When an eagle-eyed pharmacist discovered that she’d been diverting pain medication from a patient to fuel her own opiate addiction, Ruth Conoryea, RN, was immediately fired from the nursing job that had defined her life.
Though the sudden dismissal was painful, Conoryea now believes that it was actually a blessing in disguise. For months, she’d been praying for help to beat her addiction, which had developed after her chronic knee pain was treated with opioids.
If she ever wanted to work as a nurse again, Conoryea had to complete an addiction-treatment program. In her heart, she knew that she’d need a specific kind of support to successfully make it through addiction treatment, but she wasn’t sure if she’d ever find it.
“My first thought when I got fired was, ‘I have to find another nurse in recovery,’” Conoryea recalled. She knew that only another nurse would be familiar with the mix of shame, guilt and anxiety that was weighing her down. As a nurse, her job had been to care for others — and her addiction meant that she could have put her patients in danger.
“Other nurses understand what you are going through in a way that nobody else can,” Conoryea said. “I felt like if I could find another nurse with common experiences, someone who understood what I was going through, that would bring my anxiety level way down.”
Luckily, it turned out that another nurse was enrolled in Conoryea’s 28-day treatment program. The two women held each other up through their shared experience, and, with a lot of sacrifice and work, Conoryea was ultimately able to overcome her addiction. After nearly two years of struggle, she got her nursing license back (with restrictions), and is now working full time as an RN in an inpatient treatment facility for adults with chemical dependency.
Conoreya was fortunate to have discovered another nurse in her program, but that’s not always the case for nurses seeking addiction treatment. While addiction-treatment programs focused on health care providers exist in Minnesota, they have a broader reach, welcoming nurses alongside doctors, social workers, psychologists and other providers. Participants’ experience and worldview can be starkly different.
“Only nurses can really understand nurses’ struggles,” Conoreya said.
With that perspective in mind, last week Wayside Recovery Center, a comprehensive addiction and mental health treatment program for women based in the Twin Cities, launched a new program designed to provide outpatient addiction treatment services for nurses.
The program, which is now making assessments to build its first participant cohort, will hold 90-minute sessions on Monday and Wednesday evenings, offering a mix of psycho-education and support for nurses with addiction.
“These will be group meetings,” explained Wayside CEO Ruth Richardson. “There will be opportunities to learn about things like brain chemistry and the hereditary nature of addiction. Group leaders will talk about issues related to trauma and understanding how they can influence rates of substance use disorder (SUD). There will also be an opportunity for individuals in the group to share their own stories — and understand the stories of others.”
The Wayside program will be the first and only outpatient addiction-treatment program in Minnesota that focuses exclusively on nurses, Richardson said.
The rate of addiction in nurses is similar to the rate of addiction in the general public. “About one in 10 nurses have SUD,” Richardson explained, “but when it comes to addiction, nurses are in a unique position in terms of the challenges of being a nurse. The job includes serious stress and fatigue. This is a big issue for anyone, but nurses work in close proximity and have access to addictive substances.”
This is a dangerous combination for an overstressed workforce, she said.
“The access to addictive substances creates a unique situation for nurses with SUD,” Richardson added. It can feed an addiction and potentially cause harm to patients: “That’s another reason why we wanted to do a treatment program focused specifically on this community.”
Erin Murphy, former majority leader of the Minnesota House of Representatives and past candidate for Minnesota governor, served as executive director of the Minnesota Nurses Association. A registered nurse, Murphy is founder and executive director of Our Stories. Our Health, a nonprofit aimed at sharing stories of Minnesotans’ problems accessing health care.
She believes that the unique responsibilities associated with the job means that nurses struggle acutely with feelings of guilt and secrecy around addiction. This is why a treatment program designed specifically for nurses is such a good idea, she said. When she heard about Wayside’s new program, she was happy to lend her support.
“There is a great deal of stigma for nurses who fall into addiction,” Murphy said. “That stigma can get in the way of finding treatment. Being paired with others who’ve had that same experience is really critical. The peer support and the recognition that you are not alone in this experience and there is a path out can make a huge difference in a person’s recovery.”
Sisterhood of support
The Wayside nurses’ addiction-treatment program will be for women only. While more men are joining the nursing profession every year, more than 90 percent of nurses in the United States are women.
With a long history of serving women with addiction, Wayside is well positioned to host a treatment program for nurses, Richardson said. Gender-specific groups are now the norm in recovery programs, and Wayside, with its expertise in the mental health and addiction concerns of women, will be able to seamlessly fold this group into its offerings.
“In our gender- specific programs, we work with a number of women who have very significant histories of trauma, abuse or intimate-partner violence,” Richardson said. “One of the areas that we are aware of is that many women are coming to us with a diversity of histories. We can provide services that are very specific to their needs. These are services that mixed-gender groups can’t provide.”
Though Murphy hasn’t struggled with substance abuse herself, she does know that women often feel more comfortable being open in the presence of other women. This is especially true in addiction treatment, she said.
