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Substance Use Disorder in Nursing

It is a condition you can find across all walks of life, and throughout all types of careers, substance abuse disorder isn’t confined to anything. 
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It is a condition you can find across all walks of life, and throughout all types of careers, substance abuse disorder isn’t confined to anything.  For healthcare professionals, substance abuse poses challenges that impact both co-workers and also the patients relying on them for care.  In a profession that is dealing with life or death decisions on a daily basis, recognizing a problem, reporting it, and intervening is critical in saving patients from unintended harm and helping a fellow nurse recover from harmful addiction.

With news of the Opioid epidemic on the television and in the papers every day, it is important to recognize that substance abuse encompasses far more than dependence on legal or illegal drugs.  Substance Use Disorder is a complex condition of dependency or addiction with serious physical, emotional, and legal ramifications.  For most in the general population, alcohol is the substance being abused, but for medical professionals, access to controlled substances contribute to higher rates of dependence on them.  Early recognition of a problem in a fellow nurse can protect patients and also increase the chances of your colleague getting the right treatment and saving their career.

Understandably, nurses are preoccupied with their own duties within the chaos of a normal shift, so recognizing that a colleague has an issue with substance abuse is not always easy.  Let’s look at a few recognizable behaviors or other clues that indicate that there may be a problem to address.

  • Job performance issues.  The first indication of a substance use issue will be changes or inconsistencies in a nurse’s normal job performance.  You may find that they are frequently coming in late or leaving early more often, or even disappearing from the unit for extended periods of time.  Another indicator can be frequent trips to the restroom and most importantly, excessive mistakes and unexplained medication errors.
  • Unexplained behavioral or physical changes.  A substance issue inevitably causes subtle changes in the user’s appearance.  These changes typically escalate over time.  Behavioral changes may include increased isolation and withdrawal from colleagues and social interactions during the shift.  Other indications may show up during responses to stressful or unusual situations in the form of unusual verbal or excessively emotional responses. Another indicator may be a lack of alertness or confusion in typical situations, or they may experience lapses in memory.
  • Medication Discrepancies.  Nurses suffering from a controlled substance issue may be forced to creating diversions in the workplace to create access to the drugs.  This situation can be identified through incorrect narcotic counts or unusual amounts of narcotics waste. You may find the same nurse involved with medication record discrepancies or corrections or frequent reports of ineffective pain relief from their patients.  Pay attention when the same colleague is offering to handle your patient’s pain medications or altering phone med orders.

Clearly, there can be any number of reasons for the above situations that may be occurring with a fellow nurse.  Regardless of the reason, some action must be taken in the interest of patient safety.  Reporting a potential substance use issue not only protects your patients but ensures that your colleague receives immediate care and treatment.  Your responsibility is to make a report with the nurse manager who will investigate the concerns and take the appropriate course of action for all involved.  It isn’t easy to take that important first step in reporting a colleague who is exhibiting the signs of having a substance issue, but the alternative can end up far worse than your initial discomfort.

What are your thoughts on this important workplace issue?  Have you ever had to deal with a similar situation? Are their clear reporting processes in place if a colleague is suspected of having a problem?  Please contribute your thoughts and experiences in the comment section below or start up the discussion on our Facebook page.