Recognizing Impairment in the Workplace: What Should Nurses Be Aware Of?

Keith Carlson, RN, BSN, NC-BC - 03/14/19

 We are all aware of the ways in which substance abuse and addiction can wage war on families, schools, communities, and entire societies and nations. Here in the United States, an enormous opioid epidemic has been powerfully fueled by a variety of engines, including the over-prescribing of narcotics.

What we often forget is that nurses and healthcare providers can fall prey to addiction like anyone else, and sometimes this can lead to impairment on the job, destroyed careers, and many other negative consequences for all concerned. 

Substance Abuse and Addiction

Many Americans find themselves addicted to prescription drugs originally prescribed by a physician or nurse practitioner (e.g.: oxycodone, hydrocodone). Alcohol is, of course, a substance sanctioned by society and freely available to those old enough to purchase it, and dependence is terribly common.  

Dependence on marijuana is less widely reported, but some worry that the increasing prevalence of legalized medical and recreational marijuana around the U.S. will fuel addiction overall. 

The opioid problem in the United States is at epidemic proportions, and some reports state that benzodiazepines are the prescription medications seen as our next line of high-risk substances worthy of our attention.  

The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies five stages of addiction (Substance Abuse and Mental Health Services Administration -SAMHSA. (1999). Prevention works: Nurse training course on the prevention of alcohol and drug abuse.)

  • contact (first use of intoxicant, experiences the pleasure of using)

  • experimental use (occasional, using to feel good)

  • excessive use (chasing the high, getting drunk and passing out)

  • addiction (use despite negative consequences)

  • recovery (restoring the mind, spirit and body to health and equilibrium)

While certain news articles assert that the use of alcohol and opioids is generally down among teenagers, continued and ongoing vigilance regarding addiction is prudent for all populations and age groups.

Substance Abuse Disorder (SUD) and Nurses

According to Psychology Today, nurses are dependent on substances at about the same rate as the general public (approximately 10%).

We all know that nursing is hard work, and we can imagine that physical pain, stress, anxiety, depression, and other ills afflict nurses in large numbers. Like anyone else, nurses can have back pain, mental health issues, and other problems that can be (at least temporarily) mitigated by opioids, alcohol, benzodiazepines, and other legal and illicit substances.

It’s widely known that nurses have access to narcotics and other prescription medications, and the diversion of patients’ medications into a nurse’s own pocket is not altogether uncommon and may be incredibly tempting for a troubled nurse. “Nurse Jackie”, the well-known television show starring Edie Falco (of “The Sopranos” fame), told the story of Jackie, a nurse, wife, and mother in New York City who struggles with substance abuse and how to keep it hidden from her colleagues, friends, and family.

Recognizing the Impaired Nurse

An informative downloadable pdf by the National Council of State Boards of Nursing (NCSBN) outlines the following as behavioral changes that may be seen in nurses struggling with addiction: 

  • Subtle changes in appearance that may escalate over time
  • Increasing isolation from colleagues
  • Inappropriate verbal or emotional responses
  • Diminished alertness, confusion or memory lapse

The NCSBN pdf also states:

When nurses are using drugs and unable to obtain them from a treating health care provider, they may turn to the workplace for access or diversion, often causing narcotics discrepancies, such as:

  • Incorrect narcotic counts
  • Large amounts of narcotic wastage
  • Numerous corrections of medication records
  • Frequent reports of ineffective pain relief from patients
  • Offers to medicate co-workers’ patients for pain
  • Altered verbal or phone medication orders
  • Variations in controlled substance discrepancies among shifts or days of the week

Resources for addicted nurses and those who care about them are also available on the NCSBN website.

Vigilance, Compassion, and Action

With a widespread nursing shortage, the ongoing retirement of Baby Boomer nurses, the annual attrition of large numbers of newer nurses from the profession, and an increasing need for nurses willing to care for a rapidly aging population, addressing addiction and dependence in nurses is paramount for the benefit of both patients and the healthcare system writ large.

Addicted and dependent nurses need compassion, vigilance, and concerted and prudent action by employers, colleagues, and professional nursing, public health, and healthcare organizations.

Addiction isn’t a character flaw, it’s an illness, and we need to be sure not to cast blame or castigate the troubled nurse. If we approach the problem systematically and compassionately, we’ll run less risk of alienating nurses who might be ready to reach out for help. In so doing, we can create an environment wherein nurses with substance abuse issues are identified, treated, and cycled back into the workforce where they’re so urgently needed. 

Take the Recognizing Impairment in the Workplace CEU

Learn how to recognize impairment in your nurse colleagues, report such behavior, and advocate for the humane treatment of nurses in need of our collective and individual support with this CEU course - you can also earn 2 CE hours.