Running Head: NURSING ADDICTION: SUBSTANCE ABUSE

Nursing addiction: Substance abuse

Kelsy Dannenberg
Kapiolani Community College

NURSING ADDICTION: SUBSTANCE ABUSE

Nursing addiction: Substance abuse

A nurses work environment differs from other professions in that they are
constantly exposed to sickness and death, as well as access to medications. Increased
stress, defined as physiological or psychological tension that threatens homeostasis or a
persons psychological equilibrium (Potter & Perry, 2014), can increase the risk of drug
abuse (Epstein, Burns, & Conlon, 2010). Nurses who practice under the influence put
patients, as well as the profession, at risk. There are multiple programs available to the
drug dependent nurse that can help to eliminate their addiction and return the nurse back
to work. This paper talks about the substance abuse and drug dependence in nurses, the
risk drug dependent nurses pose on patients, coworkers, and the facility, and the different
methods they can use to return to practice with a healthy, unimpaired routine.
According to The American Psychiatric Association (2015), addiction as a
condition occurs when the body must have a drug to avoid physical and psychological
withdrawal. Dependence occurs when the drug dominates ones life and the addict
develops tolerance. This forces the person to consume larger doses of the drug to get the
same effect. If health care workers fall under the above circumstances, they may be
considered chemically dependent.
Current evaluations of substance abuse and addiction rates among nurses range
from 14% - 20% (Monroe & Kenaga, 2011), with the highest numbers of abusers found
in specialties of oncology (42%), psychiatry (40%), and emergency and adult critical care
(38%) (Naegle, 2006). Registered nurses have a 50% higher rate than the general public
for substance abuse (Epstein et al., 2010). These percentages can be related to the
demanding work environment and the stress they endure. Some nurses turn to alcohol and

NURSING ADDICTION: SUBSTANCE ABUSE

tobacco to cope with their stress, and some turn to more illicit drugs. Other illicit drugs
include marijuana, hashish, cocaine, inhalants, hallucinogens, heroin, and prescription
drugs (Naegle, 2006). Any coping method listed above can increase their risk for
addiction (Monroe & Kenaga, 2011).
Professionals within the field have recognized addiction amongst nurses for over
100 years (Monroe & Kenaga, 2011). Current rates place substance misuse, abuse, and
addiction as high as 20%, as mentioned above. Unfortunately, fear of punishment keeps
many nurses silent (Monroe & Kenaga, 2011). There are many reasons why nurses who
are addicted to substances will not be reported. One of these reasons is because
dependent nurses believe they have pharmaceutical invincibility in which they can selfmedicate without becoming addicted (Epstein et al., 2010). These nurses dont report
themselves because they dont believe they have a problem. They are under the
impression that they can handle the drug and avoid addiction. As far as nurses reporting
their colleagues, only 37% of nurses who knowingly work with a chemically dependent
nurse will report their coworker (Kunyk & Austin, 2011). Because of this, addicted
nurses are not always reported and they may continue to practice under the influence. If
none of these nurses are reported, the number of addicted nurses will accumulate, putting
many people at risk for danger.
The people at risk from nurses who practice under the influence include the nurse
themself, the patients, their coworkers, and the facility. Impairment related to substance
abuse can negatively affect nurses performance in alertness, attention, concentration,
reaction time, coordination, memory, multi-tasking, perception, and thought processing as
well as on self-estimation of impairment and disinhibition (Kunyk & Austin, 2011). Job

