Substance abuse contributes to missing work, injuries, reduced productivity, liability, societal harm, personal harm, and increased health care costs. It is beneficial for the employee and the employer to assist their workers in managing alcohol and substance abuse (International Employee Assistance Professional Association, n.d. & IPN, n.d.). Employers should implement strategies to promote safety and provide assistance. Guidelines should be developed to promote safety for nurses and their patients and offer help to nurses who suffer from substance abuse or other conditions that lead to impairment.
Policies should include a drug-free workplace and have all nurses fit to practice. Practices that will reduce the risk of impaired nurses on the worksite include pre-employment drug testing, for-cause testing (testing when there is logical suspicion that the employee is under the influence of drugs while working), and fitness to practice evaluations (SAMHSA, 2021). The workplace should promote a culture of transparency and consist of clear expectations and consequences. In addition, it should be clear that there is openness to help the nurse with a substance abuse problem or other conditions that lead to impairment.
Nurses lack education regarding the addiction process, identifying those with addiction, and implementing effective interventions. Nurses must receive education about substance use disorders, and with proper programming, employers can significantly improve the nurse's knowledge and attitude toward substance abuse. The workplace has the potential to identify and help workers with drug and alcohol problems. Workers spend a lot of time at work, and co-workers and supervisors may be able to notice signs or symptoms of drug or alcohol problems in impaired workers and get them the help they need.
Employers may influence employees to get help for impairment. Many employers have employee assistance programs (EAP) and educational programs to help prevent and treat drug or alcohol problems. These programs may include health promotion, education, and referral to alcohol and other drug abuse treatment programs. These programs look to identify issues quickly and intervene early. Drug or alcohol problems are often identified in the workplace when there is a poor quality of work, attendance problems, when an employee self-refers to an EAP, or when a co-worker identifies a drug or alcohol problem in another worker (Webster, 2022; Toney-Butler & Siela, 2022). The primary goal of an EAP is to help employees maintain their job and career.
Employers can mandate treatment for impairment, including education, referral to treatment centers, or health promotion. Treatment is in the employer's best interest because it is easier to retain a nurse than train a new hire. Training comes in education regarding the dangers of drugs and alcohol, stress management, coping skills, and identification of impaired co-workers (Toney-Butler & Siela, 2022).
While it is not illegal to drink alcohol, drinking off the job can affect job performance. For example, binge drinking may lead to hangovers the next day, compromising work performance. Employers have a reason to attempt to modify employee drinking, which may positively affect work performance. Hangovers increase the risk of bad judgment injuries, impair motor or cognitive function, and reduce work productivity.
Addressing off-the-job drinking is often done through alcohol education programs at work through EAP or another health promotion program to encourage behavioral change. Having programs available may encourage impaired patients to self-refer to treatment. Alcohol education programs may teach workers to identify an impaired co-worker. A nurse who works alongside another nurse is more likely to identify problem behaviors before a supervisor notices the same problem behaviors.
Employers often put on health promotion programs to help motivate their employees to change behaviors. Drinking and drug use can affect health; teaching employees about healthy alternatives have the potential to change behaviors. For example, engaging in exercise, adopting a healthy diet, or taking up a stress management program may reduce drug or alcohol use.
Risk factors in the work environment for alcohol and drug use include stress, alienation, and a culture of drinking within an organization (Toney-Butler & Siela, 2022). At times, nurses abuse substances because of work-related stress. Common work stressors leading to substance abuse include bullying, anxiety, a traumatic clinical incident, and workloads (Pezaro et al., 2021). The employer is responsible for determining if risk factors are present within the work environment and attempting to modify the work environment to reduce the risk of alcohol and drug use.
Addressing alcohol and drug use in the work setting has many similarities to managing it in primary care. Preventative efforts can reduce substance use in both the worksite and the primary care setting. Unfortunately, there is the potential to hide problem behaviors, and unless the health care provider or the worksite finds a problem, no intervention will occur. Both the primary care setting and worksite have many roles to fulfill, and preventing, identifying, and treating substance and alcohol abuse is not the highest priority goal.
Employers may resist intervention in prevention programs for multiple reasons, including:
- Concern that reducing alcohol problems will be costly and only benefit the individual and not the employer.
- A concern that prevention programs may suggest the employer is contributing to drug and alcohol abuse.
- Concern that those treating alcohol or drug use will not have the workplace's best interest in mind and will be unreasonable, costly, and impede work productivity.
EAP assists substance abuse programs within companies. Over 97% of companies with more than 5,000 employees have EAP; 80% of companies with 1,001 - 5,000 employees have EAP; and 75% of companies with 251 - 1,000 employees have EAP (International Employee Assistance Professional, n.d.). EAP is not solely derived to address substance abuse; they also help employees with other issues such as mental health, marital problems, parenting problems, financial problems, legal issues, and balancing life and work. They offer visits to provide assessments or short-term counseling and referrals to an outside provider for follow-up treatment.
Employees may not get involved in EAP for a variety of reasons. Employees often fear breaks in confidentiality, even though that is a false assumption. Many employees may also feel shameful for looking for help. Some employees fear that they need to get permission from their boss, but they can self-refer to an EAP. Lastly, many do not know that they exist. Individuals who use a company EAP are more likely to take part in and stay engaged in alcohol and other drug treatment programs. Factors associated with greater use of EAP include major depression, black race/ethnicity, or any drug use disorder (Office of Personnel Management, n.d.). When looking at EAP outcomes, most studies suggest that they provide positive economic benefits and improved work and clinical outcomes (Song & Baicker, 2019). Some workplaces more strongly promote EAP than others.
Determining impairment from mental illness is a tricky task. A scale, the Nurses Work Functioning Questionnaire, has been developed to determine if there is impairment from common mental illnesses. It is a 50-question survey that has been determined to be highly reliable and valid. The survey includes seven subscales that predict the exact aspect of impairment and helps in determining interventions to help the impaired nurse (Williams, 2017).