National Nurses United

Books:1 copy 9/2/09 3:34 PM Page 13 If there's one crucial difference between the United States and all the other countries he surveyed, says Reid, it's the moral dimension. Whether a society should "guarantee health care, the way we guarantee the right to think and pray as you like, to get an education, to vote in free elections? Or is medicine a product like a car, a computer, or a camera?" media recently. The new Showtime drama Nurse Jackie follows an RN protagonist with an addiction to painkillers. And a recent Los Angeles Times article questioned the efficacy of the California Board of Registered Nursing's program for addicted nurses. Yet there's still too little discussion about or insight into why registered nurses become addicted to drugs or alcohol, how these situations can be prevented, and what can be done to rehabilitate nurses who use. Patricia Holloran's gripping and easy-to-read memoir, Impaired, offers a first-hand account of what happens when your typical, highachieving registered nurse starts abusing a drug to cope with work and home, then gets caught and has to defend her nursing license and rebuild her life. The story starts in June 1996, when the author is confronted by hospital administrators and state drug control officials for stealing the drug Stadol from work, then flashes back to the start of her slippery road to addiction. Holloran is a 45-year-old, experienced labor and delivery RN working nights at a hospital in Connecticut, married with three teenage sons. Two years earlier, with increasing stress at work due to hospital restructuring, Holloran had started using Stadol Nasal Spray—with a prescription from her doctor—to treat her migraine headaches. While not a controlled substance by the Food and Drug Administration, Holloran soon started depending on the spray to help her sleep and "cope when the exhaustion and anxiety became intolerable." Holloran also often administered Stadol at work to laboring mothers as a pain medication, but the dosages ordered were usually less than one vial. One day, she pocketed the remainder of a vial to inject into herself at home (as a diabetic, Holloran was used to giving herself injections). "I began taking home whatever Stadol remained in the vials I administered to patients. It seemed to make sense. The injectable Stadol worked much faster than the nasal spray—five minutes as opposed to fifteen—and I wouldn't have to call my doctor's office for so many prescriptions. I couldn't possibly become addicted to it. All of the literature stated that it wasn't physically addicting," she wrote. When Holloran's disabled, elderly father came to live with her family and she became largely responsible for his extensive care on J U LY | A U G U S T 2 0 0 9 top of her normal duties as wife, mother, and RN, her stress load skyrocketed. She had difficulty sleeping, and used Stadol to get more rest. Soon, instead of merely carrying home remainders of vials, Holloran was stealing whole vials and beginning to inject the drug intravenously instead of through her thigh muscle. Luckily, Holloran's drug addiction appeared never to have directly harmed a patient. But hospital administrators eventually caught on to the large amounts of missing Stadol and confronted Holloran. On that day, her entire life turned upside down. She was forced to admit that she was an addict. As Holloran describes, it's particularly hard for registered nurses and other healthcare providers to admit they have a substance abuse problem. As educated and trained medical professionals, they believe that they better understand drugs and their effects. As RNs, Holloran said that she and her coworkers looked down upon addicts. "Never in my nursing education or during my nursing career had I learned about what it really meant to be an addict. Yes, I had been told that it is a disease, but I had never truly accepted that 'theory.' I thought that once someone went through treatment for a month or so their problem was solved. I thought that they would no longer experience cravings, and that any desire to return to the drug was purely the result of their being weak-willed or selfish or lacking moral fiber...Contempt for addicts was pervasive among nurses, including me," wrote Holloran. In the rest of the book, Holloran recounts in detail her treatment program, the wonderful support network of both RNs and recovering addicts she befriends, her legal fight to save her RN license before the Connecticut Board of Nursing, the drama of coming out as an addict to her husband, kids, and friends, and finally, the constant inner struggle and growth she experiences. Holloran W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

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