The Massachusetts Nurses Association (MNA) has the longest standing peer support program for impaired practice in the United States. It is also the only program that is completely separate from the state's Board of Registration in Nursing (BORN). The MNA's Peer Assistance Program was developed by a group of innovative nurse leaders who saw the need to create a support network separate from the BORN to provide a truly confidential means of support.
In the early to mid-1980s, most state BORNs were actively developing "Alternative to Discipline Programs" in response to the American Nurses Association's resolution in 1982 calling on states to address nursing complaints related to substance use with a nondisciplinary approach (American Nurses Association, 1982). This resolution was prompted by a report from the National Boards of Nursing, which explained that approximately two thirds of all complaints presented to the state Boards of Nursing were related to either substance use or mental health issues. The American Nurses Association's resolution became the driving force for states to develop a better approach to nursing license complaints in which substance use was involved (American Nurses Association, 1984). In Massachusetts, while the BORN was laying down the regulatory and structural foundation for the Substance Abuse Rehabilitation Program (SARP), the MNA Addictions Nursing Council was developing its peer support network to confidentially assist nurses with impaired practice.
The nurses on the MNA Addictions Nursing Council had the foresight to anticipate the need to provide a free and confidential support mechanism that was completely separate from the BORN. The initial concern, which is still an issue today, is that nurses who are struggling with the disease of addiction are unlikely to contact the BORN to request assistance for fear of discipline or impact to their nursing license. By providing a truly confidential resource to nurses, the MNA Peer Assistance Program is able to reach out to nurses who would otherwise not seek assistance until they were required to because their substance use problem was impacting their nursing practice.
ABOUT THE MNA PEER ASSISTANCE PROGRAM
The MNA Peer Assistance Program's mission is to provide support, hope, and guidance for nurses seeking recovery. The MNA maintains a confidential telephone line, which serves as a "warm line" to receive calls from nurses in need who have concerns about a substance use problem in either themselves or a nurse colleague. The MNA's number is referred to as a warm line, not a hotline, because it is not manned 24/7 but rather maintained during business hours Monday-Friday. The telephone calls are directed to nurses who serve as associate directors within the MNA's Division of Nursing and who are trained on how to assist nurses who are struggling with the disease of addiction. The associate directors provide confidential telephone support to nurse callers, direct nurses to appropriate resources, and offer them further follow-up with a peer assistant. If the nurse agrees, the associate director obtains only a first name (alias names are acceptable) and telephone number to refer to the peer assistant for further contact. Currently, the MNA Peer Assistance Program has 25 volunteer peer assistants located throughout the state. The key role of the peer assistant is to provide support and hope to the nurse in need. The support the peer assistant provides is not intended to replace other essential components of recovery such as professional counseling, Alcoholics Anonymous, or Narcotics Anonymous. In addition, nurses can utilize the MNA's Peer Assistance Program if they are enrolled in the SARP program. Peer support is provided to all nurses and student nurses in Massachusetts, not just to our MNA members.
The MNA maintains a comprehensive resource website, PeerAssistance.com, which has information on area support groups, a guidebook, and links to other helpful addictions-related resources. One of the most popular resources located on the site is the "Nurses Guidebook to Impaired Practice." The guidebook was developed by the MNA Addictions Nursing Council in 2011 as a resource to labor representatives, nurse managers, and human resource representatives. It provides detailed information on how to support a nurse colleague with a substance use problem, a quick reference algorithm for acute situations in the workplace setting, and a sample "return to work contract." The committee's intent was for the guidebook to serve as a best practice standard for addressing impaired practice, diversion, and other substance use issues within the workplace.
The MNA Addictions Nursing Council provides oversight of the MNA Peer Assistance Program. Members of the council speak locally and nationally on a variety of topics related to impaired practice and peer support, and they use these speaking opportunities as a vehicle for sharing the importance of addressing the issue of impaired practice. In addition, the MNA, which is the professional association and union for over 23,000 nurses in Massachusetts, is able to share information regarding impaired practice with our members and provide support resources. Our union representative leaders are often at the initial meetings with nurses where diversion and/or impaired practice is being addressed in the workplace setting, so they are in the ideal position to refer nurses to the MNA's Peer Assistance Program and guide them toward recovery.
