Breaking the Stigma: Substance Use Disorder in the Hospital Setting

Unfortunately, previous decades saw nurses with SUD treated harshly and without forgiveness. The label “drug addict” meant an automatic removal from the nursing profession for reasons easily understood. Fear of liability, theft, and misappropriation of client-issued meds was enough to make employers immediately separate from those with the illness. Over time, however, society has created a better understanding of the disorder and its underlying causes, which has allowed for the creation of treatments to help nurses and other medical professionals maintain employment even after a diagnosis. Let’s look at the facts, history, and options now available to nurses who may find themselves in a position to need help.

What is Substance Use Disorder (SUD)?

First, it is essential to define SUD and how it affects us. According to the National Institute of Health, SUD is “the abuse of, misuse of, or dependency on alcohol or drugs.” The article continues to state that the estimated current percentage of nurses with dependency issues ranges from 2% to 10%, and estimates of misuse and abuse may exceed 14% to 20%. With these type of numbers, a more compassionate solution focused on recovery and re-entry to the workforce aren’t just a nicety – it is a necessity. As a population, it is critical that we do not lose nurses who struggle with SUD due to the potential repercussions. To fully understand the disorder and how it affects nurses, researchers should be asking questions, such as whether nurses are exceptionally vulnerable to this disorder and what can be done to resolve this issue.

In answering the first of these questions, are nurses at substantially greater risk for SUD than other professions? The answer is, thankfully, no. Despite what media coverage might have you believe, according to New Directions for Women, nurses are much less likely than the general public to have SUD. However, for those dealing with nurses and trying to manage SUD, there is no easy, quick solution to a complex addiction problem, and the numbers prove that out all too well.

SUD & the Nursing Industry

According to the National Institute of Health, “generally half of the nurses who attempt recovery succeed, with many state monitoring programs reporting success rates from 48% to 90%.” The article mentions that between 750 nurses per month, or 9,000 per year, are carefully re-entering their profession. Given the nursing shortage, what is the impact of SUD nurses re-entering the workforce? According to NIH, “The impact on the workforce, and therefore patient care, if nurses in recovery were removed from practice can be illustrated in a calculation of direct hours of patient care. For example, 9,000 nurses employed at 2,000 hours a year (50 weeks) would provide 18 million hours of direct patient care in a single year.” Given the continually predicted shortage of professional nurses, the math is simple – we cannot afford to turn away nurses recovering from SUD.

As stated on the NCSBN website, dedicated to SUD in nursing:

“Nurses who abuse substances pose a unique challenge to the nursing profession. The behavior that results from this disease has far-reaching and negative effects, not only on the nurses themselves, but also upon the patients who depend on the nurse for safe, competent care. Early recognition, reporting and intervention are fundamental for keeping patients safe from harm and helping colleagues recover.”

As previously mentioned, SUD in nursing is a substantial challenge for both employees and their employers, who should maintain the safety and integrity of client care. However, what is the answer? Given the extreme shortage of nursing professionals, casting out nurses in need of care seems cruel and self-defeating. The industry has slowly come around to this realization, and according to the NCSBN, “Non-disciplinary programs, offering an alternative to traditional discipline, are now used by a growing number of state BONs.” These programs aggressively and rapidly immerse practicing nurses in rehabilitation and treatment programs. Basic precautions are taken to ensure patient welfare and limited access to attractive drugs for those experiencing SUD. Nursing SUD treatment programs have outstanding records of recovery and return to work when appropriately administered, monitored, and supported.

What should diligent managers and coworkers look for if SUD is suspected? Signs and symptoms, according to the State of California SUD intervention guide, can include:

Signs and Symptoms of SUD

• Increased isolation
• Avoids eye contact
• Defensive
• Excessive absenteeism
• Verbally/physically aggressive
• Rapid change in weight
• Dilated or pinpoint pupils
• Lethargic or jittery
• Slurred, rapid, pressured speech
• Sweats/seizures

Signs of Impaired Practice

• Smells of alcohol or marijuana
• Narcotic discrepancies (frequent errors)
• Changes in drug ordering patterns
• Patient complaints about reduced pain relief
• Offers to administer meds for other RNs
• Volunteers for extra shifts
• At the facility on days off/at odd hours
• Leaves the worksite frequently to use the restroom, lounge, or the parking lot
• Bizarre behavior

What are the steps taken to help with SUD?

What does a robust program for treatment produce? According to NCBI, steps to successful treatment include remission from addiction, global health improvement, and community support. What is recovery? Where does it start, and when is a person cured of SUD?

• Early sobriety (first year)
• Sustained sobriety (1–5 years)
• Stable sobriety (>5 years)

It’s important to note that some nursing specialties, such as anesthesia, per the NCBI, recommend that nurse anesthetists achieve one year of recovery before re-entry into clinical practice. Additionally, most, if not all, addiction treatment programs will state that there is no cure for addiction, and it is a lifelong battle if not monitored appropriately and if the individual doesn’t receive support and oversight.

While every SUD program likely varies from the next, there are generally agreed-upon principles that limit the risk of a nurse with SUD negatively impacting patient care. According to the National Institute of Health, the criteria below is a solid foundation for a robust re-entry program for nurses affected by SUD.

1. Completion of a drug treatment program.
2. Restrictions on handling and administering narcotics for six months to one year or more.
3. Conservative work hours, which often means no on-call and no overtime hours for at least six months to a year and no night shifts, or weekends.
4. Conservative work locations, which usually means no work situations where the nurse is alone or unmonitored, such as home health or hospice.
5. Mandatory daily call-in for random urine and/or hair follicle drug/alcohol screening for up to five years.
6. Weekly documented support group meetings with other healthcare providers for the duration of the monitoring contract.
7. Documented weekly attendance of at least three Alcoholics Anonymous (AA) and/or Narcotics Anonymous (NA) meetings for the duration of the monitoring contract.
8. Monthly self-progress reports to a case manager.
9. Disclosure to the employer and, for programs that can admit nursing students, disclosure to their schools of nursing that they are in a monitoring program.

While the risks of a nurse navigating substance abuse disorder can never be entirely eliminated, a solid program with robust oversight and support can significantly increase the success rate of returning nursing staff. These professionals who give their all every day to ensure the health of our communities deserve the same support they give to patients in care.

If you are a nurse in need of support for SUD, please reach out to a professional for assistance, find out your facility’s written policy on SUD, and get help. The days of having to navigate Substance Use Disorder alone and in shame are behind us. You are not alone, and support is never more than a phone call away. Start your journey to recovery by contacting the National Substance Abuse Hotline at 800-662-4357.