Until she got sober for good in 2009, Carrie Kappel fought two enemies: her addiction to opioid-based pain medication, and her sense of shame for that very addiction.
As a nurse, Kappel felt deep inside that she should’ve been above her addiction. Like many nurses, she thought that she was member of a special breed, somehow immune to normal human failings. So when she became seriously addicted to opioids, siphoning her supply from her patients at the hospital where she worked, Kappel held her secret inside for more than a year, until she finally sought out help from the hospital’s employee assistance program.
“As nurses, we’re held to a higher standard in our professional lives,” Kappel said. “Most of us hold ourselves to an even higher standard when we have a substance-use disorder. We have a tough time not seeing addiction as a moral failure, which is often how it’s viewed in the public — and even by our nursing peers.”
When she revealed her addiction, Kappel was put on leave and required to enter the state-run Health Professional Services monitoring program. She went through addiction treatment and eventually was cleared to return to the same hospital, working in a similar position with restrictions on her access to patient medication.
For a time, this worked, but even with her addiction at bay, Kappel still battled with shame, feeling as though she was the only nurse who had ever succumbed to the daily temptation of easy access to drugs intended for patients. Eventually, a few years later, she lost the fight again, relapsing to her old addiction.
“I felt extremely isolated,” Kappel said. “I was dealing with a deep shame that I didn’t want to talk about. I didn’t think anyone else could understand.”
Nurse to nurse
Kappel isn’t alone in that sense of shame and isolation, said Marie Manthey, a well-known nurse leader, author and chair of the board of Nurses Peer Support Network, a peer-run support organization for nurses struggling with recovery and re-entry into the profession. The nonprofit has been up and running in Minnesota for just two years. Manthey has been in recovery herself for 38 years this month.
Peer support networks for nurses “exist in about 40 of the 50 states,” Manthey said. “I don’t know why one hadn’t existed in Minnesota before, because there is a clear need.”
Right now, there are five Nurses Peer Support Network groups meeting in different locations across the state — downtown Minneapolis, downtown St. Paul, Mankato, Edina and Duluth. The organization has plans to start more.
There wasn’t a Nurses Peer Support Network in the state when Kappel was going through her addiction treatment. After her relapse, she realized that her isolation was part of the reason she returned to drug use.
Having a peer support program available when she was going through addiction treatment “would’ve made my recovery and building connections with others that had similar issues with recovery or work so much easier,” Kappel said. “It would have helped me so much to have that support as I walked through those challenges.”
Kappel was eventually able to find support through Hazelden’s Healthcare Professionals treatment program. Through Hazelden, she met other health-care professionals with substance-use disorders. Finally being able to connect with nurses who’d struggled with the same issues was a revelation — and key to her ongoing sobriety. Kappel completed her treatment in July 2009, and has been sober ever since. Today, she is assistant director of Hazelden Betty Ford Foundation’s Healthcare Professionals program and coordinator of Hazelden’s Nurse Professionals program.
“That peer support was everything for me,” she said. “Through my peers, I finally found acceptance. I found people who did not judge the things I had done. Lord knows I was already judging myself enough. I needed people that were going to love me enough to support me as I began to open up, and I found that.”
Because she can personally attest to the healing power of peer support, Kappel is a strong advocate for the Nurses Peer Support Network. She has recently joined the group’s education committee. She volunteers to speak to nursing students about her own addiction journey, trying to spread the word that nurses, like all other humans, are at risk of substance-use disorder. Sometimes a struggling nurse’s greatest advocates can be her fellow nursing professionals.
“Nurses need to talk to nurses about their addiction,” she said. “They can talk to their family. They can talk to their friends and their therapists. That’s all wonderful. But the real healing comes when a nurse is talking to a nurse. There is a connection and an understanding there that cannot be met in any other kind of relationship.”
The burden of positive perception
Sometimes a good reputation can turn out to be a big stumbling block. To illustrate this, Manthey likes to point to an annual Gallup survey where respondents are asked to select professions they consider most trustworthy.
“Of the professions in the survey, nursing is always listed as No. 1,” she said. “It has been No. 1 every year except for 2001 when firefighters made No. 1. As nurses, we have this relationship with society that is very important and we take that very seriously, until such time as we become addicted. Then we do things that are not in the patient’s best interest.”
When a nurse like Kappel violates her patients’ trust by siphoning their medication, she has put herself in a painful position, Manthey said.
“Although we as nurses understand intellectually that addiction is a disease, when it comes to ourselves, we believe it is a moral failure of the worst kind,” Manthey said. “This perception makes it extremely difficult for an nurse to move out of shame and into recovery.” Sometimes that means that nurses put off treatment until their addiction grows out of control.
Back to work
Manthey believes that one way to move away from shame and toward recovery is to educate the public — and nurses themselves — about the real issue of addiction in their profession. Another important message is that, with peer support and guidance, nurses with substance-use disorder can eventually return to work.
The cultural bias against addicted nurses means that many nurses who have completed substance-use treatment and are in strong recovery have a hard time getting hired, Manthey said.
“They could be five years into recovery and employers still won’t hire them. They’d say it is too risky. This is a serious problem. We have a terrible nursing shortage and we are letting highly experienced nurses work in retail, or the tourist industry or as waitresses just because they’ve struggled with addiction and are in recovery.”
The Nurses’ Peer Support Network has a two-part mission, Manthey said: “One is to provide peer support where nurses can talk to nurses about their shame and stigma. The second part is to educate the profession and the public about the risks and consequences of addiction in nursing.”
If nurses work to remove the shame surrounding addiction in their profession, maybe more will be willing to come forward and seek treatment before their addiction has a negative impact on their work, Manthey said.
“At the very minimum we know that 10 percent of the general population is or will become addicted at some point in their lives. The same goes for nurses. So if I am an employer, of every 100 of my nurses, 10 are going to have a problem with alcohol or opioids. If all 10 are hiding their addiction, the risk is high that they are eventually going to do something in an impaired state that will harm a patient. But if all are in recovery, I know that they’re not using, and are therefore not harming patients.”