Peer Assistance Mission Statement

ANA Resolution
Originally drafted at the International Conference on the Addicted Nurse
Announcement for Websites and Newsletters

A CALL TO ACTION: The following resolution reflects the efforts of many nurses working in
peer assistance all across our country. The intent of this activity was to bring about
continuity of approaches and fairness so that ALL nurses, regardless of geographic location,
would be offered advocacy. It has taken years to get to this resolution process after much
networking and now WE NEED YOU, to encourage YOUR state nurses association's delegates
to the ANA House of Delegates to support his resolution. They will be the voting members
who decide whether this resolution is adopted or rejected. Since it IS based on the initial
resolution of 1982 by the ANA our hope is that it will be accepted. However, it is not a
given. The reason the signatory organizations have brought this resolution is because we
feel we need to unite as ONE voice, behind ONE national organization with broad
membership to have the desired effect to bring about change in EVERY state. As you know
many states still have no alternatives to discipline and/or no advocacy for nurses. The only
effective way to encourage ALL state regulatory boards to consider changing is to bring
about sufficient demonstration of the success of those programs that do offer alternatives
and to have a united voice. Please get this message to all nurses through your state
newsletters, websites, meetings and support groups. It is the broadest reaching attempt to
bring about nursing advocacy in two decades and long overdue.

GIVE YOUR FAVORABLE OPINION ON THIS RESOLUTION TO THE NURSES WHO ARE YOUR
REPRESENTATIVES FROM YOUR STATE NURSES ASSOCIATION WHO WILL BE THE VOTING
MEMBERS AT THE HOUSE OF DELEGATES IN JUNE.

ENCOURAGE THEM TO VOTE IN FAVOR OF THIS RESOLUTION. IF IT IS PASSED IT WILL THEN
BE A MANDATE FOR ANA TO ENCOURAGE ALL STATES TO HAVE AN ADVOCACY-BASED
ALTERNATIVE FOR NURSES. THIS WILL ALSO MEAN THE URGING OF LEGISLATION TO
DEVELOP ALTERNATIVE PROGRAMS IN THOSE STATES WITHOUT ANY. LET YOUR
REPRESENTATIVE KNOW IT IS THE HUMANE WAY TO TREAT A DISEASE, OUTCOME STUDIES
HAVE DOCUMENTED IT IS THE SAFER THAN TRADITIONAL DISCIPLINE SINCE NURSES REMOVE
THEMSELVES FROM THE WORKPLACE SOONER, REENTER SOONER, RECEIVE APPROPRIATE
MONITORING AND MORE ARE RETAINED IN PRACTICE. IN THIS TIME OF ACUTE NATIONAL
NURSING SHORTAGE, THIS IS ANOTHER MAJOR REASON TO TREAT AND RETAIN THOSE
NURSES WILLING TO VOLUNTARILY SUBMIT TO MONITORING WITHIN AN ALTERNATIVE
PROGRAM. For more information contact peerassist@aol.com

RESOLUTION before the ANA House of Delegates, Philadelphia, PA, June, 2002
(As submitted in its final form)

SUBJECT: Reaffirming the Profession's Response to the Problem of Addictions and
Psychological Dysfunctions in Nursing

RELEVANT CORE ISSUE: Nursing shortage, workplace advocacy

INTRODUCED BY: K. Lynn Wieck, RN, PhD., President, Texas Nurses Association on behalf of
the signatory organizations.

EXECUTIVE SUMMARY: A changing workplace, multi-state compacts, and decreased access to
reimbursed treatment programs for the nurses with addiction or psychiatric disorders
creates a heightened need to readdress the lack of universal alternative-to-discipline
programs. To maintain standards of the profession and a sufficient workplace, ANA should
advocate for comprehensive and consistent access to alternative-to-discipline programs for
nurses with addictions or psychiatric disorder. This report addresses the preservation of the
health and professional practice of nurses with addiction and/or psychiatric illness.

RECOMMENDATIONS:

WHEREAS, substance abuse, the number one preventable national health problem, occurs
among registered nurses at rates at least similar to those reported in the general
population; and,

WHEREAS, education promotes the early identification of, intervention with, and treatment
of, persons, including registered nurses, who experience addiction and psychiatric
disorders; and,

WHEREAS, treatment is effective in reducing drug use, deterioration of health, improved
social and occupational function; and,

WHEREAS, nurse employment policies and procedures supportive of alternative-to-discipline
programs result in improved employee job function and return and retention of nurses to the
workforce; and,

WHEREAS, the American Nurse's Association Code of Ethics for Nurses mandates workplace
advocacy and promotion of nurses' well-being; and,

WHEREAS, society's health needs require the preparation, support and retention of a healthy
workforce; and,

WHEREAS, in ten states, nurses do not have access to programs that provide alternatives to
discipline during recovery; and,

WHEREAS, the development of multi-state licensure compacts underscores the need for
consistent availability of alternative-to-discipline programs across all jurisdictions; and,

THEREFORE BE IT RESOLVED that the American Nurse Association will:

Support efforts to educate the public and professional nurses on the prevalence of addiction
and psychiatric disorders as diseases for which society and registered nurses are at risk.
Seek to preserve the current and future workforce by promoting awareness of impaired
practice, its prevalence, management and implications for public safety and well-being.
Increase awareness of the health and patient safety risks associated with untreated
addiction and psychiatric illness.
Promote member and affiliate actions that encourage the development and use of
alternatives to discipline for health professionals in those states where they currently do not
exist.
Support expansion of peer assistance to include professional nursing students.
Support efforts by United American Nurses and the Commission on Workplace Advocacy to
advocate for the retention of nurses who experience addiction and psychiatric disorders.

