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Regardless of whether they have been through recovery, all good chemical dependency nurses are able— in some way—to identify with the patients they treat, those who work in the field say.

A few months after she started attending Alcoholics Anonymous meetings in 1977, Mary Mitch, RN, marched into the chemical dependency unit at St. Mary’s Hospital—now Fairview-University Medical Center—in Minnesota and said, “I want to work here.”

Mitch, who has been a nurse for 39 years and a chemical dependency nurse for 26 years, wanted to learn more about herself and her addiction. “I was having such a struggle with my own drinking,” she said. She was married to an alcoholic. She had drinking in her family. She had three children to raise and wanted to turn her life around.

“I felt [chemical dependency nursing] was an area where I could learn,” she said. “I sought it out mostly because I wanted to discover more about myself.”

As a chemical dependency nurse at Fairview Recovery Services, Mitch still is learning and sharing her experiences when she thinks it will help her patients, especially those who come to the center for the first time. She sees their tears and remorse, and tells them she has walked in their shoes and has struggled with chemical addiction.

“It seems to break the ice,” she said. “When people feel really bad and beaten down, it helps to know that others have been through it, that they’re not the only ones.”

Regardless of whether they have been through recovery, all good chemical dependency nurses are able—in some way—to identify with the patients they treat, those who work in the field say. “You have to have a heart for it,” said Jeanne Moore, RN, director of nursing at Greenbriar Treatment Center in Washington, Pa. “Either you understand it and want to help them or you don’t.”

Nurses who work with chemically dependent patients cannot be judgmental, no matter how many times they have seen someone come through a detox unit or a recovery program. They must combine infinite patience with an ability to set firm boundaries. They must empathize and listen to patients without becoming too involved in the sad stories they hear. They must be skilled at dispensing medications, assessing medical conditions and catching changes in physical conditions, while at the same time listening carefully to what patients are saying and watching what they are doing.

“The nurse’s job is to set up the situation so that the patients can do the work they need to do,” said Steve Gottlieb, MA, RN, a charge nurse at Sierra Tucson hospital in Tucson, Ariz.

Variety of services

Whether they are called rehabilitation centers, recovery centers, chemical dependency units or treatment centers, most places for those who go to deal with some form of chemical addiction offer a variety of services, ranging from a detoxification process to residential treatment to outpatient support programs. They may be freestanding psychiatric hospitals, part of a medical hospital or residential treatment programs, with acute detox facilities, subacute facilities or no detox program at all.

Chemical dependency nurses say they see patients of all ages, social and economic backgrounds and professions. They work with people addicted to alcohol, sedatives, painkillers, opiates and methamphetamines. Many have more than one addiction. Some are dually diagnosed with mental illness.

Most chemical dependency nurses work on the detox units with one or two others in the residential areas to dispense medications, observe patients and monitor medical conditions, such as high blood pressure or diabetes. Nurses also assess new patients, process admissions and do utilization reviews. They often work with a team that may include physicians, therapists, psychiatrists, counselors and dietitians.

Detox work requires a combination of psychiatric, med/surg and critical care nursing skills, said Carol Power, MSN, RN, nursing director at Sierra Tucson. A lengthy and detailed admissions process, increasing amounts of paperwork and faster turnover of beds force nurses to work quickly and think on their feet, while dealing with incoming patients who may be intoxicated or suffering painful withdrawal symptoms.

“There’s a lot to do in a little bit of time,” Moore said. “It gets very hectic. The people aren’t dying here, but it’s more stress than you would think.”

The most dangerous drug to come off of is alcohol, chemical dependency nurses said. Alcohol withdrawal can kill a patient who is not properly monitored and medicated, they said. Detoxing alcoholics may experience hallucinations, shakes, nausea, sweats and chills, as well as sudden changes in blood pressure and other vital signs.

Withdrawal from certain painkillers and sedatives also can have serious medical consequences, including seizures. Detoxing from opiates, such as heroin or morphine, is not deadly but is miserable for the patient—and often the nurse.

“Patients have been very difficult to deal with when they’re coming off opiates,” Mitch said. “They’re miserable. They feel like they’ve got a bad case of the flu.”

During the first few days and sometimes during the recovery process as well, nurses give patients medications to help ease the pain and physical problems caused by withdrawal. The type and amount of medicine depends on the symptoms and the substance patients are withdrawing from.

“The nurse is instrumental in those first two or three days in keeping patients in treatment,” Power said. Nurses try to keep the detox environment calm and unthreatening, she said. The nurse’s message to the patient is, “We’re glad you’re here and we want you to stay.”

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