What Happens When a Nurse Has a Substance Abuse Problem?
Substance abuse can affect any socioeconomic class, gender, race, and profession. Nursing is certainly not immune to the pitfalls of this terrible disease. Nurses are entrusted to protect the patients in their care from harm at all times. This protection includes the ability to perform at a high level of critical thinking. Caring for patients while under the duress of substance abuse puts the entire nursing process in harm’s way.
Prior to the 1980s, before substance abuse was recognized as a disease, nurses were relieved of duty and/or had their nursing license revoked with little recourse or treatment options when found to have a substance abuse disorder. Since that time, many states have enacted non-disciplinary rehabilitation programs to assist nurses with recovery. These intensive programs allow the nurse to gradually return to the working environment once it can be established and confirmed that the nurse is safe to practice in a clinical setting.
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Although alcohol has been a main source for substance abuse disorders, there are more mind-altering and dangerous options for those with an addiction disease. Chemical changes occur in the brain of an addict, making it more and more challenging to recover and rehabilitate from the abuse. The earlier the disease and abuse is recognized and treated, the better the outcome for recovery for the nurse and the option to return to the work environment.
A unique challenge to the nursing profession and substance abuse is the access to narcotic medications. Diversion of these drugs for self-use is not only harmful to the nurse, but is also unethical in the failure to protect the patient from harm by diverting the drugs from the patient. Furthermore, the impairment of the nurse may endanger the life of the patient in their care.
Identifying nurses who have a substance abuse disorder and assisting them to find appropriate treatment programs can save lives. Signs of impairment can include extended absence, frequent trips to the restroom, arriving late and leaving early, excessive medication errors, isolation from colleagues, inappropriate emotional outbursts, or diminished alertness.
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Once a substance abuse disorder is suspected, the nurse is typically placed on leave until an investigation can be conducted. The nursing leadership team and human resource leaders are required to, in most states, report the abuse to the Board of Nursing (BON) and the local police authority. Each BON has a process for investigation and varying levels of programs to assist nurses through recovery. The Nurse Practice Act for each state will define the process for programs in the state to assist the nurse with returning to work once they are safe to practice.
Many states offer a graduated program of returning to work where there is oversight of the nurse with strict restrictions on the work environment. These restrictions can include a weekly check-in with a nursing leader, a weekly or monthly report to the BON, restrictions on shift assignments such as no night shift work, or complete removal of the nurse from clinical practice such as an advice nurse or case-manager role.
The National Council of State Boards of Nursing, who oversees each BON, has many resources for nurses and nurse leaders on addressing the disease of substance abuse disorder. Nurses should check with their local Board of Nursing to learn the process of reporting substance abuse disorders and the programs that are offered for recovery and rehabilitation in the state(s) in which they are licensed.
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