News about employment office counselors guiding people with mental health issues, alcohol or drug abuse history to start studying for practical nurse degree once again reached headlines in Finnish newspapers and online newsrooms last November. According to the Finnish National Authority for Welfare and Health (Valvira), the national agency operating under the Ministry of Social Affairs and Health that acts as a supervising authority for health care services and professionals, there have been multiple cases where a person with alcohol or drug abuse history has been guided to apply for practical nurse education. Representatives of Valvira stated that the agency is concerned that guiding people with an alcohol or drug problem to apply for nursing education may be used as a treatment or rehabilitation method. The reports also mention that Valvira has already had to warn employment officers not to guide unsuitable people to apply for nursing education. One news site interviewed Valvira’s director Tarja Holi, who stated (informally translated): “These people (employment office clients with mental illness, alcohol or drug abuse background) are unable to practice the (nursing) profession. They cannot be guided to get the (practical nurse) degree only because they are not accepted to study elsewhere.”
In Finland, a student position in the practical nurse education is generally considered easy to access, and the growth of unemployment numbers in recent years has lead to increasing number of unsuitable people applying for nursing education. It seems that employment officers are in fact under the impression that practical nursing is a profession that anyone can learn and practice for living, and the employment officers seem to apply this idea to other nursing degrees as well. It’s as if these people are thinking: ‘How hard can it be to work in three shifts, change diapers for elderly, perhaps demented people and treat their pressure ulcers?’ As a result, it’s not unusual that an unemployed +50-year-old man is urged to apply for practical nurse education by employment officers even if he has previously worked in an industrial occupation for all his life. After all, there are plenty of working years still left for him before retirement since at the moment, people around their 50’s are expected to retire around the age of 63 to 65 years in Finland. If the man declines the suggestion, he may end up losing his unemployment benefit for three to six months as a punishment. The withholding of unemployment benefits is in fact a standard protocol for just about anyone declining to take a job or student position offered via the employment office. But hey, nursing is an easy and suitable option for anyone, right?
An intoxicated nurse equals nothing but patient safety hazard
The number of health care professionals with a severe alcohol or substance abuse problem has grown dramatically in Finland. When in 2005 the Valvira supervisory committee dealt with more than twenty cases, the prognosis for 2014 was 260 cases. During last year (2015), a total of 36 practical nurses and 17 registered nurses lost their license. Common reasons for losing a license include errors in prescribing medicine, in addition to severe alcohol or drug abuse. Nurses have also lost their license after getting caught stealing drugs, and medication thefts are a typical first sign of a drug problem among nurses. The thefts are usually detected by fellow nurses and nurse managers, who have become more sensitive in noticing the problem over the years.
The greatest problem with an alcohol or drug addictions is that it will start to affect work at some point. A nurse with an alcohol or drug problem often starts making a lot of mistakes at work and as the number, frequency, nature and extent of errors increases, the co-workers will end up spending more and more time in damage control. Typically, an addicted nurse also begins to seem unfocused, decreasingly alert and unable to notice changes in their patients’ condition that require action. There have already been cases in Finland where a medication error, done by a nurse with an addiction, has in fact led to the death of a patient in a very short period of time.By the time a nurse with an addiction or mental health issues is detected and the case is put under investigation the underlying problem may have lasted for several years already. It’s either the co-workers or managers at work who blow the whistle, but patients are also known to have made complaints about problems and 
incidents during their care, and these reports have in some cases lead to an investigation revealing the nurse’s predicament.
Some bystander experiences
During the very first few years of my career as a dental health professional I stumbled upon a couple of cases at two separate private dental clinics where a dental assistant obviously had an alcohol problem. Luckily I never witnessed them drinking at work or anything but it’s quite obvious that something’s going on when a colleague repeatedly calls you late in the evening asking to cover their morning shift (background noises revealing that they’re calling from a bar) or calls in sick suspiciously often. Both of these ladies in their late 40’s or early 50’s would show up at work looking very tired and pretty obviously having a hung-over and I bet their blood-shot eyes weren’t caused by an eye infection. In the first case one day I got an urgent call from work to come cover for the dental assistant who then got fired in the middle of her shift and in the second case the party animal quit before she would have been fired, I think. One day she just didn’t show up at work in the morning, the managers mentioned nothing about it and shortly after that new assistant was hired. I was too young and unsure what was going on to talk to anyone about my notions and suspicions at work but I got the impression that there had already been problems with both women for quite some time before I was hired.
Silence fixes nothing
There is clearly a strong need to develop supervision and whistle-blowing policies to detect and catch nurses and nursing students with mental health issues and addictions. You can always try to confront the person with the problem to seek help but what if it doesn’t work? Whistle-blowing on a colleague or a co-worker shouldn’t be considered as interfering into other people’s business let alone some kind of a deception but an attempt to help them in solving the problem. After all, whistle-blowing on someone with a mental health problem or an addiction is intended to act as means of ensuring and promoting the patient safety and quality of nursing.
In the nursing profession, taking care of patients means taking care of yourself, your colleagues and co-workers as well. This way everybody wins.
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