Two months ago, the results of the Philippine licensure examination for nurses was released amid the anxiety-ridden days and nights spent by the tens of thousands of hopefuls and their families who all waited with bated breath for the announcement by the Philippine Regulation Commission.

Such is the premium that we have given to Florence Nightingale’s profession that for many Filipino families, a nursing course in college seems to be the saving grace to an otherwise humdrum existence in this country. However, many locals are unaware of the true state of things in hospitals in the United States, considered a mecca for Filipino nurses because of the attractive benefits one gets from the Land of Milk and Honey. Unfortunately, the milk and honey have since then dried up because of the current retrogression of nurses in the USA. Moreover, nurses in the US have not exactly lived up to the standards of the profession for reasons that may be known to them alone. Recent information from researches about this phenomenon will bear us out.

These days, the use and abuse of drugs among health care workers is a sad, but very real health problem. Nurses who abuse drugs endanger themselves as well as the health and safety of patients who depend on their mental, emotional, and critical thinking skills for recuperation and recovery.

Nurses have the duty to safeguard all patients from harm; to assume responsibility and accountability for all their actions; uphold competency and participate in the profession’s efforts to establish and maintain conditions of employment conducive to the delivery of excellent nursing care. These are the basic tenets of the profession, the essentials expected of a nurse.

A nurse who is a drug user or drug dependent can jeopardize the delivery of quality health care services to patients who already are experiencing precarious, guarded, or fragile health conditions. Conversely, a nurse who gains access to prescription medications may propagate the vice that has silently consumed his/her well-being and could deprive the patient of needed prescription that would have addressed the current ailment. Further, the advent of computer technology in the dispensation of drugs in a health care facility makes it easy for a malefactor to procure controlled drugs.

The issue on the controversial mandatory pre-employment drug testing will eventually occupy centerstage. However, a one-time pre-employment drug testing will not bring about a long-term solution to the proliferation of drug users in the health care industry. A person with drug problems may be a product of years of abuse and neglect in society, thus, they take drugs to escape the realities of their world.

While drugs do not extinguish sorrows, these may provide temporary relief from problems. Therefore, a person tested negative for drugs during pre-employment drug testing may later turn out to be positive for drug use if the person, during the course of employment, may have resorted to drug use as a means of coping with changes in current circumstances, whether psychological, emotional, physical, or financial in nature.

The more challenging and stressful the circumstance, the more likely the drug seeker tends to find relief. And yes, some do go into drug use as a new form of recreation.

To use or not to use drugs is a choice any person can make. If one decides to take drugs, he or she is merely exercising the basic right of choice. However, this right is not  absolute, especially when it tramples on the rights of helpless individuals. Such is the position of a nurse relative to the delivery of safe health care to his/her patients.

It is, therefore, imperative that an employee who exhibits actions that create reasonable suspicion or if an employee’s job performance has been compromised in any manner and objective evidence supports that drug usage is a consideration, then  another drug testing may be called for. However, subjecting a person to a drug test after employment needs hard-core support by the company, emphasized in the policy and procedures, and strongly communicated at the time of orientation.

 Aside from the mandatory pre-employment drug testing, an annual drug screening may be implemented as part of the culture to fortify and protect compliance of a drug-free environment resulting in more competent, safe, and trustworthy health care providers rendering excellent care for those they serve.

It is disconcerting to note and somehow ironic that, of all the health care providers, nurses are more prone to drug addiction or substance abuse. Not only is this alarming, it also defeats the education and the training they had to undergo with the purpose of caring for and nurturing their patients/clients.

This is a reality, however, especially in the workplace where substance abuse and narcotics diversion is a growing problem among professionals. While it may be difficult to pinpoint the reasons why professionals, like nurses, subject themselves to such a despicable situation, it would be interesting to delve into existing data that support this phenomenon in American hospitals.

      It was only in 1984 that the American Nurses Association recognized narcotics use and diversion as a problem. Substance abuse among nurses has been found to range from 2 percent to 18 percent. Furthermore, the rate of prescription type drug misuse was pegged at 6.9 percent. Chemical dependency was likewise estimated by the American Nurses Association at 6 to 8 percent or roughly between 130,000 and 170,000.

The North Carolina State Board of Nursing, in a study done in 2001, revealed that in Cincinatti alone, police enforcers have arrested at least one health care professional every six days because of substance abuse and addiction. Of the number, 70 percent were nurses. The study, however, qualified that despite this relatively high occurrence of addiction among nurse, not all have been caught or have actually been reported. Thus, the number can drastically go higher, most especially that the study was done seven years ago.

While it may be easy to identify some tell-tale signs that a health care professional is into drugs, like absenteeism or change of behavior and attitude, other nurses and even some employers tend to go into denial. They refuse to acknowledge the fact that, indeed, a colleague needs help and attention in terms of  rehabilitation.

Alcohol and drug dependency are covered under the American Disability Act of 1990, which means that for so long as an individual is pronounced to be suffering from such dependency, appropriate assistance programs and education are supposed to be provided for them. These individuals can also be productive in society because the Act provides that they should not be discriminated against in terms of employment and other worthwhile opportunities. In other words, everyone – drug dependents included – has all the right to equal opportunities in the workplace just like anyone else. However, the erring nurse is not covered by the Act if his/her presence in the workplace serves to endanger the lives of patients as well as their safety.

It is for this reason that appropriate measures be undertaken if a nurse is eventually permitted to do a re-entry into the profession. A supportive environment, especially after rehabilitation, is really most helpful. People tend to judge other people by what they have done or committed, and for a nurse-substance abuser, this kind of environment is the least that he/she would need. Peers and colleagues have been proven to be very effective support system for the nurse.

In Indiana, for example, it has a 12-step treatment plan for these nurses who have gone astray, so to speak, which was replicated in other places in the United States. Similarly, state-wide programs can be adapted to ensure that the nurse goes back to mainstream society without too much fanfare.

It is extremely important for the nurse to seek help for treatment before being allowed a conditional practice of the profession. This is similar to granting a provisional clearance to practice nursing again – not exactly on a clean slate, but knowing that you are on your way to recovery.

A system should also be devised so that hospital administrators can monitor the progress of all their workers, without reason of race or creed.

While the above recommendations necessarily assume that a nurse is actually into substance abuse or drug addiction, and perhaps, undergoing rehabilitation, what can be done to nip the bud in the first place?

This is where drug testing should be seriously considered and thought about very carefully by all concerned sectors. Not only should a satisfactory result emerge from the drug testing if done among fellow employees, it can also be done to all those who would like to apply for a job and to make it a requirement before employment. We can also consider periodic random drug testing, preferably unannounced. The costs entailed certainly far outweigh the benefits drug testing for employees would do to the company.

In a profession that is supposed to be a caring and nurturing one, the nurse should also be given security. They may have performed below par because of drug addiction, but for so long as they have been able to bounce back from their predicament, they should be allowed re-entry into the workplace in accordance to specific measures.

All in all, education plays a key role in recognizing the problem and helping recovering nurses with re-entry into the workplace.