Identify and help nurses who may have a substance use disorder

Specialized addiction treatment for health care professionals

Nurses, due to the nature of their work and dedication to patient care, can become vulnerable to a substance use disorder. Some may use controlled substances found at work, while others may use alcohol or other drugs available outside the health care setting. You can help a nurse receive the specialized care he or she deserves by understanding and recognizing the symptoms of a substance use disorder and knowing that support resources are available.

How to recognize symptoms of a substance use disorder

Changes in any of the following behaviors may indicate that a nurse is misusing substances:

Personality - Changes in personality, such as increased irritability, defensiveness, and isolation, may indicate a substance use disorder, especially when assessed with other signs of addiction.

Physical behavior - Slurred speech, lack of coordination, or unusual forgetfulness may be attributed to substance use.

Work patterns - A sudden willingness to work on days off, volunteering for overtime, or skipping vacations may indicate a desire to maintain ready access to substances found in the workplace. Likewise, coming in late for shifts, increased absenteeism, including not calling in or not showing up for shifts as scheduled, may indicate a use of substances not found at work.

Performance - Diminished work performance may indicate a substance use disorder, which, if unaddressed, can have a significant impact on patient care and safety. Common changes may include inaccuracies in medication counts (especially narcotics), lack of follow-through, difficulty completing work, coming to work late, leaving early, or disappearing for extended periods of time during a shift.

How to help nurses suspected of a substance use disorder

To effectively identify and treat a substance use disorder, and to support reintegration into the workplace, an organization must have established policies and processes that are understood and implemented across the board. Support available varies by role and organization but typically includes the following:

Administrator - The administrator of a hospital, nursing home, or other health care facility employing nurses sets the tone and policies when dealing with substance use disorders. The administrator must make a critical decision: Should misuse of substances be seen as a problem addressed with punitive disciplinary steps, or should it be seen as a disease addressed with compassion? Many states offer support programs that address substance use disorders as a disease. These programs provide employers with a monitoring or diversion option for nurses struggling with this issue. Monitoring programs work in conjunction with employers to support affected nurses by helping to ensure that they complete treatment, attend Twelve Step meetings, participate in self-care, take drug tests, and return to work, as well as satisfy employer and supervisor work rules and performance requirements.

Human Resources - HR professionals need to create and support options for nurses with substance use disorders. Two common options are state nurse monitoring or diversion programs and employer-sponsored Employee Assistance Programs. Both programs provide nurses with the opportunity to meet confidentially with professionals/counselors to discuss issues and explore treatment options.

Supervisor - Nursing supervisors need to have a zero-tolerance policy for anything that could compromise patient safety and quality of care, including a nurse who might be impaired or diverting medications. Policies that support treatment of substance use disorders can also help the supervisor monitor the nurse's reintegration into the work environment. Some treatment programs work closely with the supervisor to provide workplace reintegration support.

Additionally, nursing supervisors can be a key resource for education related to signs and symptoms of substance use disorders and how best to help a peer diagnosed with the disease.

Coworker - Nurses are required by the Code of Medical Ethics to report a colleague they suspect may have a substance use disorder. However, they will likely do so only if they are guaranteed confidentiality and know the nurse will be helped and not punished or terminated. Peers can also offer support and connection for a nurse returning to work after successfully completing a treatment program.

Employers can create an environment that supports effective identification, intervention, treatment, and reintegration of nurses into a healthy life and career. This is accomplished through understanding the signs of substance use disorders and having an established process to address the disease.

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