The KBRC newsletter is offered on behalf of the Board to provide important respiratory care information to the therapists in Kentucky and all surrounding states.
New! Newsletter Fall Winter 2012 is now here.
Previous Newsletters
KBRC 2006 Fall Newsletter
Newsletter Summer 2007 Edition
Newsletter Fall/Winter 2007
Summer 2008 Newsletter
Newsletter Fall Winter 2008
Summer 2009 KBRC Newsletter
Newsletter Summer/Fall 2010 Edition
Newsletter Winter Spring 2011-2012 Edition
Mrs. Tamera G. McDaniel recognized at April 19, 2012 Meeting
Mrs. Tamera G. McDaniel was recognized by the KBRC Board and Staff members at it's April 19, 2012 Board Meeting for her service on the KBRC Board from 11/1/2005 - 10/31/2011 as Board Member and former Board Chair. (From left to right: Mrs. Janet R. Vogt, RRT, BHS, Current Board Chair, Tamera G. McDaniel, RRT, Peggy Lacy Moore, Executive Director of the KBRC Office.
New CRT and RRT Content Outlines available!
New detailed content outlines for both the CRT and RRT Examinations have been posted to the NBRC's website! The CRT content outline becomes effective July 10, 2009 and the RRT content outlines become effective January 1, 2010. Please see the CRT and RRT Examination web pages for details.
For the CRT Content Outline
For the RRT Content Outline
Support not punishment is the key to tackling substance abuse and addiction among nurses
As many as ten to 20 per cent of nurses and nursing students may have substance abuse and addiction problems, but the key to tackling this difficult issue - and protecting public safety - is support and treatment, not punishment. That is the key message in a paper in the February issue of the Journal of Clinical Nursing.
Researchers have recommended six key points that could be built into alternative-to-dismissal (ATD) strategies after reviewing the latest research and professional guidance from countries such as the USA, Canada, New Zealand, Australia and the UK.
They believe that ATD programmes provide greater patient safety, as they enable managers to remove nurses from the work environment quickly, unlike traditional disciplinary procedures that can take months, if not years. ATD programmes also provide non-judgemental support and treatment that encourages nurses to seek help and improve their chances of staying in the profession.
"Addiction among nurses has been recognised by professionals in the field for over a hundred years" says lead author Dr Todd Monroe from the Vanderbilt University School of Nursing, Tennessee, USA. "While research consistently reports incidence rates of 10 to 15 per cent, some studies suggest that this could be as high as 20 per cent.
"Doctors and nurses are only human and face the same problems as everyone else, which can include chemical dependency. The fact that they work in a highly stressful environment with easy access to powerful drugs can expose them to an increased risk of substance misuse and abuse. They are expected to show compassion when caring for patients who are alcohol and/or drug dependent and they should extend the same compassion to colleagues struggling with chemical dependency, which is an illness."
Research suggests that ATD programmes help many nurses recover from addiction, reduce the chance of dismissal and return to work under strict monitoring guidelines, with random substance checks, support and meetings with managers and regulators. ATD programmes can also lead to a 75 per cent reduction in practical problems, like obtaining liability health insurance after disciplinary action, and they usually help nurses to re-enter the workforce.
"ATD programmes appear to be the best way to protect patients and retain nurses at a time when the profession is facing serious shortages of experienced professionals" says Dr Monroe.
The review covers nearly three decades of research papers and professional guidance from nursing regulators and brings together a number of previous studies by Dr Monroe on substance abuse policies in the nursing profession.
"We believe that the incidence of substance abuse among nurses, and especially nursing students, is both under-researched and under-reported, partly because it is considered taboo among many healthcare providers and nursing school faculty and staff" he says.
"Poor or ineffective policies that mandate punitive action are more likely to endanger the public, as they make it more difficult for impaired nurses or students to seek help.
"That is why we support ATD strategies that motivate individuals to voluntarily seek assistance for their dependency or encourage colleagues to urge them to seek the help they need."
Dr Monroe teamed up with Dr Heidi Kenaga, from The University of Tennessee Health Science Center, to come up with six key points that they believe should be incorporated into ATD programmes developed by regulators, educators and healthcare facilties:
- Promoting open communication by discussing substance abuse in healthcare and nursing education settings.
- Encouraging an atmosphere where people feel they can report problems confidentially.
- Providing information about the signs and symptoms of impairment.
- Conducting mock interventions to help people feel less fearful or uncomfortable about approaching a colleague or fellow student about suspected chemical dependency.
- Inviting ATD experts to speak to hospital or school administrators.
- Participating in scholarly forums about addiction among healthcare providers.
"We believe that these key points will help to transform perceptions of substance abuse among nurses, so that they are seen as a medical disorder requiring treatment, rather than a moral failing" says Dr Monroe."
The information from this discussion is for those interested in health professional recovery issues. The referenced article is Monroe, Todd and Kenaga, Heidi. Don't ask don't tell: substance abuse and addiction among nurses. J Clin Nurs. 20:504-509 (Blackwell Publishing; February 2011 issue; doi: 10.111/j.1365-2702.2010.03518.x). This article provides a good review of the literature related to nurse assistance programs, including international programs. For those interested in the impact of nursing addiction, I would encourage your review of this article if you can obtain a copy.
