Aspects of employee drug abuse in veterinary practice by Catherine Budd

ABSTRACT: Working in a profession which requires daily access and handling of controlled drugs, entails maturity, integrity and responsibility. If there is an absence of a strict protocol on the signing in and out of these drugs, there is the potential for this responsibility to be abused. This article explores the issues that arise when one member of the team abuses this trust which leaves the rest of the team with an ethical dilemma. It also explores the moral and ethical theories that play a significant role in dealing with such a dilemma.

Ethical theories

Deontology is a theory that aids in the ability to ensure that decisions are based on the ‘right thing to do’; instead of what may be the ‘most good’. Telling the truth and abiding by your duty to be honest plays a pivotal role in this dilemma when informing the practice principal. Dunn (2005b) suggests that if a colleague is suspected of drug abuse, he or she should be discreetly approached in a non-confrontational manner, as there may be a reasonable explanation.1

This is easier said than done, as some nurses – having never experienced a dilemma like this and in the absence of formal guidance – may not feel confident in approaching the offending nurse for fear of making the situation worse; which may result in the evidence being removed or destroyed. They may also worry that to raise such an issue may brand them as a poor team player who is a ‘storyteller.

Nurses have an ethical and legal obligation to report colleagues whose actions could cause harm to patients, and they also have a duty to act as advocates for their patients and clients.2 The Royal College of Veterinary Surgeons (RCVS) Guide to Professional Conduct for Veterinary Nurses (2007), does not overtly state that veterinary nurses have a role as advocates, but it is implied that nurses should act in the best interests of the animal, owner and employer. It further states that veterinary nurses have a responsibility to report health and safety concerns regarding staff or patients at risk.3

Advocacy is not about winning, but is concerned with professionally representing the interests of others.3 Reporting a colleague can be an act of advocacy – in the dilemma in question, the nurse must act as an advocate for both the patients and for the offender regarding their health and safety.

According to the RCVS Guide to Professional Conduct (2007), an RVN has a responsibility to his or her professional colleagues. Deontology plays a role in this dilemma as the RVN may be torn between her responsibility towards the practice principal and her responsibility toward her colleague.

Utilitarianism is the belief that the right course of action is the one that will lead to the greatest happiness for the greatest number of individuals. This moral principle may also have a place in this scenario – the employee must weigh up the consequences of reporting an offender as he or she has a moral duty to the employer as well as to colleagues, the patients and clients in wanting to benefit all parties and cause the least misery and harm.3

Autonomy can be defined as allowing people to make their own decisions regarding how to live their life. A paternalistic approach to this particular dilemma would be the practice principal stepping in to take charge of the offenders actions.4 The principal would prioritise the offenders best interests over their own independent wishes.

An individual’s right to live autonomously is lost if he or she behaves in a criminal manner and breaks laws. The RCVS Code of Professional Conduct maintains that it is the RVN’s responsibility to care for the patients in their care, to be trustworthy and honest and to uphold the good reputation of the veterinary nursing profession.

In line with this, Luck and Hedrick (2004) state that the nurse has a legal responsibility to report a chemically dependent care provider, indeed they may be held liable if a patient is harmed through a failure to report.5

Why abuse?

Veterinary professionals have been taught that medications solve problems; that they alleviate pain, cure infections, and can reduce anxiety. Not only are medications accessible, but as professionals, we also have a mistaken belief about our personal ability and level of knowledge to self-medicate, without becoming addicted.

Self-medicating behaviours may only be viewed as inappropriate when these behaviours grow in magnitude and their occurrence increases.2 Having access to these medications creates a familiarity with controlled substances which can increase the chances of abuse.

According to research, human-centred nurses can be especially vulnerable to addiction and abuse as a consequence of stress in their workplace or personal life, irregular shift work, night shifts and sleep deprivation. Critical care work with continuous exposure to pain and death, extended shifts for overtime, ongoing musculoskeletal injuries and pain, and having easy direct access to narcotics can, for some, be a coping strategy or a way to keep up the fast pace.6

Veterinary nurses can also be under the same pressures in their professional and personal lives. Our profession can be competitive and owners’ and employers’ expectations and demands can put pressure on already diligent nursing staff. Chemical dependency and controlled substance abuse is not new in today’s society and it can affect people in all professions and from all walks of life.5

The continuing abuse of drugs can soon develop into an addiction, which then becomes an illness that, as Maher Brisen (2007) states, needs to be treated and not punished.

Some people who suffer from substance abuse are unwilling to acknowledge that they are suffering from this condition and that the negative impact of this abuse may affect others in their personal and professional life – and in some cases, the individuals in their care.

Human-centred nursing is now considered as a risk profession, with soaring levels of emotional exhaustion and stress, and these levels are almost certainly on the increase.7 This could also be reflected in our profession as veterinary nurses are under similar pressures within the workplace.