NURSING ADDICTION: SUBSTANCE ABUSE

performance becomes inconsistent as the nurses ability to function declines. Issues such
as forgotten orders, incorrect charting, decreased quality of care, and decreased
productivity and efficiency occur (Epstein et al., 2010). There is an increase in patient
and family complaints which decreases the value of client centered care. An example of a
decrease in client centered care is an addicted nurse who may administer less than the
required dose to the patient. The addicted nurse may then save the rest of the medication
for him/herself (Epstein et al., 2010). This limits the amount of trust the public can put in
the nursing profession. When only a few nurses are considered untrustworthy, the general
perception of the profession is untrustworthy (Kunyk & Austin, 2011). If the public does
not trust their health care provider and workers, individuals may be discouraged to seek
health care. This can decrease the overall status of the publics health, which may prove
detrimental to society. Therefore, nurses who are chemically dependent may require the
help of certain programs to remove their addiction.
There are several different ways the drug dependent nurse can approach their
addiction. Some strategies include state legislation and regulations, peer assistance
models, alternative to discipline programs, and education. The first approach of state
legislation and regulations acknowledge diversion legislations. Diversion legislations
refer to diverting a defendant out of the criminal justice system by having them complete
a diversion program rather than be imprisoned or serve an alternative sentence
(Diversion, 2015). State nursing boards recognize addiction as an illness, so action is
undertaken in circumstances such as substance abuse (Naegle, 2006). According to
Naegle (2006), diversion programs offer confidential, voluntary programs for nurses who

NURSING ADDICTION: SUBSTANCE ABUSE

do not get charged with criminal acts if they acknowledge the need for addiction
treatment (Naegle, 2006).
The second approach, peer assistance models, is implemented through specialty
nurses associations, state nurses associations, and in multidisciplinary non-profit
agencies. These programs receive confidential calls, accept outreach to nurses and their
families, and facilitate legal assistance (Naegle, 2006).
The third approach is alternative-to-discipline (ATD) programs. This type of
approach motivates individuals to seek help for their dependency (Monroe & Kenaga,
2011). This approach includes programs such as Impaired Professional Nurse Program
(IPNP) and Peer Assistance Program (PAP) (McHugh, Papastrat, & Ashton, 2011). ATD
programs are sponsored by state boards for nursing and collaborate with state nurses
associations or other peer assistance programs. They provide support, monitoring,
mandatory attendance at support groups, and relapse prevention counseling (Naegle,
2006). As research shows, ATD programs result in a 75% decrease in the overall problem,
which may help nurses with treatment and to resist relapse. Nurses reported the support
they received from their ATD program is what motivated them to return to work (Monroe
& Kenaga, 2011).
The last strategy stated above is education. Health care facilities can ensure that
their employees are educated and trained to recognize signs of impaired practice. These
facilities can provide drug and alcohol prevention education, drug testing using a certified
laboratory, and Employee Assistance Programs (EAP) to ensure a drug free environment.
An EAP is a referral program that provides counseling for workers who may have
personal problems that affect their quality of work (Salazar, 2006).
Education not only helps the addicted nurse, but may also prevent future nurses
from becoming dependent. Many education programs are implemented in nursing

NURSING ADDICTION: SUBSTANCE ABUSE

schools. They are important because younger nurses are at a higher risk for drug abuse
(Epstein et al., 2010). To reduce this risk, nursing students can be educated on the risks,
symptoms, and resources of drug abuse (Epstein et al., 2010), as well as on stress and
how to manage it. These types of education programs will make soon-to-be nurses aware
of the reality of substance abuse and how to avoid it. Educating nursing students as well
as the working nurses can potentially decrease the percentage of addicted health care
workers.
In conclusion, substance abuse occurs in health care facilities. According to
Moustaka and Constantinidis (2010), nurses are challenged with demanding work
assignments and conditions, understaffing, a high prevalence of patient deaths, an erratic
work pace, and excessive work demands. Because of these factors, nurses are placed at
high risk for addiction and substance abuse. Fortunately, there are multiple strategies
available for the chemically dependent nurse. State legislation and regulations, peer
assistance models, and ATD programs can be considered if a nurse becomes addicted or
is already addicted. These programs support nurses to return to work while confidentially
and continually treating their addiction. With the help of these programs, nurses can
eliminate their drug dependencies and return back to practice. This can lead to the
increase in the overall credibility of the health care provider and their facility.

