Substance use disorder (SUD) impacts both the individual experiencing it and everyone in their life. SUD does not discriminate and affects people from all walks of life, regardless of age, occupation, economic circumstances, ethnic background, or gender. Healthcare professionals are not immune, but their potential impairment directly impacts patient safety, clinical judgment, medication management, and public trust in the healthcare system.
Nurses Supporting Each Other
Regulators are aware of the implications of SUD and deal with the fallout of issues that arise at the bedside. When necessary, they will evaluate the need to remove nurses from practice and often help them receive treatment and monitoring designed to support safe return to practice when appropriate.
Recognizing the importance of research on this subject, the National Council of State Boards of Nursing (NCSBN) Journal of Nursing Regulation (JNR) publishes articles exploring how SUD impacts all aspects of the healthcare environment. Just recently, they published the Substance Use Disorder Spotlight, a special collection of highly regarded articles from the last several years focused on the topic of substance use disorder (SUD). This collection will be offered free of charge through Dec. 31, 2026.
Understanding SUD in Nursing
SUD affects healthcare professionals at rates comparable to the general population, but when SUD affects nursing professionals, the potential consequences are significant and warrant careful attention.
By their very nature, healthcare systems can be fast-paced and high-stress environments. In some instances, ready access to controlled substances combined with long hours, demanding schedules, burnout, emotional overload, and personal issues can potentially create conditions that lead to a nurse developing SUD.
When individuals go unidentified or untreated, the outcomes can extend well beyond the individual nurse and compromised clinical judgment; in some cases, erosion of patient safety may follow.
Understanding that SUD is a treatable disease is foundational to protecting both the workforce and the patients in its care.
Substance Use Disorder Spotlight Collection Highlights
The collection covers topics that include the integration of SUD education throughout the graduate nursing curricula, the psychosocial implications of whistleblowing, a study that looked at whether practicing nurses recognized signs of SUDs in a colleague, investigative guidance for nurse leaders and hospital administration, the effectiveness and functioning of alternative-to-discipline programs, and providing healthcare workers with appropriate access to evidence-based medications.
Two of these articles address the idea that if healthcare facilities foster an environment where nurses know what to do when a colleague is impaired and feel empowered to report it, patient safety can improve.
The first, “The Registered Nurses’ Awareness of Workplace Signs, Actions, and Interventions for Nurses with Substance Use Disorder” study assessed whether practicing nurses recognized signs of SUDs, what actions they would take if a colleague had a SUD, and their knowledge of registered nurse SUDs interventions.
Most nurses recognized common warning signs of impairment. More than 80% identified signs like frequent medication errors and excessive absences or breaks as potential indicators of a colleague’s SUD. However, despite recognizing these warning signs, only about half of nurses felt confident in their ability to identify an impaired colleague. Although 93% said they would report concerns to a supervisor, 20% were unsure what to do if they suspected a colleague had a SUD, and 21% were afraid to get involved. More than half worried that the nurse could be punished or lose their job. While most nurses believe that SUD is a treatable condition and support helping affected colleagues, they often are not fully prepared for dealing with such issues.
The study concluded that healthcare facilities could do more to educate their nurses about SUD and stressed the importance of developing a culture of safety, accountability, and support that encourages nurses to report issues of concern.
Likewise, the “Investigating a Nurse with Suspected Substance Use Disorder: Guidance for Nurse Leaders and Hospital Administration” article details the processes of conducting nurse SUD and drug diversion investigations.
This article emphasizes that healthcare leaders working to create a culture of speaking up, when suspicious behaviors or concerns are found, promotes patient safety and nurse health.
Ongoing education on recognizing signs of SUDs and diversion, and what to do if they occur, is essential to protecting patients and nurses.
From Recognition to Response
An extensive body of scientific research demonstrates that approaching substance use disorders as a treatable illness is extremely effective for the individual using substances, as well as for society. Long-term recovery is possible for those who maintain a rigorous relapse prevention program, and nurses in recovery can re-enter the workplace safely when treatment and monitoring are in place.
Recognizing that substance use disorder is a complex and challenging issue within the nursing profession, NCSBN and its members work to provide resources that help ensure that nurses are armed with knowledge to help identify the warning signs of SUD in their colleagues as well as provide guidelines for prevention, education, and intervention.
With the intervention of informed, supportive supervisors and colleagues, nurses who are struggling can be recognized earlier and connected to the treatment, resources, and support they need to recover and safely continue their careers.
Timothy Arehart, JD, is Senior Policy Advisor at NCSBN.
