Decades of research on substance use disorders (a.k.a., addiction to alcohol and/or drugs chemical dependency) confirms one ugly truth about addiction: it can affect anyone at any age, from any race, any gender and any income level. And this includes nurses, doctors and other healthcare professionals, even though their job entails committing to the health and welfare of their patients.
The problem with a nurse (or other healthcare professional) developing an alcohol or drug dependency is that it’s not confined to generating risks solely to themselves. A substance abusing or addicted nurse potentially puts his or her patients at risk, since they’re substance-impaired and more than likely no longer doing their jobs with sufficient alertness and expertise.
Given there is research data indicating number of nurses living with substance abuse hovers around the 10% range (similar to the rate of the general adult population)[1], this is not a “small issue” – countless people can be affected by addicted nurses not seeking and getting treatment to recover from a substance use disorder.
How is it so many nurses develop issues with substance abuse or addiction? One of the main reasons cited is their likely having access to addictive substances not available (unless prescribed) to the general population.[2]
Prescription medications (including, but not limited to opioids) can be accessed as follows:
- Acquiring floor medications for personal use
- Retrieving medications that should have been disposed of
- Diverting medications* from patients
[*: Diverting medications is when a nurse diverts a portion of the full dose prescribed for a patient, taking it for themselves, instead, in order to temporarily satiate their addiction.]
The amount of stress and fatigue nurses routinely experience on the job can also be contributing factors to their developing a substance use disorder. Regularly facing seriously ill and often dying patients on a daily basis, too, can be emotionally draining. In addition, other workplace factors can add to the risk of addiction for nurses, including:
- Staff shortages
- Long hours
- Increased patient assignment ratios
- Demands from administration
- Shift rotations[3]
Besides the above, nurses are most often on the front lines of patient care, most likely to experience verbal or physical abuse from patients, which only adds to the stress of an already-intense job.
Because the job stress for a nurse can be compounded by personal challenges and stress at home or in relationships issues, it can be easy—again, due to the access to controlled substances—to begin seeking “alternatives” to relax, cope or take the edge off. Prescribed drugs, as pointed out above, are a readily available source of options for a stressed-out nurse.
Another problem that nurses can use diverted drugs or seek a doctor’s pain medicine prescription to alleviate is if they experience an on-the-job injury that takes some time to resolve. Many of these pain medications are habit-forming and addictive, hence not so easy to quit once the injury is resolved.
It goes without saying, a nurse who get addicted and tries to divert medications has to hide their activities from their fellow nurses, doctors and administrative staff. Indications a nurse may be diverting drugs from patients’ medications include:
- Greater controlled substance (e.g., opioid, etc.) pull volume than normal
- Discrepancies in reported doses and medication administration
- Increased instances of being late to work
- Sudden bouts of irritability
- Increased number of mistakes while on their shift[4]
While in the past, a nurse found to have a substance use disorder would have either lost his or her job, or faced disciplinary action by the Board of Nursing. However, these days there are a variety of different approaches to addressing substance abuse in nurses. An impaired nurse can be referred to a treatment center or drug and alcohol rehabilitation program where the program focuses on the unique needs of healthcare professionals struggling with addiction issues. A treatment protocol aimed at establishing the nurse’s recovery from chemical dependency is developed, agreed to, and if completed, succeeded by follow-up care and monitoring for an agreed upon amount of time.
The good news is a substance use disorder is treatable, and nurses seeking recovery from substance abuse or dependency can get the individualized care they need. With the appropriate support and willingness on the part of the nurse, he or she can get the recovery being sought and look forward to getting back to work, free from active addiction.
[1] Baldisseri M Impaired healthcare professional. Crit Care Med. 2007;35(2):S106–S116
[2] National Council of State Boards of Nursing. Chemical Dependency Handbook. 2011.
[3] National Council of State Boards of Nursing. “Substance Use Disorder in Nursing.”
[4] Perry, J.C., et al. Nursing Management. “Drug Diversion Detection.” Feb. 2019.
