The Silent Epidemic: Nursing and Addiction
Remember the popular Showtime series "Nurse Jackie"? As a refresher, actress Edie Falco played a hospital nurse, Jackie Peyton, who was competent and talented but struggled with an addiction to prescription pills, popping Adderall and Vicodin to make it through her stressful workdays. And spoiler alert, though she succeeded in maintaining a brief period of sobriety, the demands of her job and lifestyle led her to return to substance abuse in the end.
Despite the fictional nature of the show, for many real-life nurses, the story is all too familiar. In the state of Virginia alone, for example, 900 nurses were disciplined by the Board of Nursing for drug theft and use at work between 2007 and 2013.
Why Are So Many Nurses Abusing Drugs?
One in 10 nurses will struggle with a substance addiction in their lifetime. Several factors contribute to the high prevalence of substance abuse among nursing professionals. These include:
- Access to Medications. Because of the nature of the job, nurses have easy access to narcotics and other prescription medications they can use illegally, reports the National Council of State Boards of Nursing (NCSBN). One survey of 300 nursing professionals cited in the NCSBN report found that as many as one-sixth had intentionally changed work sites for the purpose of gaining better access to illicit drugs.
Nurses' familiarity with these medications, as a result of their administration of them to patients, may also contribute to substance abuse when nurses believe they are educated enough to take them without becoming addicted themselves.
- Chronic Pain. Nurses spend most of the day standing and are often tasked with lifting or transporting patients, which can lead to painful and chronic conditions such as aching feet or back strain. Thus, many nurses abuse narcotics or other drugs as a means of coping with their pain.
One study cited by NCSBN compared nurses who had been disciplined for substance use to nurses who had not and found that 40 percent of the former group had been using drugs to control physical pain, compared to only 20 percent of the latter group. Emotional pain was also a factor — 42.5 percent of disciplined nurses used drugs to manage emotional problems, compared to 6.5 percent of those who were not disciplined.
- Job Stress. Let's face it — nurses have one of the most stressful occupations in the world. Many nurses work shifts of at least 12 hours at a time, which can lead to burnout and job dissatisfaction.
Besides the long hours and heavy responsibility, nurses face high levels of violence, including physical assault, from mentally ill patients and their caregivers. The National Institute on Drug Abuse (NIDA) recognizes the link between stress and substance abuse, citing that stress can be one of the most powerful triggers for relapse, even after a long period of abstinence.
- Workaholic Personality. Many people with a natural workaholic personality are drawn to caretaking professions, and this includes nursing. But even though being a workaholic is considered America's "best-dressed addiction," research has shown that perfectionists and workaholics are prone to other addictions, such as alcoholism.
For example, in one study, those who worked 48 or more hours per week were 13 percent more likely to exhibit risky drinking behaviors than those who were unemployed. Because many nurses are workaholics, they are particularly at risk for issues with substance abuse.
What Are the Protective Factors?
Not all nurses will fall prey to addiction, of course. Most won’t, and that’s great news. According to the National Council of State Boards of Nursing, the following protective factors lead to a lesser likelihood a nurse will succumb to substance abuse:
- Beliefs in societal norms and values
- Strong religious beliefs
- Early attachment to parents or caregivers
- Occupational satisfaction
- Strong social support system, especially at work
- Strict workplace restraints on use
- Age — young adults are more likely than older adults to use drugs
What Are Warning Signs a Nurse is Using Drugs?
If you work in the health care industry and want to know whether one of your nursing colleagues is abusing substances, look out for the following warning signs:
- Physical changes such as sweating, trembling, dilated pupils or poor grooming
- Personality changes such as irritability, agitation or mood swings
- Irregular changes in handwriting
- Long or unexplained absences from work
- Bathroom breaks immediately after being observed at a drug dispensary
- Requests to be in charge of medication or administer medication to another nurse's patient
- Requests for less supervision from management
- Lack of sufficient charting or documentation
- Patients report they did not receive enough or received no pain medication
What Should I Do If I Suspect a Nurse Is Abusing Substances?
If you suspect that a nurse you know or work with is addicted to drugs, you may be afraid to initiate a confrontation. However, remember that an impaired nurse presents a safety risk to patients, and competent patient care should always be top priority.
If you approach an addicted nurse and are met with animosity or a refusal to seek help, it's important to report the suspected substance abuse to the nurse's manager. Legal issues related to reporting nurse impairment vary by state, but according to the American Nurses Association Code of Ethics, nurses have a moral and ethical duty to do no harm to their patients — and that includes an obligation to not provide treatment while under the influence of drugs.
How Successful Is Treatment?
Nurses who actively pursue treatment for their drug addiction have a good chance of recovery. Most states offer substance abuse programs specifically for nurses that monitor their treatment and help them re-enter the workforce while maintaining their license with the National Council of State Boards of Nursing. According to the Georgia Impaired Physician Program, the following factors are predictors of high recovery success rates:
- Regular participation in 12-step meetings
- Frequent contact with a 12-step sponsor
- Random drug testing by employer or third party
- Close attention to emotions or other compulsive behaviors, such as gambling or sex
- Consistent monitoring and evaluation of treatment
- Close involvement with family members and other support systems
- Regular involvement in leisure activities
- Frequent exercise
- Support for triggers such as occupational stressors and financial burden
- Additional education and training, if needed
The bottom line? Nursing is a grueling career, and substance abuse is a harmful but all-too-effective way for many professionals to cope with the stresses of the job. But with a commitment to active treatment, if you or someone you know in the health care business struggles with a substance issue, there's still hope for recovery and a successful re-entry into the workforce —- without putting patients at risk.