REPORT:

In 1980 the Ohio State Nurses Association introduced the resolution "Peer Assistance
Program for Nurses Impaired by Illness or Chemical Dependency" to the American Nurses
Association's (ANA) House of Delegates. The resolution, along with an overview to the
problem and a model for planning and change to help guide organizations, was provided in
ANA's 1984 monograph: "Addictions and Psychological Dysfunctions in Nursing: The
Profession's Response to the Problem," (American Nurses Association, 1984)

Since that time, "alternatives to discipline" programs, offering comprehensive monitoring
and support services to reasonably assure safe practice, maintenance of nursing standards
and rehabilitation of the nurses, have been developed in many states. These are used by
regulatory agencies, often collaboratively with nursing organizations, schools of nursing and
state boards for nursing, to offer non-public management of the nurses' treatment and
monitoring for safe practice. This approach has been demonstrated to be equal in
effectiveness to the disciplinary process in protecting public safety and promoting
rehabilitation and maintenance of health for nurses. (Yocom & Haack, 1996) National
nursing organizations and national accrediting bodies advocate for alternatives to discipline.
(National Council of State Boards of Nursing, 1994) (International Nurses Society on
Addictions, 1997) (American Association of Nurse Anesthetist 1997) (National Organization
of Alternative Programs, 2001) (Joint Commission on Accreditation of Healthcare
Organizations, 2001)

Since ANA last reviewed this position, changing workplace conditions (US General
Accounting Office, 2001) (American Hospital Association, 2002) and resources have resulted
in the increased need/risk, decreased access to treatment options, and fewer treatment
related policies for nurse employees. (ANA, 1984) Parity or health insurance benefits for the
treatment of behavioral health problems remains unavailable. Therefore the decreasing
availability of reimbursed treatment makes it even more important that nurses have access
to alternative-to-discipline programs.

In 2002, at least ten states have not implemented programs providing alternatives to
discipline. Emerging multi-state compacts are resulting in the need for nurses to have
access, across jurisdictions, to consistent and comprehensive care and monitoring via
alternative-to-discipline programs (Van Doren & Bowling, 2002) and protection of public
safety.

In keeping with the intent of the Action on Alcohol and Drug Misuse and Psychological
Dysfunctions Among Nurses, (ANA House of Delegates, 1982), this report seeks renewed
commitments to the support of activities that improve nurses' access to
alternative-to-discipline programs.

In preparing this report, the submitters relied on input and support from the Florida Nurses
Association, the Massachusetts Association of Registered Nurses, the New York State Nurses
Association, American Association Nurse Anesthetists, National Consortium of Chemical
Dependency Nurses, International Nurse Society on Addictions, and the National
Organization of Alternative Programs.

References:
American Association of Nurse Anesthetists (1997). AANA Position Statement 1.7, Chemical
Dependency

American Hospital Association (2002). In Our Hands: How Hospital Leaders Can Build A
Thriving Workforce. AHA Commission on Workforce for Hospitals and Health Systems.
Washington, DC: Author

American Nurses Association (1984). Addictions and psychological dysfunctions in nursing:
The professions response to the problem. Kansas City, MO: ANA, 1984:2

International Nurses Society on Addictions (1997). Peer assistance. Position paper.

Joint Commission on Accreditation of Healthcare Organizations (2001). Physician Health
standard MS.2.6. JCAHO: Hospital accreditation standards.

National Council of State Boards of Nursing, Inc. (1994). Model Guidelines: A nondisciplinary
alternative program for chemically impaired nurses. Chicago.

National Organization of Alternative Programs (2001). Mission statement, National
Organization of Alternative Program's By-Laws.

Robert Wood Johnson Foundation. (2002, February). Substance abuse: The nation's number
one health problem: Key indicators for policy - update. Prepared by the Schneider Institute
for Health Policy, Brandeis University.

U.S. General Accounting Office, (2001). Nursing Workforce: Emerging Nurse Shortage Due
to Multiple Factors (GAO-01-944). Washington, DC: Author.

Yocom, C.J. & Haack M.R., (1996). An Interim Report: A Comparison of Two Regulatory
Approaches to the Management of Chemically Impaired Nurses. (Available from the National
Council of State Boards of Nursing, 676 North St. Clair Street, Ste. 550, Chicago, IL,
60611-2921)

Van Doren, M. and Bowling, C. (2002, January). Cost savings realized by Baylor University
Medical Center with RNs in an alternative to discipline program. Paper presented at the
meeting of the National Organization of Alternative Programs, San Antonio, TX.

Past House Action (s):

1991 Position Statement on Abuse of Prescription Drugs
1990 Resources for the Treatment of Drug Addiction
1982 Action on Alcohol and Drug Misuse and Psychological Dysfunctions Among Nurses

Relation to ANA Goals/Priorities

__X___ II. ANA and the CMAs will continue to be strong and effective in advancing the
profession through their multi-purpose strategies at the state, national, and international
levels.

Proposed Implementation Activities:

Collaborate with nursing education organizations, the National Student Nurses Association,
and CMAs to make peer assistance programs available to professional nursing students.
Collaborate with education organizations and the NSNA to increase awareness of health risks
and patient safety risks association with untreated addiction and psychiatric illness.
ANA support initiatives by CMAs and national nursing organizations, including NSNA and
NCSBN, to promote uniform alternative to discipline programs in all states by 2010
Collaborate with CMAs, national nursing organizations, along with state and federal
legislators to support passage of a federal law that will provide full parity for behavioral
health care including treatment of substance abuse and dependency.