The Importance of Alternative to Discipline in your State

There is often resistance from the CRNA/SRNA with substance use disorder to accept help. Complicating matters, there can also be resistance from coworkers or supervisors to offer help. Traditional workplace discipline is often punitive & leads to loss of job, license, or career. A void is filled with hushed conversations, judgment, and fear in the wake of discovery. The default action is often inaction. What if a program existed that protects the public and the livelihood of the CRNA/SRNA by keeping sensitive health information private? What if this program assisted hospitals and employers in streamlining help? Indeed, programs in association with State Boards of Nursing (SBON) exist. Many states, although unfortunately, not all states provide Alternative to Discipline (ATD) pathways. All fifty states have ATD for physicians, sometimes called “diversion programs” or Physician State Health Programs (PSHP). Patient harm, patient death, selling diverted medications & substituting medications can disqualify any anesthesia professional from participation in ATD, regardless of license.

Nurses with substance use disorders are three times more likely to admit their problem in states with ATD programs than in states with traditional discipline programs. A study published in Nursing Research concluded that alternative-to-discipline programs for nurses potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more nurses with substance use problems, thereby initially removing more nurses with active substance use problems from direct patient care. ¹

The purpose of the ATD program is to: 1) ensure public safety through the early detection, treatment, and monitoring of nurses who have SUD. 2) provide the opportunity for rehabilitation for nurses who acknowledge they have, or are at risk for, a condition that may impact their nursing practice, and wish to obtain the treatment and/or support needed to maintain safe practice. The overall goal of ATD monitoring programs is to help a healthcare professional with a substance use disorder successfully complete treatment, maintain sobriety, and effectively reintegrate into a career and home life.

ATD programs create a supportive environment where the healthcare professionals can be forthcoming about their progress of recovery. Completion of in-patient & out-patient treatment, 12-step participation, random urine drug screens (UDS), employer reports & counselor reports allows the BON, the employer, and the family to gain assurance that recovery is in process.

CRNAs on BONs must advocate for the well-being of all nurses. We have a responsibility to guide members on the occupational hazards specific to anesthesia professionals. Ignorance allows fear to fester, pushing the threat underground and into darkness. Our whole profession suffers when a CRNA/SRNA is found comatose or dead or incarcerated due to the behaviors of end-stage SUD. When a recovering anesthesia professional complies with an ATD program contract and successfully re-enters practice, it is a win-win situation for everyone. The health, dignity, license, and profession of the recovering individual are restored, colleague support is justified, department morale is increased, the professions retain highly competent practitioners, and public safety is protected.² Supporting the return to work or new hire of a recovering anesthesia professional is an affirmation that SUD is a treatable disease and may result in helping the next suffering CRNA/SRNA or physician anesthesiologist. Early treatment for SUD contributes to better outcomes. Like the change in reporting & discussing medical mistakes, a change of culture from discipline to alternative for those with SUD, allows all healthcare providers to feel secure and free in order to help our brothers and sisters. If you see something, do something. Confidential support is available 24/7 through the AANA Helpline: 1-800-654-5167.

1- Munroe, T. B., Kenaga, H., Dietrich, M. S., Carter, M. A., Cowan, R.L. (2013). The prevalence of employed nurses identified or enrolled in substance use monitoring programs. Nurs Res 62(1): https://journals.sagepub.com/doi/10.1177/0193945920987123
2- Roche, B. T. (2007). Substance abuse policies for anesthesia. All Anesthesia.