Support for nurses who struggle with mental illness or substance use disorders

By Jonathan Sher

On an intensive care unit where nursing staff and doctors try to stop or stall death, an Ontario RN engages in a more private fight, keeping secret an addiction that she knows compromises the quality of her care.

Kathy* worked hard to earn a plum assignment in 2007 at a teaching hospital, and did so hiding her addiction, she says. While she never used alcohol or narcotics while working, by the one-year mark in the ICU, she knew her conduct away from work was hampering her ability to look after patients.

“Everything was spiraling downwards,” she says. “I was less than my best.”

Kathy hid her addiction for another two years, unwilling to be exposed to public shame and professional disaster. That’s why she is thrilled that four Ontario nursing organizations, including the Registered Nurses’ Association of Ontario (RNAO), have joined forces to create a path for nurses who need support for mental illness and/or substance use disorders. It is a path that focuses on recovery, not shaming and punishment.

Launched in January 2019, the Nurses’ Health Program (NHP) provides nurses a way to seek help outside the glare that comes when they are reported to the College of Nurses of Ontario (CNO), referred to the Fitness to Practice Committee, and have restrictions or conditions placed on a public register. Similar programs exist for other health professionals in the province, including pharmacists, physicians and veterinarians.

The new program is run independently of CNO, which provides two of the eight members of NHP’s board, the other six split evenly among RNAO, Ontario Nurses’ Association (ONA), and the Registered Practical Nurses Association of Ontario (RPNAO).

“RNAO is delighted to partner with CNO, ONA and RPNAO in developing this program. Nurses who are dealing with issues of mental illness and addiction need support to overcome their challenges,” RNAO CEO Doris Grinspun explains. “NHP offers them a new avenue. We take great pride in being able to offer a program like this.”

Nurses have two avenues to NHP. They can contact the program and seek help on their own, or, if they are reported to CNO, they may be given a choice to enrol in NHP as an alternative to a possible health inquiry process, so long as they comply with their treatment and monitoring plan, including any limits placed on them. At no time will their health disorder be publicly disclosed.

This anonymity will not shield nurses from public accountability. Those who can’t practise safely won’t be allowed to do so. And nurses who too often fail to follow through on treatment and monitoring commitments can be removed from NHP and referred to CNO. “This program is a huge step forward. It will help nurses to get the specialized treatment and support they need, so they can work towards healthy recovery to be able to continue in their dedication to high-quality patient care,” ONA President Vicki McKenna says.

Indeed, NHP strikes the right balance between protecting the public from harm and providing timely and confidential support for nurses who need it. “There is significant research showing that voluntary and confidential professional health programs are highly effective both in supporting recovery and protecting the public,” says Anne Coghlan, CNO’s chief executive officer.

From a nurse’s perspective, the NHP approach is far better for everyone, Kathy says, because a strictly punitive approach drives nurses to hide illness and addiction, something that places them and their patients at risk.

After years of treatment and monitoring that included twice weekly urine tests, CNO’s Fitness to Practice Committee removed restrictions on Kathy’s license, and she began her search for a nursing position. She estimates more than 200 employers turned her away. The few that offered interviews did so having not read Find a Nurse, the public register. When she volunteered the information on the register – which she believed she was obligated to do – she was quickly shown the door.

NHP assigns a case manager to each nurse, which is critical, Kathy says. “It’s so helpful to have a human face and voice you can talk to. Otherwise, the self-hate and self-loathing (can be) overwhelming,” she says. “I had suicidal thoughts. You know you let your profession down, yourself down, your family down.”

Nurses place so much focus on helping others, they too often neglect themselves, says RPNAO CEO Dianne Martin. “I’m proud that this evidence-based program will help tackle the stigma and support nurses to come forward and get the help they need.”

Now clean for nine years, Kathy is enjoying work and life. She’s worked hard for clarity and peace, and thinks that NHP could have provided a far speedier and less traumatic path to recovery. “(Nurses) always envied doctors because they had a program that offered (confidentiality). This is such a great step.”

*A pseudonym has been used to protect privacy.

Jonathan Sher is senior writer for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the January/February 2019 issue of Registered Nurse Journal.