More than 120 Maine doctors, nurses and other healthcare professionals participated in a substance abuse and mental health monitoring program in 2021, part of a steady increase over the past three years, according to a new report. status report.
Although they represent only a small percentage of the overall workforce, the growing number of professionals in the program comes at a time when healthcare workers are under grueling demands during the pandemic, and also reflects the increase in substance abuse in the general population.
Records reviewed by The Maine Monitor show cases ranged from a doctor showing up at a hospital drunk to a nurse trying to get a prescription in the name of a family member.
Guy Cousins, director of the Medical Professionals Health Program, said the increase in the number of professionals entering the intervention program reflects greater education and awareness to reduce the stigma associated with drug and alcohol abuse, and the support needed to treat the conditions.
The Health Professionals Health Program is part of the Maine Medical Association and contracts with state licensing boards to provide mental health support and random toxicology testing.
“Our mission is really to protect the public and to help healthcare professionals be able to practice at their highest level of care,” Cousins said.
Last year, 123 Maine medical professionals were referred to the MPHP for the first time, an increase of nearly 10% from 112 in 2019. And Cousins expects this year to continue this trend.
The new participants included 57 nurses, 39 medical doctors, 12 pharmacists, 10 dentists, four osteopathic doctors and one veterinarian.
Professionals can be referred to the program by someone, required to attend by a licensing board, or register voluntarily.
The number of voluntary participants has increased slightly over the past three years. The cousins said this represents successful awareness of the program and declining stigma as our understanding of substance use disorders improves.
More people could take part in the program, he said, if the pandemic starts to slow down and medical professionals have time to catch their breath and think about seeking help.
Caring for those who provide care
The program’s healthcare professionals represent a very small percentage of the overall healthcare workforce in Maine. For example, the 57 nurses monitored by the MPHP represent less than 0.2% of the Maine Board of Nursing’s 32,000 licensees.
However, it is important to provide support for professionals whose behavior could compromise their ability to provide the highest standard of care, Cousins said.
Last year, 21 nurses were disciplined by the board of nursing for incidents involving drug or alcohol use, according to a review by The Maine Monitor of disciplinary records.
In one case, a nurse took oxycodone pills at work. Another was visibly drunk. And another nurse picked up a prescription on behalf of a patient.
In a similar review of disciplinary action taken by the Maine Board of Licensure in Medicine, seven physicians and physician assistants were disciplined for drug or alcohol use last year. A doctor arrived drunk when called to the hospital. Another met a patient outside of work and received medication from him.
Experts estimate that 10-15% of the general population struggles with substance abuse. And the the pandemic has exacerbated these numbers.
The proportion may be higher for healthcare professionals, Cousins said. Doctors, nurses and other healthcare workers deal with the physical, psychological and emotional pain of their patients, sometimes with very little respite. During the COVID-19 pandemic, in particular, there has been higher demand, faster care, fewer resources and a shrinking workforce.
They also work in settings with access to medication.
“There’s sometimes this projected expectation that the other person on the other side doesn’t have issues when in fact they have families, they have relationships, they have jobs, they have stressors. at work, they’ve got professional challenges,” Cousins said.
Participants can be followed for several years, depending on individual situations. In 2021, there were 264 active participants in the MPHP program and 54 have completed the program.
Last year, 127 participants underwent toxicology tests and seven were checked for alcohol.
Healthcare professionals are rightly held to high ethical standards, Cousins said. But it is important to remember that they are human and fallible. The expectation of perfection is unattainable and unfair, he said.
“If we’re going to put them on a shelf or put them in this idealistic place, that’s a setup,” Cousins said. “It’s a setup for expectations that are definitely not being met.”
Stigma also creates barriers for people seeking help, he said. The science around substance use disorders has evolved in recent years, but many still fear being labeled and having negative career impacts if they seek help.
Healthcare workers can request assistance from the monitoring program confidentially.
The Board of Nursing may also mandate someone to complete the program. He is required to investigate any complaint he receives. If a violation of the Nurse Practice Act related to substance or alcohol abuse is found, the board offers the licensee a consent agreement which may include supervision. The licensee can sign the agreement or request a hearing, after which the commission issues a decision and an order. The holder may appeal this decision to the district court.
A nurse is allowed to continue practicing while under supervision as long as probationary terms are met, said Kim Esquibel, executive director of the State Board of Nursing. At the end of the agreement, a nurse can ask the board to end the probation.
“The board’s goal is to allow them to continue to practice safely in a monitoring program,” Esquibel said. “They give them the opportunity to continue to earn a living and to continue practicing, as long as they practice safely and are supervised.”
The State Board of Licensure in Medicine follows a similar pattern for physicians. The council investigates a complaint and can schedule a hearing, offer a consent agreement, or refer the case to the district court.
The council’s mission is to protect the public, said its executive director, Dennis Smith. It does not provide direct health care services, but supports physicians and physician assistants “through education, outreach, annual financial support to MPHP, free continuing medical education, and, when necessary, through action directed and structured remedies required by a decision and a consent order or agreement”.
The need to take care of yourself
The pandemic has highlighted the need to emphasize self-care among nursing students as a preventative measure, said Brenda Petersen, associate dean of the University of Southern Maine School of Nursing.
Students learn about substance abuse and the process with the nursing board. But resilience practices must be incorporated into lessons so nurses learn to navigate difficult situations to avoid falling into self-medicating practices, she said.
That’s especially true during the pandemic, when medical professionals grapple with a “moral injury,” which goes beyond burnout, Petersen said.
“Moral hurt” is a term used to describe one’s way of dealing with good and bad.
“For moral harm to occur, the individual must feel that a transgression has occurred and that they or someone else has crossed a line from their moral beliefs. Guilt, shame, disgust, and anger are some of the hallmark reactions to hurt feelings,” according to the U.S. Department of Veterans Affairs.
“The pandemic has shown us that we need to do a better job of really preparing nurses for everything we know they need within that skill set, and that includes how they are really engaged in the personal care,” Petersen said.
Petersen said she tries to build a culture of accountability where co-workers directly ask themselves what they did that day to take care of themselves.
“We lack nurses who can handle the environment, the stress and all that goes with it. We have an obligation on the education side to teach our nurses how to manage this stress so that we can keep our caregivers strong.
Rose Lundy covers health care for The Maine Monitor as a member of the Report for America body. Contact her at email@example.com.