Intoxicants are out of question in hospital work
The Hospital District of Helsinki and Uusimaa (HUS), which covers 24 municipalities, has been declared a totally intoxicant-free workplace. Some years ago a comprehensive substance abuse programme was drawn up for the HUS hospital district to provide clear instructions for dealing with the substance abuse of employees.
In the HUS administration building, Cenita Blomqvist, manager of well-being at work, and Leena Forss-Latvala, leading occupational health physician, are sitting in Blomqvist’s office and discussing the extent of substance abuse in the HUS hospital district. Both women say that substance abuse is no bigger concern in HUS than in any other workplace.
According to Forss-Latvala, every year about 10–30 cases of substance abuse at HUS lead to intervention and guidance to treatment.
– So all in all, the problem is not a big one, as over 23,000 people work in the Hospital District of Helsinki and Uusimaa, Blomqvist points out.
In work that involves the lives of people, even one case of substance abuse is too much. To guarantee patient safety as well as occupational safety, a system for referring substance abusers to treatment was launched at HUS 13 years ago. The current substance abuse programme became effective in 2009. It was prepared by a large group including employers’ and employees’ representatives, lawyers, occupational health professionals, and occupational safety specialists. The preparatory work took a long time and was very thorough.
– At that time drug testing was added to the programme. Simultaneously the legislation was revised to include items on drug testing and guarantees of confidentiality, says Blomqvist.
HUS is the largest hospital district in Finland; that is why its substance abuse programme is unique.
– I’ve heard that it has served as a model also in other hospital districts, nationwide, Blomqvist adds.
”You can simply go over to a workmate and ask ‘How are you really doing?’”
Training for difficult situations
The HUS employees work under 322 different occupation titles. The substance abuse programme applies equally to the entire organization, regardless of whether the employees are nurses, pharmaceutical staff, office workers or kitchen workers.
Testing for example office staff for drugs or alcohol use at work may seem exaggerated. Forss-Latvala, chief occupational physician, nevertheless does not think that the programme is too strict.
– All new employees starting health care work could be tested for drugs. But we decided that we wouldn’t go quite that far.
The aim of the substance abuse programme is to describe the rules of the game and give instructions for handling difficult substance-related situations at work. HUS implements the model of early intervention. Supervisors and even workmates are obligated to intervene immediately if they notice signs of substance abuse.
– Coming to work late and being absent from work often, neglecting work tasks, changes in behaviour and appearance, Forss-Latvala mentions the most common signs of substance abuse that are listed also in the substance abuse programme.
Intervening with a colleague’s substance abuse is never easy. Cenita Blomqvist emphasizes that if an employee is concerned about their colleague’s substance abuse, they should either confront the person face-to-face or tell their supervisor. The supervisor is obligated to notify his or her own supervisor.
– A person can simply go to one’s workmate and ask how he or she is doing really. At our training sessions we go over these kinds of difficult situations. Supervisors also get to practise, using for instance sociodrama, how to approach an employee who might have a substance abuse problem, Blomqvist explains.
Tackling problems early
According to Leena Forss-Latvala, the occupational health service unit is often the first place where abundant use of intoxicants comes up.
– At their first occupational health examination, new employees are asked about their use of intoxicants, and later also during other visits to the health service unit. We advise employees, and if necessary, refer them to treatment, says Forss-Latvala.
She says that very rarely is anyone seen intoxicated at work, and that is not the usual reason for starting treatment. Helena Leppänen, occupational safety delegate, does remember a few cases, however.
– On one occasion the supervisor was not present, so the substitute confronted a nurse who appeared to be drunk. She was subjected to the breathalyzer alcohol test and sent home. Such cases can sometimes be quite traumatic, so the supervisor later holds a briefing session of the incident with the work community, if the employee in question permits it.
The substance abuse programme states: When a case of substance abuse is revealed at the workplace, the supervisor must arrange a meeting with the employee in question and give notice. If this is insufficient, the supervisor gives the employee a written admonition for an appointment with an occupational health professional. If the employee does not seek treatment or if the treatment is not effective, his or her work contract may be terminated.
– The main aim, however, is to recognize the employee’s substance abuse early enough, to start the treatment immediately, to rehabilitate the employee and restore his or her work ability, Forss-Latvala says.
The employees praise the programme which, according to Blomqvist, works well.
– But long-term efforts are needed for it to be successful: in other words, continuously talking about it, informing and training. We all work together to create an intoxicant-free workplace.