Hailed as one of the most trusted professions and elevated to the status of hero during the COVID-19 pandemic, nursing remains one of the most rewarding yet challenging careers today. The demands on nurses are increasing and multifold – from long shifts and staffing shortages to high-acuity and unreasonable and often unsafe patient loads. These stressors coupled with a global pandemic physically and mentally broke many of these altruistic healthcare providers leading some to unsafe personal choices and ultimately substance use disorders (SUDs).
The Nursing Council of State Boards of Nursing (NCSBN, 2014) describes SUD as a condition comprised of a pattern of behaviors that range from misuse to addiction to substances such as alcohol, legal drugs, or illegal drugs. It is a complex and progressive disease that can have physical, emotional, financial, and legal consequences. Nurses are particularly vulnerable and at a higher risk of dependence on controlled substances due to their easy access in the clinical setting.
The Nurse Worklife and Wellness Study conducted by Trinkoff et al. (2022) estimated the prevalence of substance use (SU) and SUD among a sample of 1,200 nationally represented and randomly selected registered nurses in nine states. The investigators found illicit drug use was 5.7%, and prescription-type drug misuse was 9.9% in 2021. Rates were highest among nurses working in home health or hospice (19%) and nursing homes (15.8%). Overall, 18% of nurses screened were positive for SU problems of which one-third (6.6%) of the total screened positive for SUD.
According to the NCSBN (2014) “many nurses with SUD are unidentified, unreported, untreated and may continue to practice where their impairment may endanger the lives of their patients.” The signs can be very subtle but if you think a colleague may have a problem, you have a professional and ethical responsibility to report suspected alcohol or drug use to your nurse manager, supervisor, or in some states, to the board of nursing.
Warning signs of substance use disorders
Be aware of the following warning signs outlined by the NCSBN (2014):
- Change in job performance
- Absence from the unit for extended periods of time
- Frequent trips to the bathroom
- Arriving late or leaving early
- Making excessive number of mistakes, including medication errors
- Subtle changes in appearance that progress over time
- Increasing isolation from colleagues
- Inappropriate verbal or emotional responses
- Reduces alertness, confusion, or memory lapses
In addition, when a team member cannot gain access to drugs from a health care provider, they may attempt to take, or divert, these drugs from the workplace. This will cause narcotic discrepancies, such as (NCSBN, 2014):
- Incorrect narcotic counts
- Large amounts of narcotic wastage
- Many corrections to the medication records
- Frequent reports of ineffective pain relief from patients
- Offers to medicate co-workers’ patients for pain
- Altered verbal or phone medication orders
- Variations in controlled substance discrepancies among shifts or days of the week
The good news is that when identified, SUD can be successfully treated. In the early 1980s, alternative-to-discipline (ATD) programs were developed to support nurses in their efforts to overcome SUD and return to work. These programs focus on monitoring and testing nurses for drug and alcohol use. Nurses participating in these programs can stop practicing and undergo treatment without losing their license or receiving disciplinary measures, and ultimately return to work (Fauteux, 2022). ATD programs do not provide treatment but have been successful when coupled with an SUD treatment program. See our list of resources below.
American Addiction Centers
American Nurses Association
National Council of State Boards of Nursing (NCSBN)
National Alliance on Mental Illness (NAMI)
Substance Abuse and Mental Health Service Administration (SAMHSA)
Fauteux N. (2022). Are Impaired Nurses Getting the Help They Need?. The American journal of nursing, 122(1), 18–19. https://doi.org/10.1097/01.NAJ.0000815408.11692.b4
National Council of State Boards of Nursing (2014). What You Need to Know About Substance Use Disorder in Nursing. https://www.ncsbn.org/substance-use-in-nursing.htm
Rathburn J. (2022). Destigmatizing alcohol use disorder among nurses. Nursing, 52(7), 23–29. https://doi.org/10.1097/01.NURSE.0000832364.28141.12
Substance use Among Nurses and Nursing Students: A Joint Position Statement of the Emergency Nurses Association and the International Nurses Society on Addictions
Trinkoff AM, Selby VL, Han K, et al. (2022). The prevalence of substance use and substance use problems in registered nurses: estimates from the Nurse Worklife and Wellness Study. Journal of Nursing Regulation.;12(4):35-46. https://doi.org/10.1016/S2155-8256(22)00014-X