“In the safety of a recovery program that is geared for nurses that are women, the ability to find your way through recovery may feel more secure. I’m surmising that for women like nurses who are expected to be caregivers to then need to become someone who needs care can be tricky. That transition into a position of vulnerability, I believe, is made easier when you are in a space surrounded by other women who have had that same experience.”
The outpatient program will be co-facilitated by Tamarah Gehlen, Wayside’s senior director of outpatient services, and Carol Bell, a nurse and Wayside alumni.
Conoreya said she’s excited to hear that the program will be women run — and women focused.
“I think it is a women’s program because most nurses are women,” she said. “I think even in 12-step groups we are always encouraged to stick with the women. It is something I would be attracted to. It makes it a safe place where participants can be honest and open in a way that they might not feel comfortable doing if men were there, too.”
Issues specific to nurses
Nurses often define themselves as caretakers, so they can have a hard time admitting that their lives have been overtaken by addiction.
“What happened for me is there was a lot of arguing in my mind, a lot of, ‘This is not right. Don’t do it,’” Conoryea said. “I tried thousands of times to stop the behavior on my own, not knowing what resources were available for me and being afraid of getting into trouble or being seen as weak. I was afraid of the consequences, afraid of the judgment. I felt guilty, like I should know better. I didn’t want anyone to know what was going on.”
Those feelings of guilt and shame can make asking for help particularly hard, Richardson said.
“Nurses are often the last ones to say they are not OK. They are always taking care of other people. That’s their job. They often don’t want other people to know that they are struggling.” The option of attending a treatment program designed with nurses in mind might make taking the next step feel less daunting, she added: “To be able to point to place where nurses can be around other nurses is going to be an important part of addressing the addiction issue within the field.”
Marie Manthey, board chair of Minnesota Nurses Peer Support Network (NPSN), a peer support program for nurses with SUD, said that for many nurses, addiction can feel like a violation of nursing’s covenant with society to care for the vulnerable.
“The professional commitment to caring for patients is broken when a nurse becomes an addict and has impaired judgement,” she said. “That is the source of the shame and stigma that the Peer Support Network helps to deal with.” She thinks that insider knowledge of that internal struggle will make the Wayside program especially effective: “Bringing those kinds of opportunities for overcoming stigma and shame into treatment will enhance and speed up the recovery process.”
Many nurses say that the built-in pressures of their work play a role in their addiction. Sometimes, when work stress gets too overwhelming, they self-medicate to cope. Before long, the substances they use to relax become a habit that’s hard to break.
“At its root, in nursing, you are in another person’s life,” Murphy said. “Nurses are often contending with very difficult issues that don’t always have a good outcome.”
Hospitals around the state are seeing shortages in their nursing staff, Richardson said. This means that existing nurses are called on to work longer hours with less support. It only adds to the pressure of an already stressful job.
“We’re seeing this sort of perfect storm, where nurses are seeing less resources, where there are nursing shortages, and because of that there is this need within different hospitals and clinics and ERs to have their existing nurses working long hours over long periods of time in a way that just isn’t sustainable in terms of thinking about the impact on mental health,” she said.
Increasing pressures at work mean more personal pressure for nurses, Murphy said. This is a recipe for addiction.
“When I think about my early nursing practice and the way I would sometimes leave work feeling, and to know there are now nurses who are practicing with even fewer resources than I had back then, it is not surprising to me that the use of substances among nurses is on the rise today.”
Tied to the shame and secrecy around addiction for nurses is the fear that if their habits are discovered, they will lose their job. This is why Wayside’s outpatient program is such a good option, Murphy said: If a nurse knew about a treatment program where she could continue to work while seeking help, she might be more likely to step forward early, before her addiction gets out of hand.
“Especially for nurses practicing in hospitals, the threat of getting into treatment is about the ability to continue your profession,” Murphy said, “so having a place to go to get outpatient care with other nurses who are having that shared experience is really important.”
An outpatient treatment program is a good option for nurses, Manthey said. Many nurses, like many people in other professions, struggle with addiction. The option of seeking help while remaining employed helps cut down shame and reduce risk.
“I believe that on an outpatient basis, many nurses can and should receive the help they need without having to leave their work. That seems to be very important. We know there are a lot of people in nursing who are going to AA and are in solid recovery, who have never gone into treatment or monitoring but also have never had their license jeopardized, who have never gone into work impaired. A program like this one could help nurses stay on a path of recovery.”
Conoryea is determined to make her years of struggle an important part of her ongoing recovery. She regularly gives talks about her experience with addiction, sharing her story in the hope that other nurses, feeling lost and alone, won’t turn to substances to ease their pain.
“I’ve spoken to nursing students,” she said. “I’ve spoken at conferences to nurses about my story of addiction and how the lack of treatment services for nurses in the community has been a big problem. I think this Wayside group will really fill a need that’s already out there.”
Murphy agrees. Addiction, she said, “is a struggle for a lot of people in the nursing profession. I have seen the damage that the lack of effective treatment can do.” The Wayside program could be a tool to help nurses struggling with SUD find their way back into the profession, she added: “Substance abuse is a disease. When it is properly treated, there should be room for redemption, for return to your work, to your life.”