Reentry of the Addicted Certified Registered Nurse Anesthetist: A Review of the Literature

Abstract

Although not extensive, there is a body of literature pertaining to addiction and reentry to practice in health care providers (HCPs), including nurses, physicians, and anesthesiologists. Yet very little has been published regarding addiction and practice reentry among Certified Registered Nurse Anesthetist s (CRNA), a population of HCPs at unique risk for developing addiction. This paper provides an extensive review of the literature pertaining to reentry of the recovering CRNA and relevant topics thereof. Discovered is that that there are clear gaps in knowledge about reentry to practice in general, and that available data are quite dated. The results of reentry studies in the anesthesiologist are conflicting, and across the research literature, flaws in design and operationalization of successful reentry are evident. Further, although extant recommendations for reentry tend to be consistent across sources, there is very little empirical data to support them. Acknowledging limited understanding of the issues associated with reentry to practice for the CRNA, consideration of the role of “cues” in the practice environment is proposed as a fruitful approach for studying the successful return of these advanced practice nurses to the workplace.

Keywords :

• CRNA
• Reentry
• Addiction
• Chemical dependency
• Impaired practice
• Nurse/ Peer/ Nursing student

Registration Form for Continuing Education Credit

Journal of Addictions 20(4) Nursing CE Credit

Article: Reentry of the addicted Certified Registered Nurse Anesthetist: A Review of the Literature

CE Instructions

1. Read the article.

2. Locate the answer sheet and posttest questions following the article.

3. Complete the posttest questions and program evaluation by circling the selected responses on the answer sheet.

4. Fill out the registration form.

5. Send registration form, answer sheet, and a check for $10.00 to:

   • Continuing Nursing Education

   • IntNSA

   • PO Box 163635

   • Columbus, OH 43216

6. Send before December 31, 2011

Within three weeks after receipt of your posttest and registration, you will be notified of your results. A passing score is 70%. If you pass, your CE certificate will be forwarded to you. If you do not pass, you will be notified and may repeat the test once at no cost.

Note: Approved status refers only to CE activities and does not imply ANCC COA and PA Nurses endorsement of any commercial product.

Registration Information:

Name: _____________________________

Address: __________________________

City/State/Zip: ___________________

Social Security Number: ___________

State(s) of Licensure: ____________

Telephone Number: _________________

Answer Sheet and Evaluation Form for Continuing Education Credit

Article: Reentry of the addicted Certified Registered Nurse Anesthetist: A Review of the Literature

Journal of Addictions Nursing (20:4)

Continuing Education Credit: 1.0_ contact hours

Purpose: To examine what is known about reentry of the recovering CRNA into the anesthesia practice workplace.

At the completion of the article and the posttest, the reader should be able to;

1. Identify the prevalence of addiction among CRNAs and explain why the statistics are conflictual.

2. List at least five components of effective reentry into practice for CRNAs.

3. Describe two outcomes of alternative-to-discipline programs.

Posttest Answer sheet: (Please circle selected response.)

Select a for true and b for false in true-false questions.

Table

Program Evaluation

Table

What other journal CE opportunities would you like to see?________________________________________

How long did this program and posttest take to complete?_____ hours.

Posttest for Continuing Education Credit

1. Most states offer health care professionals with an addiction problem, unlike other addicted patients, which of the following first-line interventions?

   1. License suspension

   2. Engagement in self-help meetings

   3. Admission to a monitored treatment program

   4. License restrictions

2. The highest likelihood of illicit drug use was associated with:

   1. Easy workplace access

   2. Working in a critical care specialty

   3. Both a & b

   4. Neither a nor b

3. In a 2006 survey, the drug most diverted by CRNAs was:

   1. Fentanyl

   2. Oxycontin

   3. Valium

   4. Nitrous oxide

4. The highest incidence of drug diversion for CRNAs occurs:

   1. During their student training

   2. Within two years of practice after graduation

   3. After they have been in practice for over 10 years

   4. Only when they are permitted to practice independently

5. Which of the following is NOT a component of effective reentry?

   1. Involvement in a 12-step program

   2. Attendance at caduceus

   3. Random drug screens

   4. Admission to a methadone program

6. A recommendation prior to reentry is:

   1. Work in a field outside of nursing

   2. Work in a field outside of anesthesia

   3. Do not work on night shift, weekends or holidays

   4. Do not work in anesthesia for a period of at least one year

7. In a study by Galanter et al, the most important element in the professionals' recovery was identified as:

   1. Participation in a 12-step program

   2. Use of Naltrexone

   3. Permission to return to work

   4. Immunity from prosecution

8. Which of the following states continues to have a purely disciplinary intervention for addicted CRNAs?

   1. Colorado

   2. Alaska

   3. New Jersey

   4. Pennsylvania

9. In one survey, with respect to reentry, a majority of the CRNA respondents agreed that it was acceptable, while in the event of relapse, a small minority felt reentry was appropriate.

   1. True

   2. False

10. One of the key brain structures identified in the process of cue-induced craving is the:

    1. Ventral tegmental area

    2. Amygdala

    3. Circle of Willis

    4. Locus ceruleus