The nurse is the glue that holds most medical operations together. So you may be surprised to hear that an estimated 10 to 15 percent are abusing substances while on the job. And nurses aren’t the only ones. Drug and/or alcohol abuse can affect many healthcare workers over the course of their career. In this article, we will explore this issue in more depth, as well as describe the warning signs you may notice. We will also highlight how a supervisor or patient can help if they are concerned that a nurse has an alcohol or drug problem and what treatment programs are available. Impairment in the workplace greatly risks patient safety. It’s crucial that they get the support they need before their patients and job become seriously jeopardized.
Substance Abuse in Nurses Is Common
Easy access to pharmaceuticals makes substance abuse among nurses far too common. For example, the addictive opioid fentanyl is widely available in hospitals. Fentanyl is dominating the headlines about our nation’s ongoing addiction epidemic and opioid crisis. The drug is powerful. According to the Drug Enforcement Administration, it is 50 to 100 times more powerful than morphine and up to 50 times more potent than heroin. And it’s potentially deadly even at low levels. In hospital settings, it’s usually reserved for post-surgery pain or for those who need end-of-life pain relief, such as cancer patients. Kristin Waite-Labott, a recovering drug-addicted nurse, points out the common problem of substance-impaired nurses in her book, An Unlikely Addict: One Nurse’s Journey Through Addiction. She writes: “It’s one of my biggest messages to the public: There are people—doctors, pharmacists, nurses, nurse anesthetists, a lot of them, a minimum of 10% of them, they say, are addicted, and you would never know by looking at the person.” Waite-Labott advocates for a more open dialogue about the problem and random drug screening for those in the medical profession. This is so someone can “intercede before everything falls apart,” she says. Identifying those who need help is a point she wants to hammer home. Addicts aren’t just the skinny, haunted-looking people portrayed on TV shows. Anyone—your friend, your spouse, your child, your doctor or your nurse—can have an addiction without showing a single sign that there is a behavioral health problem. Waite-Labott recalls when she was finally arrested for stealing drugs from the hospital, “I never had one person say, ‘Oh, I thought you were using.’ It was shock and dismay. Nobody knew. Nobody.”
Nurses Can Struggle with Substance Abuse Like Anyone Else
The reasons for substance use disorders are varied and complex. But nurses can struggle with the same mental health issues that lead others to addiction. For example, Waite-Labott could trace the roots of her addiction back to a sexual assault that took place during her childhood. She also had a difficult relationship with her parents. She found that substances helped her deal with her emotional pain. This is a similar story we see with many others struggling with substance abuse problems—both in and out of the medical field. In terms of the opioid crisis, many begin using prescription drugs for legitimate pain relief, only to become addicted and abuse them later on. This happened to Waite-Labott too. It wasn’t until she was prescribed the painkiller Percocet (a combination of oxycodone and acetaminophen) after a minor surgery in 1997 that she discovered the lure of opioids. She said: “I took it as I was supposed to in the beginning, but as I started healing from the surgery, I found myself taking it for no good reason. I didn’t have pain but I’d think, Boy, I need one of those pain pills. And I just remember feeling very calm and sedate when I took them, like everything was fine, everything was good.” A couple of years later when she threw out her back, she was prescribed another opioid, Vicodin, for pain relief. “I remember calling for a refill when I really didn’t need it and using the pills not for the pain, but for the effect of the pills,” she said. For a registered nurse, it can be easy to feed a substance abuse problem. While working as an ER nurse, Waite-Labott was also going through a divorce. She recalls: “It just occurred to me that there were a lot of really good drugs going to waste at the hospital. And so I started taking them. I had myself convinced that there was nothing wrong with it because it was waste. It was very occasional at first, but over the years, it became something I sought out. And I didn’t start stealing from stock until I tried Fentanyl. The first time I took that drug—I don’t know how to explain it—but I immediately began to crave more of it. And I know that pretty much the next day at work was when I started stealing from the floor stock—not just taking the waste on occasion, but every day I was working I was taking something. And most of the time it was Fentanyl.” Even though a nurse practitioner may be aware of the effects of opioids, this doesn’t mean they are immune to addiction. Waite-Labott remembers what it felt like taking fentanyl for the first time. She said, “There’s getting high and there’s getting lost, and I just feel like I got lost once I took that.” She, like other addicted nurses, started to steal fentanyl from the hospital she worked at. She said, “Every time I walked in the door of the hospital, it just called to me. I had so much guilt and shame over what I was doing, but I just couldn’t not take any. It was a compulsion. I was powerless over it, but I also had no idea how to get help.” Many addicted nurses don’t know how to get help, as they often fear the repercussions of admitting they have a substance abuse problem.