Relevant legislation

An individual in possession of a Controlled Drug is in breach of the Misuse of Drugs Act 1971 (Chapter 38 Section 5). If a practice principal is informed of this situation, he or she has a general duty of care under the Health and Safety at Work Act 1974 (Chapter 37 Section 2), which regulates the health and safety of employees.

Under the Management of Health and Safety at Work Regulations 1992 (No 2051), employers also have to assess the risks to the health and safety to their employees. If they knowingly allow an employee to continue to work while under the influence of drug misuse and their behaviour puts others at risk, this is also an offence and they could be prosecuted (HSW Act 1974).

Gray & Wilson (2006) assert that the offender in this dilemma has also broken civil and tort law, committing a wrong against someone’s personal safety, possessions or against someone’s reputation.8 They may also be in breach of their written employment contract.

A nurse who withholds medication for personal use and signs drugs out dishonestly, or tampers with the record book, can be arrested for theft through the civil law under The Misuse of Drugs Act 1971.6

Professional bodies

The BVNA is the national representative body for veterinary nurses in the UK. It offers advice and support to its members on issues such as employment law, contracts, maternity leave and bullying in the work¬place. Veterinary nursing lacks a dedicated governing body which prevents it being an autonomous profession, as the RCVS maintains the RVN R
egister and governs what the veterinary nurse can and cannot do.

The Veterinary Defence Society (VDS) is an insurance company which is run by experienced veterinary surgeons on behalf of the veterinary profession. It insures veterinary surgeons and registered veterinary nurses against professional negligence, offers advice and guidance and provides legal representation.

Whistle-blowing

Registered Veterinary Nurses need to be aware of their responsibilities as professional or expert witnesses in a civil or criminal trial.6 These situations may require the witness to breach confidentiality and to report the unprofessional behaviour of colleagues in the public domain.

Confronting problems in the workplace can prove very difficult, especially when working in a small practice; and it is true to say that the close-knit nature of the veterinary profession can make it difficult for a veterinary nurse to raise concerns about the behaviour of colleagues. A hierarchical environment can lead to nurses feeling vulnerable, and some will turn a blind eye, others will resort to whistle-blowing if they feel their complaint is being ignored.

RVNs are advised to contact the RCVS Professional Conduct Department for advice concerning complaints that cannot be dealt with satisfactorily within the workplace.

Author

Catherine Budd RVN MBVNA

Catherine qualified in 2006 in a mixed equine and small animal practice and went on to become a theatre nurse in Murdoch University, Perth, Australia. She currently works in a spinal and orthopaedic referral practice in Surrey and enjoys all aspects of surgery and nursing. Catherine is in her second year of studying for the Dip HE Clinical Veterinary Nursing.

To cite this article use either

DOI: 10.1111/j.2045-0648.2012.00156.x or Veterinary Nursing Journal Vol 27 pp 112-114

References

1. DUNN. D. [2005b] Substance abuse among nurses – Intercession and intervention*. Aorn Journal 82[5]: 775-799.

2. DUNN. D. [2005] Substance abuse among nurses – Defining the issue', Aorn Journal 82[4]: 572-596.

3. PULLEN. S. and GRAY, C. (2006) Ethics. Law and the Veterinary Nurse, Edinburgh: Butterworth Heinemann Elsevier

4. RAINBOW, C. (2002) Descriptions of Ethical Theories and Principles' (online) Available from http://www.bio.davidson.edu/people/kabernd/lndep/carainbow/Theones htm Accessed on 22nd February 2011.

5. LUCK. S. and HEDRICK, J. (2004) The alarming trend of substance abuse in anesthesia providers' Journal of PeriAnesthesia Nursing 19[5]: 308-311.

6. MAHER-BRISEN. P. [2007] 'Addiction: An Occupational Hazard in Nursing’, American Journal of Nursing 107[8]:78-79.

7. GARROSA, E.. RAINHO. C.. MORENO-JIMENEZ.B. and MONTEIRO. M. J. [2010] The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: A correlational study at two time points'. International Journal of Nursing Studies 47(2): 205-215.

8. GRAY, C. and WILSON, K. [2006] Introduction to the legal system' in Pullen, S. (Eds) Ethics Law and the Veterinary Nurse. Edinburgh: Butterworth Heinemann Elsevier.

Information sources

Health and Safety at Work Act 1974 (Chapter 371, (online) Available from http://www.legislation gov.uk/ukpga/1974/37/section/37 Accessed on March 19th 2011. Management of Health and Safety at Work Regulations 1992 (No 2051) (online). Available from http://www.legislation.gov.uk/uksi/1992/2051/introduction/made Accessed on March 20th 2011- RCVS Guide to Professional Conduct for Veterinary Nurses [2007].

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