Nursing Paper on Impaired Nurses: Drug and Substance Abuse

Impaired Nurses: Drug and Substance Abuse


Drug and substance abuse affects all generations, cultures, careers, and occupations including nurses. Although nurses are not placed at a higher risk than the public sector in alcohol and substance abuse, they are placed in a unique position. Nurses have greater access to drugs in their work environments than other occupations. Thus, nurses’ unique positioning depends on pattern of dependency. For example, nasal spray butorphanol (Stadol) is widely abused by nurses as they can easily access it or obtain a prescription from doctors within the work environment. Nurses facing difficulties in sleeping especially after long shifts often consume the drug.  Additionally, it helps them to cope with stress if they are taking extra shifts while maintaining their social and financial responsibilities. This report, therefore, will discuss the high prevalence of substance abuse and addiction among nurses.

Alcohol, Drugs, and Substance Abuse and Addiction among Nurses

According to Thomas and Siela (2011), at least 10% of all nurses are impaired due to alcohol and drug addiction. They also assert that 15% of all nurses are likely to be in recovery from either alcohol or substance use and abuse. Impaired nurses prefer night shifts as they can access and use drugs within the working environment without raising suspicion among colleagues and supervisors. Ivey (2015) states that the National Nurses Society on Addictions (NNSA) conducted a study in 1980 to investigate nurses’ misuse, abuse, and addiction to drugs, alcohol, and illegal substances. A Peer Assistance Program was established to assist impaired nurses dealing with dru]g addiction. The program involved installation of automated computerized delivery systems of medication in decreasing the prevalence of drug use among nurses. The NNSA acknowledged that substance use and abuse is are problems that affected nurses more than the general public. The raised concerns, therefore, were used to encourage medical professions at increased risks of abuse substances to seek help. Nurses experience high levels of stress in the course of heir work. At the same time, they have access to drugs and substances. Because of stress and availability of relievers, nurses misuse drugs and, eventually become dependent on them. Lack of emotional and physical health can hinder nurses from providing proper care. Consequently, they can embrace the use of medicines they can easily access if they believe the substances can help them deliver quality nursing care services comfortably.

Cynthia and Debra (2011) discuss various myths associated with substance abuse among impaired nurses. Foremost, they assert that impaired nurses do not use street drugs, contrary to common belief. In fact, nurses abuse substances and medication that they access in the workplace. Thus, a nurse can become impaired easily, for instance, when they take patients’ stress medication or painkillers. Additionally, nurses who abuse substance often substitute saline for injectable medications such as Demerol, codeine, and morphine sulfate. Thus, nurses using harmful and addictive substances ought to seek help as they impair their skills and ability to deliver quality nursing care to the patients.

The second myth is the belief that impaired nurses have long histories of drug and alcohol abuse. Conversely, Cynthia and Debra (2011) affirm that nurses who abuse substances are mainly those that have recently experienced a stressful event. For example, nurses that have gone through divorces, involved in an accident, or been ill can embrace substance abuse to cope with the stress and pain. There are specific signs and symptoms of substance abuse. Nurses, however, have skills and experience to avoid being detected. Thus, identifying nurses impaired due to use of harmful and addictive drugs and substances can be challenging.

Signs and Symptoms of Impaired Nurses

It is vital to understand that substance abuse is voluntary among nurses and the public sector. Health practitioners assert that alcohol and drug addiction is a compulsive behavior. The disorder often affects the brain causing emotional, mental, and physical instabilities (Ivey, 2015). For example, nurses from abusive families that do not have support systems or which often make poor choices in life are vulnerable to drug addiction. Such nurses are the most vulnerable because they believe that drugs assist them to fulfill their social and professional duties and responsibilities. Unfortunately, they fail to understand that drug addiction leads to an adrenaline rush coupled with unstable lifestyle and denial. Most nurses addicted to alcohol and drugs often combine the substances. The combination leads to devastating consequences such as permanently impaired emotional, psychological, and physical skills and abilities.

Common signs and symptoms of substance abuse among nurses are diverse. Nurses’ primary responsibility is taking care of patients. Thus, nurses can either fail or ignore to caring for their patients (Thomas, & Siela, 2015).  Health care professionals including nurses use and abuse either alcohol or illegal addictive substances. Most nurses, however, opt to combine alcohol with addictive substances such as cocaine, Ritalin, hallucinogens, antidepressants, and ecstasy. Impaired nurses often have a strong need to abuse such drugs to cope with stress and satisfy their addiction. Coworkers should, therefore, show interest in each other’s lives. Consequently, they must be aware when an impaired nurse abuses alcohol or drugs. For example, an alcoholic nurse is more likely to report to work drunk, with a hangover, or reeking of alcohol. The nurse is also likely to drink more beverages that are alcoholic during work breaks. Conversely, they can consume more soft drinks, chewing gum, mints, and drink mouthwash in attempts to reduce the stench of alcohol. Such signs should be acknowledged by coworkers to identify nurses who abuse alcohol.

