ETHICS: Substance Abuse in Nurses

Ethics: Substance Abuse in Nurses

Substance abuse is a common problem in the nursing population, approximately 10% of
the nursing population has alcohol or drug abuse problems (Talbert, 2000). American Nurses
Association (ANA) estimated that 6%8% of nurses are impaired at work and it affects their job
performance. Oncology nursing is considered one of the most stressful specialties, and this
stress leads to nurses trying to cope by abusing drugs and alcohol. Nurses also have access to
many drugs, including frequently abused opioids. Nursing practice encourages nurses to solve
problems with medication so nurses often self-medicate with drugs and alcohol during stressful
periods.
According to Tanga (2011), there are signs and symptoms of nurses who are impaired at
work. If left unrecognized, patient safety may be compromised. Nurses under the influence can
hide their habits and signs of abuse can be subtle. Coworkers often notice absenteeism,
tardiness, frequent or unexplained disappearance from the unit, deteriorating personal
appearance, reduced productivity, and diminished alertness are some of the behavioral signs of
impairment or chemical dependency (Tanga, 2011). Patients cared for by nurses taking drugs
often complain of unresolved pain. Frequently volunteering to count or administer narcotics and
are eager to relieve colleagues for lunch are other signs that they want opportunities to take drugs
from work or their patients.
Nurses in the past had Throwaway Nurse Syndrome, which was to punish their
colleagues who violated the rules, including those with an addiction and steal meds from patients
(Kunyk, 2012). Addiction was dealt with using harsh discipline where nurses lost their jobs and
their licenses. Harsh discipline is not effective for stopping addictive behavior and is a barrier

ETHICS: Substance Abuse in Nurses

against seeking treatment. Now, addiction is seen as a sickness and treated as such. The goal is
to protect the patient, not punish the nurse.
According to Tanga (2011), diversion of drugs is defined as the unlawful channeling of
regulated pharmaceuticals, including the misuse of prescription medications. Thorough
investigation must be performed in patient records, which is why thorough documentation is
necessary. Discipline can involve the board of nursing, local and federal authorities if the nurse
is found to have committed a felony. Nurses aware of their colleagues stealing drugs could be
charged with negligent supervision. This is the failure to report, making it a nursing
responsibility to report an impaired coworker or coworker stealing drugs. However, there is still
a negative stigma associated with addiction. This stigma is a big reason for nurses not to seek
help or report their colleagues for an addiction that affects their work. Nurses are morally
obliged to report colleagues suspected of stealing drugs at work, but only 37% of nurses actually
report.
Nurses in rehab for addiction may be enrolled in a long term aftercare program. The
program will monitor their progress through rehab and identify early signs of relapse. Nurses
can be visited when they return to work to monitor attendance or subject to random drug tests.
This can last for 5 years. These aftercare programs have been recommended by the American
Nurses Association, the International Nurses Society on Addiction, and the National Council of
State Boards of Nursing.

ETHICS: Substance Abuse in Nurses

Reference
American Nurses Association (2015). Code of ethics for nurses with interpretive statements,
Washington, DC, 2011. American Nurses Publishing, American Nurses Foundation,
retrieved from www.nursingworld.org/about/01action.htm#code.
Kunyk, D., & Austin, W. (2012). Nursing Under the Influence: A Relational Ethics Perspective.
Nursing Ethics, 19(3), 380-389. doi:10.1177/0969733011406767
Talbert, J. J. (2009). Substance Abuse among Nurses. Clinical Journal of Oncology Nursing,
13(1), 17-19. doi:10.1188/09.CJON.17-19
Tanga, H.Y. (2011). Nurse Drug Diversion and Nursing Leader's Responsibilities: Legal,
Regulatory, Ethical, Humanistic, and Practical Considerations. JONA's Healthcare Law,
Ethics, and Regulation, 13(1), 13-16. http://www.nursingcenter.com/static?
pageid=1193263