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.
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MAP posted-by: Jay Bergstrom