Challenges for Nurse Anesthetists Re-Entering Practice Following Substance Use Disorder Treatment

Abstract

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared to other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of Certified Registered Nurse Anesthetists (CRNAs) to obtain employment or maintain employment after treatment for SUD treatment is not well documented. CRNAs in recovery from SUD in the United States experience challenges when attempting to return to work following treatment for SUD for reasons yet to be identified. The purpose of this qualitative multiple-case study was to explore the challenges encountered by nurse anesthetists in recovery as they attempt to re-enter practice following SUD treatment. The phenomenon was explored through multiple-case study, using qualitative semi-structured interviews with participants in four cases: CRNAs in recovery, CRNA colleagues, CRNA employers, and professional health program employees. Multiple-case study research provided 36 participants an opportunity to convey their perspectives about the challenges CRNAs in recovery face upon re-entry into practice following SUD treatment. The Worker Well-Being conceptual model, introduced by NIOSH, was used to guide this study. The conceptual model includes the safety and health of the worker in the workplace and circumstances that positively or negatively impact the well-being of the worker beyond the workplace.

The study revealed that participants described stigma as the most significant barrier for CRNAs in recovery. Stigma persists as a considerable barrier in many facets of SUD, contributing to an increase in shame associated with having the disease. All cases agreed that more SUD education is a key facilitator for more CRNAs in recovery to re-enter the workplace. Across all participant groups, risk of relapse was a major concern, though most participants believed that CRNAs in recovery should have an opportunity to re-enter practice under the right circumstances. More research is needed to create uniform standards of care, including re-entry guidelines, departmental policies, and continuing education, that facilitate re-entry into practice following SUD treatment.