescription drugs and illegal drugs. Opioids were the most frequently abused class of drugs, followed by alcohol and stimulants. Most nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical-surgical units, and home health care had the highest prevalence of impaired practice. Psychiatric comorbidity was not significantly associated with relapse, but self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of abstinent days. Men were also more likely to be employed while in the program.

Complaints about chiropractors, osteopaths, and physiotherapists: a retrospective cohort study of health, performance, and conduct concerns.

Background: Recent media reports have highlighted the risks to patients that may occur when practitioners in the chiropractic, osteopathy and physiotherapy professions provide services in an unethical or unsafe manner. Yet research on complaints about chiropractors, osteopaths, and physiotherapists is limited. Our aim was to understand differences in the frequency and nature of formal complaints about practitioners in these professions in order to inform improvements in professional regulation and education. Methods: This retrospective cohort study analysed all formal complaints about all registered chiropractors, osteopaths, and physiotherapists in Australia lodged with health regulators between 2011 and 2016. Based on initial assessments by regulators, complaints were classified into 11 complaint issues across three domains: performance, professional conduct, and health. Differences in complaint rate were assessed using incidence rate ratios. A multivariate negative binomial regression model was used to identify predictors of complaints among practitioners in these professions. Results: Patients and their relatives were the most common source of complaints about chiropractors, osteopaths and physiotherapists. Concerns about professional conduct accounted for more than half of the complaints about practitioners in these three professions. Regulatory outcome of complaints differed by profession. Male practitioners, those who were older than 65 years, and those who practised in metropolitan areas were at higher risk of complaint. The overall rate of complaints was higher for chiropractors than osteopaths and physiotherapists (29 vs. 10 vs. 5 complaints per 1000 practice years respectively, p < 0.001). Among chiropractors, 1% of practitioners received more than one complaint - they accounted for 36% of the complaints within their profession. Conclusions: Our study demonstrates differences in the frequency of complaints by source, issue and outcome across the chiropractic, osteopathic and physiotherapy professions. Independent of profession, male sex and older age were significant risk factors for complaint in these professions. Chiropractors were at higher risk of being the subject of a complaint to their practitioner board compared with osteopaths and physiotherapists. These findings may assist regulatory boards, professional associations and universities in developing programs that avert patient dissatisfaction and harm and reduce the burden of complaints on practitioners.

[Retrospective analysis of the accidents causing work inability in a teaching hospital during the time 2002-2006]. / Analisi retrospettiva degli eventi infortunistici causa di inabilità lavorativa relativi al quinquennio 2002-2006 in un'Azienda Aspedaliera Polo Universitario.

This study is a retrospective inquiry, based on the data of University Hospital "L. Sacco" in the period of five years 2002-2006. They were analyzed the relevant data to beyond 350 events cause of working inability.

Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability.

OBJECTIVE: To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability. PARTICIPANTS: Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009). DESIGN AND MAIN OUTCOME MEASURES: The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model. RESULTS: ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health. CONCLUSIONS: ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.

The prevalence of alcohol, cigarette and illicit drug use and problems among dentists.

BACKGROUND: Primarily on the basis of qualitative data, use of alcohol and illicit drugs has been speculated to be higher among dentists. The authors conducted a study to assess self-reported substance use by dentists and compare these data with those regarding physicians and the general population (GP). METHODS: A total of 113 dentists (65.3 percent) and 104 physicians (63.4 percent) from a northeastern state responded to a seven-page self-report survey during the summer of 2002. The survey assessed health care professionals' alcohol, cigarette and drug use; consequences of use; disciplinary occurrences and treatment; and professional and social influences. RESULTS: Although about twice as many physicians as dentists reported heavy alcohol use, a greater number of dentists reported heavy episodic alcohol use over the past year and past month, as well as having more alcohol-use problems than physicians. Roughly twice as many physicians and three times the GP reported using anxiolytics than did dentists. More dentists than physicians reported past-year, but not past-month, minor opiate use. While more dentists reported being in social situations in which they were offered alcohol, more physicians reported being offered alcohol by pharmaceutical companies at various functions. CONCLUSIONS: Contrary to previous speculation, there is little evidence from the prevalence data the authors analyzed for this report to suggest that dentists are at a greater risk of developing alcohol- or other drug-use problems than is the GP. PRACTICE IMPLICATIONS: While the findings of this study do not suggest that substance use is more prevalent among dentists, educational institutions and state organizations still must be vigilant in educating, monitoring and encouraging dentists to voluntarily receive treatment.