Substance

Disorders in
Nursing:

Leigh Anne
Koonmen
NURS 450

Objectives
Be able to identify
Estimated prevalence of substance abuse in
nursing
Limitations in nursing research regarding
impaired nursing
Warning signs of impaired nursing
Reporting impaired nursing

Discuss
Ethical dilemmas surrounding impaired nursing
Barriers to treatment

Introduction
Addiction Defined
Estimated Rates
Relevance to Nursing Practice
Limitations in Research
https://www.youtube.com/watch?v=NWDU1iSRk
2M
Source: National Council of State Boards of Nursing (2011)

Systems Theory
Betty Neuman

Response of patients system to actual or

potential environmental stressors
Examines how the person interacts with
their environment in response to stressors
Primary prevention is key to this theory
Relevance to substance use disorders in
nursing:
Use of substances to cope with anxiety
produced by environmental stimuli
Source: Nursing Theory (2013)

Cognitive-Affective-Pharmacogenic
(CAP) Control Theory
Steven R. Gold

Major tenet: human behavior is mediated by internal

struggles between stimulus and response to the
stimulus
Abuse process is initiated by conflict that produces
stress and anxiety
Individual believes they cannot control the situation and
are powerless to affect the environment to remove the
source of stress
This drives the individual to use substances to
alleviate the anxiety
Under the influence of the substance the individual
experiences temporary relief of the anxiety
This is the first step to the cycle of addiction
Source: Department of Health and Human Services

Warning Signs of
Substance Abuse or Addiction

Increased tardiness or absenteeism

Long breaks, frequent trips to
bathroom or off unit
Increased willingness to float, transport,
administer medications
Patient reports of poor pain control
Sloppy job performance
Forgetfulness, drowsiness
Defensiveness
Isolation
Irritability
Difficulty with work responsibilities

Sources: NCSBN (2011); MNA

Source: Thomas & Siela (2011)

Case Study
Nurse James is working his usual shift at the
hospital when one of his most trusted coworkers,
Nurse Sally, is admitted to the unit as a patient
and James is assigned to her care. Over the
course of Sallys treatment, James learns that
Sally has been abusing drugs for years, which
she admits were obtained from the hospital while
she was on duty. James is troubled to learn that
not only has Sally been stealing meds from work,
she has been performing nursing duties while
under the influence of these medications. James
is unsure whether he should report these findings
to his superiors, the police, and/or the State

Consider:
1. What is the ethical dilemma for James here?
2. Do you see any potential legal issues that
could arise if James reports Sally? Do you see
any potential legal issues if he does not report
her?
3. Would your answer change if James later
learned that Sally returned to work after her
hospitalization and caused the death of a
patient?

Reporting Suspected Impaired

Nursing
Unit Manager

Human Resources

Legal Department

https://www.youtube.com/watch?v=0nQiKEXmJP

Healthcare Environments Response

to the Impaired Nurse
Historically: Disciplinary approach
Termination
License revocation
Carries fear of punishment that keeps nurses silent

Current trends: alternative-to-discipline (ATD)

treatment approach
Supportive treatment
Encourage return to practice
Studies show this approach is more effective

Example: Spectrum Healths Policy

Source: Monroe, Kenaga, Dietrich, Carter, & Cowan (2012), Spectrum

Root Cause Analysis

Recommendations
QSEN Competencies
ANA Standards
#7. Ethics
The registered nurse practices ethically.

# 10. Quality of Practice

The registered nurse contributes to quality nursing
practice.

# 11. Communication
The registered nurse communicates effectively in a
variety of formats in all areas of practice.

Sources: ANA (2010), QSEN (2014)

Expected Outcomes
Staff will be able to identify warning signs
of impaired nursing
Nurses who have received treatment for
impaired nursing will successfully return to
work
Need for research will be recognized and
studies related to this topic will increase
Nurses will participate in policy
development that is supportive and clearly
defined
This will include appropriate lines of reporting

Conclusion
Substance abuse disorders in nursing is a major issue concerning
patient safety, nurse retention, and healthcare expenditures
Education on the warning signs of impaired nursing as well as
familiarity with reporting policies should be encouraged of all nurses
Substance use disorders in nursing mirror rates of the general
population (~10%)
ATD programs have higher success rates than disciplinary programs
Non-punative approaches identify, remove, and treat nurses
struggling with substance use disorders in addition to
safeguarding the public and increasing nurse retention rates
The need for improved and more current research could help
expand knowledge of this issue for all nurses
Supportive and clear policy development is imperative to quickly
identify and treat nurses struggling with substance use disorders

https://www.youtube.com/watch?v=Tit0-yX-BTI

References
American Nurses Association. (2010). Scope and standards of practice: Nursing.
(2nd ed.). Silver Spring, MD: ANA.
Department of Health and Human Services. (1980). Theories on drug abuse:
Selected contemporary perspectives. Retrieved from:
http://archives.drugabuse.gov/pdf/monographs/30.pdf
Massachusetts Nurses Association. (2011). Impaired practice in nursing: A
guidebook for interventions and resources.
Monroe, T.B., Kenaga, H., Dietrich, M.S., & Carter, M.A. (2013). The prevalence of
employed nurses identified or enrolled in substance use monitoring programs.
Nursing Research 62(1). 10-15.
National Council of the State Boards of Nursing. (2011). Substance use disorder in
nursing: A resource manual and guidelines for alternative disciplinary
monitoring programs. Chicago, IL: NCSBN.
Spectrum Health (n.d.) Code of excellence: Our commitment to ethics and
integrity.
Systems Theory (2013). Nursing Theory. Retrieved from:
http://www.nursing-theory.org/theories-and-models/neuman-systems-model.php
Thomas, C.M. & Siela, D. (2011). The impaired nurse: Would you know what do to
if you suspected substance abuse? American Nurse Today 6(8). Retrieved from:
http://www.medscape.com/viewarticle/748598_3