Recognizing substance use disorders in nurses

Hailed as one of the trusted professions and elevated to hero status in the course of the Covid-19 pandemic, nursing stays one of the rewarding yet difficult careers today. The demands placed on nurses are increasingly greater and more manifold – starting from long shifts and staff shortages to intense work and an unjustified and infrequently dangerous patient load. These stressors, combined with the worldwide pandemic, have broken many altruistic healthcare providers physically and mentally, leading some to make unsafe personal decisions and ultimately substance use disorders (SUDs).
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The National Board of Nursing (NCSBN, 2014) describes SUD as a condition consisting of patterns of behavior that include each misuse and dependence on substances comparable to alcohol and legal or illegal drugs. It is a posh and progressive disease that may have physical, emotional, financial and legal consequences. Nurses are particularly vulnerable and at greater risk of addiction to controlled substances as a consequence of their easy accessibility in clinical settings.
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Trinkoff et al.’s (2022) Nurse Worklife and Wellness Study assessed the prevalence of substance use (SU) and SUD in a sample of 1,200 nationally represented and randomly chosen registered nurses in nine states. Researchers found that in 2021, the speed of illicit drug use was 5.7% and prescription drug abuse was 9.9%. The highest rate was recorded amongst nurses working in nursing homes or hospices (19%) and in nursing homes (15.8%). Overall, 18% of surveyed nurses were found to have SUD issues, with one third (6.6%) of all nurses testing positive for SUD.
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According to NCSBN (2014), “many nurses with SUDs are unidentified, unreported, untreated, and may continue to practice where their impairments may be life-threatening to patients.” The signs can be quite subtle, but in the event you think a colleague could have an issue, you have got an expert and ethical obligation to report suspected alcohol or drug use to your nurse manager, supervisor or, in some states, the nursing board.

Warning signs of substance use disorders

Be aware of the next warning signs identified by NCSBN (2014):

• Change in work efficiency
• Absence from the unit for an prolonged time frame
• Frequent trips to the lavatory
• Late arrival or early departure
• Making an excessive variety of errors, including medication errors
• Subtle changes in appearance that progress over time

• Increasing isolation from colleagues
• Inappropriate verbal or emotional reactions
• Reduces alertness, disorientation or memory loss

Additionally, if a team member is unable to access medications from a health care provider, they might try to collect or take these medications from the workplace. This will end in narcotic discrepancies comparable to (NCSBN, 2014):

• Incorrect drug counters
• Large amounts of drug waste
• Numerous corrections in medical documentation
• Frequent reports of patients not providing effective pain relief
• Offers pain treatment to co-workers’ patients
• Changed verbal or telephone drug orders
• Differences in controlled substance variances between shifts or days of the week

Alternative programs to disciplines

The excellent news is that when identified, SUD could be effectively treated. In the early Nineteen Eighties, alternative to discipline (ATD) programs were developed to support nurses of their efforts to beat SUDs and return to work. These programs give attention to monitoring and testing nurses for drug and alcohol use. Nurses participating in these programs can discontinue their practice and receive treatment without losing their license or facing disciplinary motion, and ultimately return to work (Fauteux, 2022). ATD programs don’t provide treatment, but are effective when combined with an SUD treatment program. See our list of resources below.

Resources:

• Signs of drug use and addiction: methods to tell if an individual is stoning upAND

• Substance use amongst nurses and nursing students: a joint position statement from the Association of Emergency Nurses and the International Association of Addiction NursesAND

• Substance use disorders in nursingAND
• Alternative programs to disciplinesAND

• Substance use disorders

• National hotline

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Fauteux, N. (2022). Do disabled nurses get the assistance they need?, (1), 18–19. https://doi.org/10.1097/01.NAJ.0000815408.11692.b4

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National Council of State Boards of Nursing (2014). What it is advisable learn about substance use disorders in nursing. https://www.ncsbn.org/substance-use-in-nursing.htm

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Rathburn J. (2022). Destigmatizing alcohol use disorders amongst nurses. (7), 23–29. https://doi.org/10.1097/01.NURSE.0000832364.28141.12

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Substance use amongst nurses and nursing students: a joint position statement from the Association of Emergency Nurses and the International Association of Addiction Nurses
https://www.nursingcenter.com/journalarticle?Article_ID=4172511&Journal_ID=1444159&Issue_ID=4172129
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Trinkoff AM, Selby VL, Han K et al. (2022). Substance use prevalence and substance use problems in registered nurses: Estimates from the Nurse Worklife and Wellness Study. ;12(4):35-46. https://doi.org/10.1016/S2155-8256(22)00014-X AND

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