NURSING ADDICTION: SUBSTANCE ABUSE

References
American Psychiatric Association. (2015). Addictions. Retrieved from
www.apa.org/topics/addiction/index.aspx
Diversion Law and Legal Definition. (2015). Retrieved from
http://definitions.uslegal.com/d/diversion/
Epstein, P. M., Burns, C., & Conlon, H. A. (2010). Substance abuse among registered
nurses. AAOHN Journal, 58(12), 513-516. doi:10.3928/08910162-20101116-03
Kunyk, D., & Austin, W. (2011). Nursing under the influence: A relational ethics
perspective. Nursing Ethics, 19(3), 380-389
McHugh, M., Papastrat, K., & Ashton, K. C. (2011). Assisting the drug addicted nurse:
Information for the legal nurse consultant. Journal Of Legal Nurse Consulting,
22(3), 11-14.
Monroe, T., & Kenaga, H. (2011). Don't ask don't tell: Substance abuse and addiction
among nurses. Journal Of Clinical Nursing, 20(3/4), 504-509. doi:10.1111/j.13652702.2010.03518.x
Moustaka, E., & Constantinidis, T. C. (2010). Sources and effects of work-related stress
in nursing. Health Science Jounral, 4(4), 210-216. Retrieved from
http://search.proquest.com/docview/758656815?accountid=458
Naegle, Madeline. (2006). Nurses and matters of substanace. NSNA Imprint. 58-63.
Retrieved from
http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_NovDec06_Feat_Naegle.
pdf

NURSING ADDICTION: SUBSTANCE ABUSE

Potter, P., Perry, A. G., Stockert, P., Hall, A. M. (2012). Fundamentals of nursing. St.
Louis, MO: Mosby.
Salazar, M. K. (Ed.). (2006). Core curriculum for occupational & environmental health
nursing (3rd ed.). St. Louis: Saunders.

NURSING ADDICTION: SUBSTANCE ABUSE

Dimension

Topic 3
Research
(20%)

Subject
Matter
(30%)
15

15

Exceeds
Meets Expectations
Expectations
Choice of topic Very original topic
Approved topic
Scholarly
Sufficient, relevant 2 sufficient sources;
sources
sources At least 2 some irrelevant
from nursing
journals
Recent
Recent, appropriate Recent but some
scholarly
sources
inappropriate
sources
sources; none within
last 2 yrs.
Use of sources data and arguments Statements are
from sources are
factually accurate but
appropriately used irrelevant to the
topic.
Sources are over
used
Content
Comprehensive and Most statements are
accurate; key
accurate; missing
elements of
one of the key
assignment covered elements of the
assignment.
Support
Major points
statements are
supported by
adequately
specific examples
supported. Minor
and references
opinion statements

Organizatio Structure
n (25%)
9

Transitions
from one idea
to the next
Introduction
and conclusion

9
Mechanics
(22%)
7

Sentence
structure
grammar,
spelling,
sentence
structure,
abbreviations
Run on
sentences

9
Needs
Improvement
Not appropriate for paper
few or no scholarly
sources
none within last 5
years
misrepresents some
sources' data or
conclusions.
Sources are over
used.
generalized
statements
Not all areas are
covered

Entire paper is very paper is clear and

clear and organized organized for the
most part

Statements are
made without
providing support.
Many opinions
stated
entire paper lacks
clarity and
structure

Excellent section
transitions

lack of section
transitions

adequate section
transitions

Introduction
clear and concise
provides sufficient intro and conclusion
background on the Introduction slightly
topic and
weak or conclusion
conclusion follow does not match the
logically from the topic
body of the paper.
Follows directions
for paper
Excellent
A few errors,
mechanics
minimal distraction

no clear intro
and/or conclusion.
The introduction
does not follow
topic directions

Many errors.
Mechanics interfere
with reader's
understanding of
text

Comments

NURSING ADDICTION: SUBSTANCE ABUSE

Paraphrasing

Not paraphrased!
Sources are
mined for facts but
the student
provides style and
structure

Use of APA
format
Line spacing

cover page,
headers, running
head, subheaders,
in-text citation,
reference page
correctly formatted

