Pubdate: Tue, 12 May 2009 Source: Winnipeg Free Press (CN MB) Copyright: 2009 Winnipeg Free Press Contact: http://www.winnipegfreepress.com/info/letters/index.html Website: http://www.winnipegfreepress.com/ Details: http://www.mapinc.org/media/502 PUT PATIENT BEFORE THE ADDICT The Manitoba Nurses Union's concern and compassion for the welfare of their members with addictions is understandable, abundantly so for the thousands of Manitobans who struggle with substance abuse and have seen their jobs threatened by the addiction. Limiting the damage that addictions can wreak upon lives must be the primary concern of employers, unions and community members. No one could argue with the position that it is best for nurses -- doctors, lawyers, teachers or bakers, for that matter -- abusing substances to be encouraged to report themselves to their regulators or employers in order that the appropriate steps be taken to deal with the addiction, safeguard patients and return the worker to health. Where the agreement ends, it appears, is where hard lines should be drawn. The Manitoba Nurses Union, not the College of Registered Nurses, is drawing that line, in insisting that nurses with addictions never be named, publicly, even upon discipline for their behaviour. There may be some room for negotiation in current practice, but prohibiting the naming of nurses, period, is probably not the solution. The college has the responsibility of ensuring those who hold a licence to nurse are capable, competent and trustworthy, that the work they do is up to standard and the care delivered is in the interest of the patient. Addictions can imperil patients if they are not managed before they progress so far as to impinge upon the work life of a nurse. And if that is the case, then there is work to be done in encouraging nurses to report themselves, something that relies heavily upon convincing nurses their best interests, too, are at stake. Last year, four nurses were disciplined and named in the college's journal for their substance abuse problems. The disciplining came about after it was found that the nurses had repeatedly failed or refused treatment; that discipline was a last resort. This indicates that the college works to assist nurses in need, but also draws a line when it appears that the addiction is not under control and, if it goes unchecked, will endanger others. The alternative to making a nurse's continued practice conditional -- restricting the scope of practice, demanding treatment and proof of improvement -- is to cancel a nurse's registration, an extreme measure as it affects the person's livelihood and future and can compound the problem of addiction. In Ontario, when a nurse is incapacitated by mental illness or addiction, his or her practice can be restricted and the public can see that limitation but not the reason for it. This can protect patients, while avoiding the stigma that is attached to mental and physical conditions that render a nurse incapable of meeting standards of care, and of being judged untrustworthy with the lives of patients. Ultimately, the college as regulator must strike the delicate balance between risks and benefits of playing out sufficient rope to a nurse in need of help, and keeping it taut enough that he or she can be reined in before someone is hurt. Not every nurse struggling with an addiction need be named, but similarly, the college should be able to make public identification a condition of continued practice where it is felt warranted. Ultimately, a conditional registration is the nurse's choice. - --- MAP posted-by: Jay Bergstrom