Recovery of a Real-Life "Nurse Jackie"

By Tiffany Swedeen, RN, BSN CPRC/CPC 05/27/19

Before I ever stole a pill from work, before I was ever a daily drinker and habitual pill-popper, I was just a burned-out nurse, exhausted and in pain.

Tiffany Swedeen, a former real-life "Nurse Jackie"

Nurses are often referred to as "angels in scrubs.” It certainly fits. 

Who else but an angelic being can provide unconditional comfort in the throes of tragedy, hold your hands through unspeakable heartbreak, and save your loved one’s life all while cleaning up an array of bodily fluids?

Nurses do it with a smile.

Florence Nightingale left her predecessors with big shoes to fill. Nurses must function as caregivers under extraordinary pressure, possess superhuman resilience, scrupulous morals, exceptional coping skills and be immune to afflictions that trouble the general population. Nurses need to be available to care, comfort and to cure. There’s no time to be ill or emotionally fragile. 

By striving to live up to Nightingale’s standards, we’ve earned the #1 spot on Forbes list of trusted professionals, but we’re also the most susceptible to job burnout. We’re brimming with intelligence and compassion, but far from celestial beings. Nurses are 100% human and just as likely, if not more so, to employ unhealthy coping mechanisms. 

A Registered Nurse for over 14 years, I can attest to this. I mismanaged work stress and job burnout in the worst way possible: by turning to drugs and alcohol. 

It’s estimated that around one in 10 nurses struggle with substance use disorder. That’s no small statistic, considering there are around 3 million nurses in the US.

Alcohol, opiates and benzodiazepines are an all-too-accessible source of fuel to get through the work day. They’re also excellent numbing agents to sleep off the stress of a shift. It’s not uncommon to hear a nurse exclaim “This shift calls for wine!” or to joke about the necessity of drugs to wash away the day.

Nurses readily encourage drinking as a coping skill, use of anti-anxiety medicine is socially approved of and sleeping pills are shared between friends. But admitting one has lost control of one or more of these highly addictive substances is absolutely taboo. 

It was eight years into my career at the hospital that I became physically and psychologically dependent on Vicodin. Migraines interfered with my ability to work and be a mother. My doctor prescribed an opiate, and I experienced blissful relief as the migraine melted away and euphoric energy filled the void. 

The progression of my addiction was insidious but certain. Since graduation from nursing school, I could count on one hand how many hangovers I’d woken up with. Recreational drugs, including smoking pot, was out of the question. Yet when all the factors fell into place – a legit prescription, disengaged from my work, overwhelmed at home and sleep deprived working nights – my fate seemed inevitable.

Slowly and steadily I transformed from a Florence Nightingale prodigy – working overtime, volunteering, climbing the ladder to nursing success – into a real-life Nurse Jackie

Eventually I became tolerant and my personal prescription wasn’t enough. I engaged in behavior I’d previously considered appalling and unthinkable. I stole from my employer. Compulsion to use and desperation to avoid withdrawal won over any rational thought process. Opiates had become a cure-all for the physical and emotional exhaustion that consumed me.

Like so many other nurses, when I realized the line had been crossed from medical and occasional recreational use to abuse and dependence, I felt trapped. I couldn’t just tell my manager. I couldn’t even tell a friend. Too much was at stake. Drowning in opiate addiction, (and drinking heavily to boost the effects or stave off withdrawal) I saw no safe shore to swim to. 

Washington State, along with most states in the US, offers an “alternative to discipline” program due to the high incidence of substance abuse in healthcare professionals. But since the problem isn’t talked about, the solution isn’t either. The organizations are spoken of in whispers, as are the nurses who “ended up in the program.”

I wasn’t ignorant to the existence of these resources, but I was completely misguided as to their intention and function. 

I’d heard rumors of nurses who were caught “diverting” – the fancy term we use for stealing the leftover or extra amounts of drugs that are supposed to be “wasted” at work in the proper receptacle.

According to gossip, they were escorted off campus by security or police as the state program was notified. At worst they were forced to relinquish their license. At best, job opportunities were limited to grueling shifts at nursing homes earning half the pay they deserved. 

It was a living nightmare. Imprisoned by addiction, paralyzed by fear. Terrified of being recognized, I refused to attend any type of peer-support group meeting. Finally, out of desperation I contacted a private counselor. She declined to treat me based on duty to report.

“Oh, you’re a nurse? I can’t treat you. Too much liability. But good luck I’m sure you’ll find someone.” 