STRENGTHS OF THE MNA PEER ASSISTANCE PROGRAM
The key strength of the MNA Peer Assistance Program is the dedication of the volunteer nurses who support the program. The MNA peer assistants are nurses who are stable in their recovery, for at least 3 years, and have undergone a training program hosted by the MNA Addictions Council. These volunteers agree to contact nurses in need and provide telephone support and guidance. As nurses in recovery themselves, the volunteer peer assistants provide hope to nurses who seek recovery.
Confidentiality is an important strength of the program. Because the program is completely separate from the BORN, nurses seeking recovery do not need to fear being reported to the licensing board. It is important to note, however, that many of the nurses calling the Peer Assistance line will be going on to the BORN/SARP program because their substance use problem resulted in impaired practice and/or diversion, which was identified by the employer and thus reported to the Department of Public Health and the BORN. The MNA Peer Assistance Program can provide the nurse with information regarding the SARP program as well as provide a peer assistant who has completed the SARP program.
Because MNA represents most nurses working in direct care in Massachusetts, the union representatives at each of the facilities are trained and supported in their role in assisting nurses who are discovered to have impaired practice and/or diversion in the workplace. The bargaining unit representative is often the key referral source for the nurse at this very vulnerable time of discovery. They serve as advocates for the nurse in the workplace and provide support and understanding.
CHALLENGES OF THE MNA PEER ASSISTANCE PROGRAM
As a confidential program, the MNA Peer Assistant Program does not maintain a record tracking system for calls received. When the program was first developed, there was an intake record form, which was forwarded to the peer assistant who would further document and return the form to the MNA. This provided a formal feedback loop. However, it also potentially exposed MNA to a break in confidentially as these forms were mailed back and forth. Approximately 15 years ago, the policies for the Peer Assistance Program were changed to a paperless, tracking-less system to ensure confidentiality. One of the tradeoffs was the feedback loop on the outcome of the nurses seeking recovery assistance.
Promoting and advertising of the MNA Peer Assistance Program as a free, confidential support service separate from the BORN is an ongoing challenge. Nurses are not always aware that the MNA is not in any way related to the BORN. In addition, nurse managers, employee assistance personnel, and human resource personnel are often reluctant to refer a nurse to the union for support. The MNA Addictions Council members who teach about the program at area healthcare facilities attempt to explain the resources available and how they are available to all nurses, not just MNA members.
GOALS AND FUTURE PLANS FOR THE MNA PEER ASSISTANCE PROGRAM
One of the key goals of the program is to continue to provide education to the nursing community on the importance of recognizing and supporting a nurse colleague with a substance use problem. In addition to poster presentations and continuing educational programs, the MNA Addictions Council is in the final development phase of an online Continuing Education program called "Assisting a Nurse Colleague with Impaired Practice." The MNA Addictions Council also plans to continue to reach out to nursing leadership organizations to share the information about the resources available with the MNA Peer Assistance Program.
In summary, Massachusetts nurses are very fortunate that the founding nurses of the MNA Peer Assistance Program sought to develop a free, confidential support program that is separate from the BORN. The peer assistant nurses volunteer their time and knowledge of recovery to assist other nurses who wish to recover from the disease of addiction. The MNA Addictions Council, which supports and provides oversight to the program, is committed to sharing information to all nurses regarding this important risk factor of our profession-impaired practice. Contact with a supportive peer assistant can help lessen the devastation in the life of a nurse struggling with addiction, preserve a career, and return a valuable resource to the healthcare community.
The committee welcomes calls from other organizations seeking information on the use of the peer assistance model in impaired practice. For more information, please contact the author and program coordinator, Carol Mallia, at [email protected] or 781-830-5755.
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