10

Paraphrased: the
other source is
identifiable as the
origin of the style
and structure. No
individual thoughts.
Citations are lacking

close paraphrase:
presentation of the
information is
clearly the work of
someone else.
Lacking citations.
This is
unacceptable.
few errors in
cover page,
formatting cover
headers, in-text
page, headers, in-text citation, reference
citation, and/or
page formatted
reference page
incorrectly
TOTAL

Dimension
Topic 3
Research
(20%)

Choice of topic
Scholarly sources
Recent scholarly
sources
Use of sources

Subject
Matter
(30%)
15

Content

Support
15
Organiza Structure
tion (25%)
9
Transitions from
one idea to the
next
7
Introduction and
conclusion

Exceeds Expectations
Very original topic
Sufficient, relevant
sources At least 2 from
nursing journals
Recent, appropriate
sources

Meets Expectations

Needs Improvement

Approved topic
Not appropriate for paper
2 sufficient sources; some few or no scholarly
irrelevant
sources
Recent but some
inappropriate sources;
none within last 2 yrs.

none within last 5 years

data and arguments from Statements are factually

sources are appropriately accurate but irrelevant to
used
the topic.
Sources are over used
Comprehensive and
Most statements are
accurate; key elements of accurate; missing one of
assignment covered
the key elements of the
assignment.
Major points supported statements are adequately
by specific examples and supported. Minor opinion
references
statements

misrepresents some
sources' data or
conclusions. Sources
are over used.
generalized statements
Not all areas are covered

Excellent section
transitions

adequate section
transitions

lack of section transitions

clear and concise intro

and conclusion
Introduction slightly weak
or conclusion does not
match the topic

no clear intro and/or

conclusion. The
introduction does not
follow topic directions

A few errors, minimal

distraction

Many errors. Mechanics

interfere with reader's
understanding of text

Statements are made

without providing
support. Many opinions
stated
Entire paper is very clear paper is clear and
entire paper lacks clarity
and organized
organized for the most part and structure

Introduction provides
sufficient background on
the topic and conclusion
follow logically from the
body of the paper.
Follows directions for
paper
9
Mechani Sentence structure Excellent mechanics
grammar, spelling,
cs (22%)
sentence structure,
abbreviations
Run on sentences
7

Comments

NURSING ADDICTION: SUBSTANCE ABUSE

Paraphrasing

Not paraphrased!
Sources are
mined for facts but the
student
provides style and
structure

Paraphrased: the other

source is identifiable as
the origin of the style and
structure. No individual
thoughts. Citations are
lacking

close paraphrase:
presentation of the
information is clearly the
work of someone else.
Lacking citations. This is
unacceptable.

Use of APA format

Line spacing

cover page, headers,

running head,
subheaders, in-text
citation, reference page
correctly formatted

few errors in formatting

cover page, headers, intext citation, and/or
reference page

cover page, headers, intext citation, reference

page formatted
incorrectly

11

TOTAL

NURSING ADDICTION: SUBSTANCE ABUSE

12

Check off List

_____ Title page including Running head correctly formulated
_____ Title on first page of body of paper
_____ Compose a First paragraph that indicates what will be discussed, and in what order.
_____ Correct citations for all ideas that are not your own
_____ Correct form of citation using APA use the APA book
_____ Double spacing exactly throughout entire paper
_____ Spelling
_____ Punctuation: commas, semicolon, colons
_____ Page numbers
_____ Conclusion paragraph
_____ Check for opinion words, (such as fortunately, should, personally, I
think/believe/suppose, I am of mixed opinions about / on, this it seems to me that)
_____ Fonts all fonts are the same size and type.
_____ Reference page APA, hanging indents, less than 5 years old
_____ Follows rubric for all requirements of paper
_____ Rubric pasted at end of paper
_____ Check off list pasted after the rubric.
_____ Sent to Brainfuse for review
_____ Find the Mark up tool on your computer and turn it on