Case study: A nurse's struggle with drugs

Sarah came to the attention of the Council after a complaint was received from her employer. The complaint alleged that a box of benzodiazepines for injection was unaccounted for at the end of her shift in the hospital. 

Sarah after being pulled over by the police was arrested and charged with drug-related offences for possession of prohibited drugs and prescribed restricted substances. NSW Police advised that the batch numbers of the medications seized from Sarah matched the batch numbers of the medications missing from the hospital.

Sarah could not provide prescriptions for the prescribed restricted substances found in her possession. These circumstances are a significant departure from the standards expected of a registered nurse. 

After coming to the attention of the Council, Sarah was referred for a health assessment by a Council Appointed Practitioner. Sarah explained that she had become distressed and depressed after a relationship breakup combined with the pressure of her job. In the course of the assessment, Sarah continued to deny stealing drugs from the hospital or that any of the drugs seized by the police were hers but ultimately, admitted she was guilty. 

Sarah's story
Sarah had let things overwhelm her and did not engage with her employer about it due to feelings of shame. Sarah reported having trouble sleeping and that a friend had given her Valium. Another friend’s son was using marijuana and she started using it too.

The health practitioner assessing Sarah was left with some concerns about Sarah's insight, due to her ongoing denial of drug use and delay in acknowledging that she had stolen the medication from the hospital, despite the evidence to support the theft. The health practitioner gave Sarah very clear advice that she needed to take responsibility for what had happened and her health, and that she would be required to demonstrate to the Council that she is managing her health with appropriate strategies, such as seeking treatment which could result in a stable recovery. 

What happens next?
For a case like Sarah’s, where some acknowledgement has occurred, usually the practitioner will be referred to an Impaired Registrants Panel (IRP). A panel will recommend registration conditions to the practitioner if satisfied these are required to keep patients and the practitioner safe. This will require voluntary acknowledgment and active participation by the practitioner to improve or manage their health. The Council therefore seeks agreement from the practitioner to the conditions recommended by the panel prior to imposing them. If a practitioner denies the incident or does not agree with the proposed conditions then under the Law the matter must be managed through an investigation pathway by the Health Care Complaints Commission.

The types of conditions recommended relate to monitoring health, seeking treatment and practice conditions, for example withdrawal of authority to administer S 8 and S 4 medications. These conditions are placed on the practitioner’s registration so they can work when it is safe to do so. Sometimes it is appropriate that a practitioner takes time out from work to recover sufficiently to safely practise.

What happened to Sarah?
The health assessor advised Sarah that they would be recommending to the Council that some conditions be imposed upon her registration. Sarah attended immediate action proceedings as there were concerns about immediate safety, both for her and for the public. The delegates of the proceedings noted that Sarah had been struggling with major life stressors and serious mental illness, factors which contributed to unacceptable professional conduct involving illegal drug behaviour. Conditions were placed on her registration. These will be reviewed by the Council following Sarah’s meeting with the Impaired Registrants Panel, who will examine Sarah’s progress in establishing treatment and compliance with monitoring.  

Since the incident, Sarah has seen a psychiatrist for her depression and anxiety. Sarah is currently compliant with the conditions and isn’t working as a nurse at this time. She will be monitored by the Council and will need to comply with the Drug & Alcohol Policy.

An updated Drug & Alcohol Policy
To ensure safety for Sarah and others, Sarah will be monitored under the Council’s updated Drug & Alcohol Policy. The new policy provides increased access to collection centres, nationally-consistent screening requirements and costs, and improved timeliness for receiving results. Sarah’s compliance will ensure ongoing assurance to the public, her colleagues and employers that she can continue safely in practice. As Sarah recovers these conditions will be made less restrictive. 

Lessons from Sarah’s story
Sarah’s story highlights the importance of the standards of practice and what can happen when a practitioner fails to comply with them. Some lessons we can learn from Sarah’s story include:

  1. If a nurse is charged with a criminal offence, they are obliged to notify AHPRA within 7 days. Read more about the Criminal History Registration Standard.  
  2. Managing your health with appropriate strategies (this is not self-diagnosis or self-medication) so that it does not have the possibility to impact upon your ability to safely and competently practise is an expected professional requirement.
  3. Rather than hide depression or other mental health concerns, practitioners should seek treatment and support early. Any illness left untreated can become severe and affect critical thinking and other vital professional attributes to the degree that practice is unsafe.
  4. If you’re concerned that you or someone you work with may be dealing with depression or drug and alcohol issues, help is available. It’s always ok to ask for help. Support your colleagues by encouraging them to seek treatment. Nurse & Midwife Support is a good place to start. 

    It is also appropriate to discuss matters with your GP and notify your employer so that they can make appropriate adjustments to your work if necessary.  This builds trust, maintains professional integrity and facilitates safe care.

  5. Honesty is important as it increases trust. Professional integrity can be damaged when practitioners withhold information, are dishonest, or minimise the impact of their illness on their behaviour. This may also result in more restrictive conditions on practice or referral to investigation and a possible disciplinary panel. 
  6. Promoting health and wellbeing is one of the professional standards identified in the Codes of Conduct for nurses and for midwives. This standard refers to the health of both patients and practitioners. There are also mandatory notification requirements for reporting drug and alcohol issues and health issues when these issues are negatively impacting on practice.
  7. Practitioners with chronic and relapsing health conditions may be monitored for their health for some years.