Fortunately, I found rock bottom. Not in the form of an overdose, which I was dangerously close to many times, but in being caught by my employer. Someone had informed them of my suspicious behavior. I was required to give a urine sample, and when it came back glowing dirty with the truth of my drug use, I was given a choice according to my state’s department of health policy: Enter into treatment or face criminal charges and potential loss of my license.

Both options felt like professional suicide. For the next two weeks as I contemplated the decision, I also contemplated actual suicide. With the support of one family member I felt I could confide in, I made my way to treatment; sick with shame and certain I’d destroyed my reputation, my dignity and life as I knew it. 

Out of work as a nurse, but intentionally working on recovery, my outlook began to change. One month of sobriety turned into multiple, and the chemical fog began to clear. I made connections with nurses who had or were recovering. I began practicing mindfulness, cultivating resilience and digging deep to understand what had transpired. 

As I researched, I discovered my story isn’t unique. Being an excellent nurse and having an addiction are not mutually exclusive. In fact, they often go hand-in-hand. The highest functioning, hardest working, most in-depth critical thinkers end up stealing and ingesting drugs from work. Numerous factors play into this, the most basic of which is drugs and alcohol offer instant relief from a mind that won’t shut off, and they are physically addictive. Nurses in particular feel invincible as the caregivers – “it’s others who are sick.”

Our comprehensive knowledge of medications and how to ingest or inject “safely” gives us a false sense of security. And 75-80% of nurses are adult children of alcoholics, including me. We’re essentially predisposed and then enter into a pressure cooker of a career. 

My research also uncovered that sober, recovering and/or “graduated” from an alternative to discipline program nurses still don’t disclose this part of their lives. This is a tragedy in itself. When nurses keep their recovery in their dark, still-suffering nurses keep their active addictions in the dark. 

Healthcare as an occupation does a disservice to professionals who enter into it by neglecting to educate, advocate and adequately treat. 

Nursing schools should provide courses in mindfulness and self-awareness, encouraging nurses to uncover the sometimes-hidden nature of addictive tendencies and teaching strategies to manage them. This should be done long before ever exposing them to the workforce and giving access to a plethora of pills and injectables. 

Educational institutions and employers should offer free education, confidential counseling and allow time off work for treatment. Lunch breaks should be mandatory and enforced; employees should be trained in self-care. 

Instead of shaming nurses who are under suspicion or undergoing treatment by posting names and license numbers on public lists, the department of health should be involved in the development of peer- support groups.

Trauma-informed rehabilitation programs need to be implemented for nurses and first responders who have been repeatedly subject to high stress and high stakes patient care. 

Asking for help shouldn’t be a trauma itself. We need to change the narrative from “being reported” to being “given an opportunity to receive treatment and protect your license.” Treatment providers need to change the verbiage from “You can’t tell me anything, I have a duty to report.” To “This is an opportunity for honesty, to find you the best treatment possible so you can achieve health and well-being again.”

I never wanted to be known as a real-life Nurse Jackie. It would have been easier to quietly complete my time in treatment and live out my career with a well-kept secret. But I know that there are many more angels in scrubs still suffering. Neglecting themselves while striving to meet the needs of their patients, too afraid to ask for help and too sick to overcome addiction on their own. 

Before I ever stole a pill from work, before I was ever a daily drinker and habitual pill-popper, I was just a burned-out nurse, exhausted and in pain. I needed a safe place to admit I was hurting and an outlet to vent the pressure. I needed somewhere to take off my scrubs, shed the angel wings, and become vulnerable without being made to feel inferior. I needed to know I wasn’t alone, and that treatment was not the end of my career; only the end of my addiction. My career would have a chance to flourish.

Stigma must be eradicated for recovery to be possible. Prevention, early intervention, and treatment must be advocated for fiercely in order for nursing to be filled with thriving, healthy individuals. I live sober out loud because I believe this change is possible.

Tiffany Swedeen, RN, BSN, CPC/CPRC is a certified life and recovery coach, She Recovers Designated Coach, and a registered nurse in recovery herself from opioids and alcohol. Tiffany lives “sober out loud,” proudly sharing her story through advocacy and blogging and is passionate about helping others do the same. Her goal is to eradicate shame and empower all to live a life of radical self-love.

You can contact Tiffany through her website Recover and Rise, read her blog and follow her @scrubbedcleanrn. 

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Tiffany Swedeen, RN, BSN, CPC/CPRC is a certified life and recovery coach and a registered nurse in recovery herself from opioids and alcohol. Tiffany lives “sober out loud,” proudly sharing her story through advocacy and blogging. She is passionate about helping others do the same. Her goal is to eradicate shame and empower all to live a life of radical self-love. You can contact Tiffany through her website Recover and Rise, read her blog and follow her on Twitter