Addicts in health professions flock to get peers' help
By Jason Blevins
The Denver Post
A group that counsels medical professionals with drug addictions and other problems has seen a 20 percent increase in patients from some disciplines, while federal agents are already investigating more drug thefts by Colorado health care workers than they handled all of last year.
In the past week, the group Peer Assistance Services has been deluged with calls, activity it traces to publicity surrounding the case of former Rose Medical Center surgical tech Kristen Diane Parker, who has admitted she stole fentanyl-filled syringes and at times replaced them with her dirty needles filled with saline. Eleven cases of hepatitis C have so far been diagnosed from Rose from the time she worked there.
"Lots of calls this week because of what's been in the paper; more nurses are realizing the severity of addiction, and they are seeking help," said Rebecca Heck, director of the Peer Assistance nursing program.
Peer Assistance, a 25-year-old Colorado program, last year worked with 84 dentists, 84 pharmacists — both more than a 20 percent increase over 2007 — and 200 nurses from Colorado, a majority of them dealing with substance abuse.
Stress, access, stigma
High-pressure work and easy access to medications contribute to the problem. Meanwhile, fear of losing respect, licenses and livelihoods often keeps health care professionals from stepping forward and admitting substance abuse or addiction.
The federal Drug Enforcement Administration is handling 11 cases of Denver-area health care workers pilfering medication so far this year, up from nine in all of 2008.
But while the number of health care workers admitting to substance-abuse problems or facing criminal drug charges is increasing, the problem is not epidemic. Various studies show that anywhere from 7 percent to 15 percent of health care professionals will struggle with chemical dependency during their careers, a ratio that mirrors that of the general population.
And the number seeking help could be considered a sign that programs designed to eliminate the stigma of seeking treatment are having an impact.
Until the late 1970s, drug addiction in the health care industry was largely addressed punitively. Licenses were revoked, careers crushed and addicts jailed. That made doctors, nurses, dentists and pharmacists reluctant to confess addiction or pursue help, further endangering patients. Even now, when addiction is better understood as a disease, health workers fear coming forward.
"It is extremely difficult to acknowledge because it is admitting to human frailty, and we as health care professionals are held to a higher standard," said Elizabeth Pace, chief executive of Peer Assistance.
For a Boulder County pharmacist, the problem began slowly, with a single pain pill to help her unwind after a hard day's work. One became a handful. Then pills in the morning and a few more at lunch. Colleagues in the pharmacy noted her weariness and weight loss. She responded vaguely, something about marital problems.
"Then it progressed very quickly and very insidiously. That's when it got scary. And still, I didn't quit," says the whisper-voiced pharmacist of 30 years, who is back at work in the pharmacy and therefore asked to remain unnamed. "It got to the point where this was going to kill me or I was going to jail."
Next month, the woman with a ready laugh will celebrate 14 years drug-free, thanks to Peer Assistance.
In the 1980s, informal programs began to flourish in several states that allowed health care workers to pursue help in their fights against addiction without forfeiting their licenses or facing discipline from their certifying boards. Those programs have since flourished, and many, like Peer Assistance and the Colorado Physician Health Program, boast five-years-sober success rates as high as 85 percent.
Monitoring Required
Peer Assistance requires participants to attend regular meetings, submit to random urine tests and have their work closely followed by peers and mentors. Violation of any requirement typically leads to an immediate suspension of a medical license.
"I had so much overwhelming shame about my secrets," said a 51-year-old Denver-area nurse who was once named Florida's Nursing Student of the Year but fell into abusing alcohol and cocaine. Following a three-year recovery program with Peer Assistance, she has been sober for 22 years. She asked that her name not be used because she remains in nursing.
"I didn't understand I had a disease," she said. "I thought I was bad and I had let down my entire profession. I had let the world down. I really thought my punishment should be that I should die."
Experts say crushing the stigma of addiction starts with education in medical, dental, nursing and pharmacy schools.
"Students are lucky if they get two hours of lecture on the disease of addiction," said Brian Fingerson, a Kentucky pharmacist who has studied chemical dependency among health care workers for 23 years.
Fingerson holds regular lectures for medical students, arming them with ways to recognize the signs of addiction in both themselves and their colleagues. He wonders about Parker's co-workers.
"Are the people who worked around this person maybe scratching their heads — I hope they are — and saying, 'What didn't I recognize? Why didn't I see this?' " Fingerson said. "That's where we need to educate health care professionals to recognize the signs and symptoms of addiction before it endangers patients."
That education should also be directed at hospital administrators, who sometimes must choose between quietly firing a pill-plundering employee or calling for help, which can lead to public scrutiny.
"There are probably people alive right now because some hospital administrators had the guts to say we are going to call in an airstrike on ourselves and fix this problem the right way," said Jeff Sweetin, agent in charge for the Drug Enforcement Administration's Rocky Mountain region.
The DEA's Office of Diversion Control works closely with hospitals in securing, controlling and monitoring medications subject to abuse. Sweetin said the agency's top ally in the fight against workers stealing medicine is other medical employees.
"There are not many professions that police each other so well," Sweetin said. "The suspects then are amazingly candid with us about what procedures they use and how they did what they did. We always ask what we can tell the hospital to make their system better, and that typically leads to changes in the system."
Jason Blevins: 303-954-1374 or jblevins@denverpost.com