Reentry into the Work Place

Source: Developed by the Peer Assistance Advisors, 1996 and updated in 2009

Reentry into anesthesia after a period of absence can create a stressful readjustment time. A person who has been in treatment for an addictive disease will experience the same adjustment period as a person who has been away from clinical anesthesia for any other reason. Recovering persons should be encouraged not to rush back to work, but to allow time to develop a new lifestyle and new coping mechanisms. People who are in recovery from substance abuse may enter the profession more aware of their feelings, who they are, what their goals are and better equipped to seek support from peers than prior to seeking treatment.

CRNAs reentering a department of anesthesia fear rejection by their peers. They are ready and willing to work to regain the trust and respect from their peers, but they need to be met half-way in this effort. Recovering CRNAs are aware of their lifetime disease of chemical dependency, a disease requiring their attention and prevention for a lifetime to prevent relapse. The internal critic is well developed in the professional and so the recovering professional often makes a better employee because of dependability, willingness to work hard, and expending great effort in keeping their personal and professional life at a high standard.

The employing institution has a legal obligation to the public. Historically, most institutions do not want to accept the potential legal liability by employing a recovering professional. However, trends are changing slowly. More institutions are establishing peer assistance programs to help and support the recovering substance abuser in his recovery. Aftercare contracts and new lab screening techniques have given the institution the tools necessary to assure the public and protect itself. New medications are also available to insure and aid in the recovery process.

Recovering CRNAs reentering the profession are role models. Much is to be learned and shared by this group of anesthesia providers. A network of recovering CRNAs has been formed called Anesthetists in Recovery (AIR). AIR is a national support organization involved with both education and networking for reasons of peer assistance. For more information on AIR, you may e-mail Art Zwerling.

Before reentry into the work place, a return to work contract should be established between the employer and recovering employee. Each contract should be geared toward the particular individual involved according to his or her particular situation. Also, state board of nursing rules and guidelines should be taken into consideration when designing a reentry contract. A reentry contract may be more restrictive than the state requirements, but must not be more lenient.

Before a recovering person reenters an anesthesia department, the department manager should assess the feelings and concerns of the staff working directly with the recovering person about chemical dependency, the recovery process, the recovering CRNA’s needs and the support needed from the staff for a successful reentry. The manager will need to monitor the reentry and keep in close contact with the recovering employee. Evaluations should be performed periodically as stipulated in the return to work contract. Sensitivity and support from the staff is essential to help the recovering employee adjust to the return to work.

Recommendations for Successful Reentry: 
Successful reentry to the anesthesia workplace is possible with supportive colleagues and an established department policy. Monitoring the recovery of nurse anesthetists and other healthcare professionals with a history of substance misuse and chemical dependency requires a well-informed reentry plan. The following is intended to provide information and education concerning these issues. If you have any questions, please contact a Peer Assistance Advisor. 

Based on over 25 years of experience with CRNAs, the AANA Peer Assistance Advisors recommend that a good starting place for reentry is:

1. Minimum of one year out of the clinical anesthesia arena
2. Meeting the Talbott criteria for reentry
   • Supportive spouse/significant other
   • No untreated psychological comorbidities
   • Acceptance of the chronicity of chemical dependency
   • Grounded in the recovery community (sponsor, etc.)
   • Supportive worksite/department for reentry
3. Willing to commit to monitoring for a minimum of five years
4. Willing to take naltrexone where appropriate
5. Willing to participate in toxicology screening on a random basis
6. Has supportive colleagues at the worksite familiar with history and needs 

Model Reentry Contract

Back to Reentry Resources

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