Signs of an Impaired Nurse
Waite-Labott did manage to beat her addiction. But the process of recovery could have been much easier if someone noticed her impairment in the workplace and she received peer assistance. An experienced Director of Nursing with more than ten years of experience offers the following ten warning signs of an abusing nurse who may have a drug addiction.
- Physical changes or alterations in the personality; look for heavy sweating, poor personal grooming and hygiene, trembling hands, trouble with coordination, pupils that are enlarged or very small, irritability, edginess and mood swings
- Long and unexplainable breaks or a high number of absences from work
- Handwriting that is hard to read or that goes downhill over the course of a single shift
- Giving medication to another nurse’s patient while that nurse steps out for a scheduled break
- Seen at the narcotic dispensary and then immediately afterward heads to the bathroom
- Volunteers to be in charge of medications
- Asks for shifts where they will have less supervision
- Patients in the nurse’s care say they never received pain medication or did not receive sufficient pain medication
- Charting that is either incomplete or not done at all
- Narcotic control forms with erratic or incomplete entries, including pages and entries that are out of order or lack properly recorded dates and times
How an Administrator or Director of Nursing Can Help an Impaired Nurse
The priority at all times is patient safety. Before deciding to confront a nurse about possible substance abuse, make sure that all patients have received adequate attention and appropriate medications. When you do confront, follow these steps:
Step 1: Look for Written Guidance
Written guidance in the form of employee policies should be available. These policies should address issues like substance abuse on the job and substance use during off-hours that affects job performance. At this point, it may be time to contact the state licensing board for further direction.
Step 2: Make a List of Support Resources
A nurse with a substance abuse problem does not necessarily face automatic license forfeiture. There are treatment programs designed specifically for nurses that allow them to hold onto their licenses and eventually return to work with supervision after continuing education and treatment. Be ready to emphasize support, not punishment.
Step 3: Have a Plan – Be Prepared
Think through when and where you will talk to the nurse. Remember, they may be dealing with a mental or behavioral health issue. Plan what you will say. In the event that policy demands drug screening, be prepared to make that happen.
Step 4: Confront with Compassion
During your meeting with the nurse explain what you have observed in a professional tone and manner. Treat the nurse with dignity even if they deny the accusation. Don’t be surprised if a nurse caught red-handed still attempts to avoid the problem.
Step 5: Be Confidential
Reassure the nurse that what you are discussing has been treated with the utmost confidentiality. Substance abuse is treated like other protected illnesses such as hypertension or diabetes.
Step 6: Emphasize Help
Tell the nurse about the resources available. Reiterate your goal of support and help—which will lead to recovery—over taking punitive action. Let the nurse know that help often leads to a full recovery and a return to a desirable career.
How a Patient Can Help an Addicted Nurse
A patient may also pick up on many of the signs of an impaired nurse—perhaps even more than co-workers. And a patient under an addicted nurse’s care should be rightly concerned about it. After all, it’s important for a patient to feel that all healthcare professionals are fit to take care of their well-being. If you’re a patient concerned about an impaired nurse, there are things you can do to help the situation. One option would be to raise the issue with your doctor or the healthcare professional that is supervising the nurse in question. This could be an administrator or the Director of Nursing. This will ensure that the issue gets resolved as quickly and professionally as possible. Another option would be to ask the nurse practitioner about it directly. If you believe this would be helpful, it’s important to raise the issue in a caring, non-judgmental way. An abusing nurse may believe that they can hide their drug or alcohol abuse from patients and other colleagues. But if a patient brings it up, a nurse may then realize that the problem is serious and they should be considering a treatment program.
A Message of Hope for Addicted Nurses
Waite-Labott’s goal now is “to get my story to as many people as I can so that if they’re struggling, they’ll know, No. 1, where to go for help and, No. 2, it is possible to overcome it and to get your life back. I know it feels like your life is over, and for all intents and purposes, for a while, it is. But if you work hard, you really can get it back.” One of the most crucial lessons that Waite-Labott learned was “to allow myself to be helped.” Effective treatment options are out there for addicted nurses. But an impaired nurse must first know when they are struggling with substance abuse. After recognizing their addiction, an addicted nurse should ask their supervisor for help and then stay committed to their long-term recovery by continuing education and treatment as well as prioritizing their mental health.