Addressing Substance Abuse among Nurses

Often, addicts do not seek help voluntarily. More so, the public believes that alcohol and drug addicts cannot recover. As a result, there exists a myth that impaired nurses only need to access treatment for a couple of weeks before they can resume their duties. It should, however, be noted that short-term inpatient programs should not last less than three weeks. Mor so, the programs should be complemented by follow-up supervised visits to check the nurses’ physical and emotional health (Ivey, 2015). The impaired nurses, therefore, should not resume duty before the inpatient program and follow-up supervisions affirm that they parties can deliver quality care. Thus, the length of treatment depends on the impaired nurses’ willingness to seek and receive help. More importantly, it should be noted that nurses that take longer in receiving treatment for substance abuse are also more likely to remain drug and alcohol-free despite the struggle for recovery lasting a lifetime. The impaired nurses can make a complete recovery. They, however, need to be given support and the opportunity to show that they have the desire and will to recover.

Cynthia and Debra (2011) assert that nurses who are impaired by drug and alcohol addiction should be encouraged or forced to seek treatment. Although they can resist entering a treatment program, a court order can ensure they seek treatment. Encouragement from peers and family can also prompt them to enter a treatment program. Thus, impaired nurses should not be dismissed, rather, they should either be encouraged or forced to seek treatment. Nurses ought to gain education on the signs and symptoms as well as myths, behaviors, and truths representing substance abuse.

It is difficult for nurses to suspect each of being substance and drug addicts, as they fear reprisal. Consequently, important steps towards confronting or notifying an impaired nurse cannot be undertaken (Easier, 2016). The healthcare sector, therefore, should identify policies and procedures to be implemented when dealing with substance abuse among nurses. Employee assistance programs should be carefully documented and changes in behavior among the suspected nurses noted. The documentations are also vital as they can be applied to enhance the nurses’ willingness, urge, and desire to seek treatment. More so, coworkers can rely on the employee assistance programs to identify and assist the impaired nurses rather than ignore the fact that colleagues could be abusing alcohol as well as substances.

There are legal aspects that should be undertaken when reporting an impaired nurse involved in substance abuse. The American Nurses Association Code of Ethics ensures nurses’ ethical and moral responsibilities are standardized. The legal aspects, however, vary among states. Thus, they cannot be applied universally as they do not provide standardized frameworks preventing nurses from embracing alcohol and substance abuse. For example, the framework is implemented to ensure nurses do not embrace poor performances and use excuses for lightening and changing their duties in providing quality care to patients. More so, it is implemented to avoid jeopardizing patient safety (Easler, 2016). The framework, however, should not be a base to stigmatize impaired nurses. Instead, the affected nurses should be encouraged to seek treatment and provided with an opportunity to affirm that they have recovered and are capable of providing patients with quality care to enhance their safety.

Nurses in recovery ought to be hired and provided with the opportunity to provide their skills and expertise in enhancing patient safety. Nurses in recovery are often regarded as risky because they can relapse, and make mistakes in the course of performing their duties. It is crucial for nurses in recovery to be given a second chance (Easler 2016). They should, however, continue working in a recovery professional program to ensure that they provide safe and quality care to patients. More so, the program can guide the nurses and encourage them to avoid or manage stressful incidences socially or professionally. Consequently, they can learn to cope with pain, stress, and the urge to indulge their addiction. Subsequently, they can acknowledge that their previous experience in enhancing patient safety through nursing is a rewarding wealth they should be grateful for and keen to maintain.


To promote, advocate, and protect patients’ rights, nurses ought to maintain a professional conduct. Consequently, nurses can ensure patients’ safety and health is attained. Impaired nurses, however, cannot fulfill their duties because substance abuse interferes with their physical and emotional functioning. As a result, they should acknowledge they have a disorder and seek treatment. The treatment programs ought to provide them with crucial skills to deal with stress, pain, and discomforts encouraging them to indulge in substance addiction. Consequently, they can resume their duties and responsibilities and enhance the quality of health accessed by patients.



Copp, M. (2009). Drug addiction among nurses: Confronting a quiet epidemic. Modern medicine Network. Retrieved from

Easier, L. (2016). Nurse Managers: Why You Should Hire a Nurse in Recovery. Peer Assistance Programs in Nursing.

Ivey, M. (2015). Substance Abuse Among Nurses. University of Kentucky College of Nursing.

Thomas, C., & Siela, D. (2011). The impaired nurse: Would you know what to do if you suspected substance abuse? American Nurse Today. Retrieved from