Substance abuse among nurses—defining the issue

The article "Substance abuse among nurses--Defining the issue" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

BEHAVIORAL OBJECTIVES

After reading and studying the article on substance abuse among nurses, nurses will be able to

1. discuss the prevalence of addiction among nurses compared to the general population,

2. describe signs and symptoms of addiction,

3. discuss adverse effects of not reporting an impaired colleague, and

4. identify the role of state boards of nursing in treatment of nurses who abuse substances.

Alcohol and drug addiction are primary, chronic, progressive, and often, fatal health problems. United States society does not accept addiction as a disease, but instead views it as a moral failure or lack of will power. (1(p27)) Many nurses choose to remain silent about a colleague who may have a substance-abuse problem because of loyalty, fear of being a hypocrite, guilt, or fear of jeopardizing a colleague's license to practice. Addiction must be accepted as an illness so that nurses can help one another recognize and seek treatment for the problem.

This article discusses how society views addiction and the nursing profession, describes signs and symptoms of substance abuse, and explains why nurses should report an impaired colleague. The code of silence that exists among nurses also is discussed, as well as board of nursing jurisdiction in substance-abuse cases. Definitions related to addiction are given in Table 1.

ADDICTION IN THE GENERAL POPULATION

Data from the 1999 National Household Survey on Drug Abuse indicated that 13.1% of the employed population in the United States were substance abusers. (2) Recent statistics from the National Institute on Alcohol Abuse and Alcoholism indicate that 14 million people in the United States (ie, one out of every 13 adults) abuse alcohol, and millions more engage in binge or heavy drinking that eventually can lead to alcoholism. (3) One author states that one out of every three employees reports being affected by a coworker's substance abuse problems. (4)

Statistics indicate that employed people who abuse substances are unreliable on the job. (2) Compared to nonusers, alcohol and illicit drug users are more likely to have

* changed jobs frequently,

* missed two or more days of work in the past month,

* resigned voluntarily from a job in the past year,

* been terminated by an employer in the past year, and

* been involved in a workplace accident in the past year. (2)