You work with a phenomenal nurse who does all the right things. She’s smart, quick and makes special connections with her patients. But she suffers a back injury at work, requiring opioid pain meds. You notice she seems more depressed, more stressed, in chronic pain and worried about hurting herself further, as well as having trouble keeping up with the demands of the job.
Over time, you start to observe suspicious behavior. She starts leaving the unit frequently, making long trips to the bathroom. Her narcotics count is off once, then twice. You happen to notice that she’s documenting large amounts of drug wastage on a regular basis. She’s late for work a lot, something she’d never had trouble with before. She looks tired, less kempt.Click on the image above to read “Substance Use Disorder in Nursing” by the National Council of State Boards of Nursing.
You suspect substance abuse, but that just doesn’t seem possible. She’s always had it together. She’s too smart and professional for something like that to occur.
What do you do?
Substance abuse disorder in nursing is a serious problem. Although the prevalence of substance abuse in healthcare is no greater than that of the general public, with 1 in 10 professionals succumbing to the chronic disease, the challenges of working in a high-stress environment with easy access to substances makes the problem more complex.
The National Council of State Boards of Nursing and the American Nurses Association both take substance abuse disorder very seriously. It’s not only a safety issue for patients, but a threat to a nurse’s health and well-being.
Check out this video, produced by the NCSBN; a brief, but thorough overview of substance abuse disorder in nursing and proper intervention:
As a nurse, you have a professional and ethical obligation to report a co-worker who you suspect is struggling with substance abuse. Many don’t because they’re afraid to cause the person harm, but the sooner action is taken, the better the chances of recovery. In some cases, you might be the one with a problem. You might feel guilty, ashamed, and afraid of what will happen if someone finds out.Click on the image above to read “Impaired Practice in Nursing: A Guidebook for Interventions and Resources.”
But suffering from substance use disorder doesn’t make you a bad person. It’s imperative that you ask for help before you harm yourself or a patient. Many state nursing boards and professional nursing associations have resources available, including Alternative to Discipline Programs. These are rigorous programs aimed at assisting the nurse in recovery while maintaining a license.
The Massachusetts Nurses Association offers a program called SARP, Substance Abuse Rehabilitation Program. They have a local anonymous line that nurses licensed in Massachusetts can call for more information without fear of retribution. Laws vary from state to state, so check with your own state’s professional nursing organization to find information specific to your area.
When You or a Co-worker is Reported: What to Expect
- An evaluation: if a concern is raised, the nurse manager should conduct an investigation to determine whether there is indeed a substance abuse problem before intervening
- An intervention with a trained professional: The nurse should be advised to listen to the concerns without interjecting. Common responses include denial/anger or shame/admittance of problem. The nurse should be provided with peer assistance information. A follow-up meeting is necessary after the nurse has had time to process the intervention.
- The manager should work with human resources to determine what leave options a nurse has while seeking treatment.
- The nurse enrolls in an ADP.
- The nurse returns to work under close supervision and with support measures in place.
If you or someone you work with is struggling with substance abuse, know that there is help and hope.
- National Council of State Boards of Nursing: Substance Use Disorder in Nursing: A Resource Manual and Guidelines
- Massachusetts Nurses Association: Impaired Practice in Nursing: A Guidebook for Interventions and Resources
- Peer Advocacy for Impaired Nurses
- American Nurses Association: Impaired Nurse Resource Center