When the Nurse is an Addict: Part Two

How to recognize the signs and intervene when your colleague may be under the influence

Two nurses are standing by a window. One nurse is comforting the other, who looks like she is exhausted

In many workplaces, they’re spoken of only in whispered breakroom gossip and terse, cryptic warnings from management — staff nurses who’ve been accused of drug diversion, been caught stealing narcotics or who showed up to a 7 a.m. shift with alcohol on their breath.

The chances that you’ve had a colleague who suffered from substance use disorder (SUD) are greater than you might think. The ANA estimates that 6 to 8 percent of nurses use drugs or alcohol to an extent that impairs their performance.

A 2010 study in the Journal of Clinical Nursing cites other estimates as high as 20 percent. That’s one in every five nurses! Could you accurately identify a colleague who’s intoxicated in the workplace? Would you know how and when to intervene and what it takes to genuinely help?

Warning Signs

Because healthcare professionals struggling with substance abuse disorder don’t necessarily fit the common stereotypes of addiction, recognizing the signs of their abuse can be a real challenge, especially in the early stages. A nurse suffering active addiction may appear to be a highly functional, knowledgeable, hard-working overachiever whose outward demeanor scarcely hints at his or her surreptitious abuse of substances to self-medicate physical and/or emotional pain.

Nevertheless, nurses struggling with addiction often demonstrate certain telltale signs. (Keep in mind that these signs alone aren’t necessarily evidence of drug or alcohol abuse. However, when they present as a trend over a period of time, they may indicate a serious problem.)

A nurse who is abusing substances may:
  • Become inexplicably irritable, experience labile moods or have angry outbursts.
  • Take frequent breaks or leave the department without proper notification.
  • Suffer numerous illnesses, increasing tardiness and frequent absences, for which he or she may have elaborate excuses.

Nurses who are diverting meds for their own use sometimes sign up for extensive overtime to ensure easier access to their drug of choice. Where nurses are required to have a witness as they waste narcotics, a nurse who’s diverting might come up with various justifications for wasting drugs alone, such as dropping meds on the floor. Diversion often comes at the expense of patients, who might complain that their pain medication isn’t working or that they haven’t received scheduled doses.

Medical administration records indicating that a patient who hadn’t previously requested anything for pain or sleep is suddenly and frequently asking for meds can also be a warning sign if all the new medication requests are documented by a single nurse.

Time to Intervene

Nurses suffering from substance abuse will often go to extreme lengths to hide their secret. By the time a nurse resorts to stealing meds or arrives at work visibly under the influence, he or she is undoubtedly desperate — and perhaps even hoping to get caught. That was my experience. I’d been using Vicodin for years, legitimately prescribed for migraines.

However, my poorly managed stress, job burnout and lack of sleep eventually made the drug an all-encompassing habit. By 2016, I was trapped: physically and psychologically dependent on opioids, long past self-regulating rules such as “never take a pill less than eight hours before work.”

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Any nurse who’s in the state I was in by then is a danger to themselves and their patients. Such nurses need help before their bad situation ends in tragedy. The good news is that there is hope for them. Almost 70 percent of nurses with substance use disorder who seek treatment are eventually able to return to the workplace with an unencumbered license.

I was one of the lucky ones, thanks in part to the nurse colleague who reported me. “You’re acting bizarre,” she announced at the end of a night shift, with our coworkers milling around. My stomach twisted at the sound of her words and I choked on bile.

That moment changed the trajectory of my life. My coworker didn’t stop at confronting me; she also told our charge nurse, which culminated in my being escorted off campus by security.  Although the days that followed were not pleasant, I could go so far as to say my coworker’s actions saved my life.

At the time, I resented her for confronting me publicly (which I still don’t recommend), but her courage in speaking up was a defining step on my path to recovery. Not long after, I was sober and enrolled in a treatment program.

Though confronting a colleague in these situations is awkward and uncomfortable, the ANA Professional Code of Ethics Interpretive Statement 3.6 clearly outlines our responsibilities:

“The nurse’s duty is to take action to protect patients and to ensure that the impaired individual receives assistance. This process begins with consulting supervisory personnel, followed by approaching the individual in a clear and supportive manner and by helping the individual access appropriate resources.”

To look at it another way, neglecting to speak up only delays treatment for your colleague while leaving the public at risk.

Supporting Nurses in Recovery

While patients should be everyone’s first priority, nurses in these circumstances also deserve compassion and support throughout their exposure, treatment and recovery. When their abuse is discovered, nurses are at high risk of suicide, so it’s important not to leave them alone. You can help ensure safety by assisting them in reaching out to supportive resources such as a family member, friend, treatment center or spiritual care services. There are also national crisis lines for both addiction (1-800-662-4357) and suicide prevention (1-800-273-8255).

In my case, even as I was coldly escorted off campus, a card with a name, number and the words “Care for the Caregiver” was tucked into my hand. Within minutes, my second savior was on the line: a nurse with 20 years of sobriety who was willing to share her experience, strength and hope. Although my next month was a nightmare of humiliation and confusion as I waded through legalese and treatment arrangements, I attribute my relative sanity and safety to conversations with that generous woman.

If you know a nurse is in treatment for a substance abuse problem, respect his or her privacy and anonymity. Avoid gossip, judgments and derogatory labels, but don’t avoid the nurse. This is an unbearably lonely time. Not only is the nurse navigating sobriety,  he or she may also be facing job loss, tumultuous family dynamics and even criminal prosecution. Reach out directly, but ask permission before asking difficult questions. A nurse in recovery may not be ready to talk, but will appreciate your attempt at connection.

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If and when they return to work, most nurses will have restrictions on their license such as “may not administer controlled substances, work overtime or float to various departments.” These limitations, while temporary and necessary for a safe recovery, are mortifying for the nurse. A compassionate reception from coworkers can accelerate your colleague’s healthy recovery.

Providing a supportive atmosphere may be a lifesaving factor for both the nurses involved and the patients they care for.

Ending the Stigma

The National Council of State Boards of Nursing recognizes substance use disorder as an illness, not a moral failure. Similarly, a 2017 joint position statement released by the Emergency Nurses Association and the International Nurses Society on Addictions declares that “drug diversion, in the context of personal use, is viewed primarily as a symptom of a serious and treatable disease and not exclusively as a crime.”

With our growing awareness of the problem of job burnout and the prevalence of substance use disorder, the focus of employers and the state boards of nursing should be on rehabilitation and retention. If nurses perceive substance abuse disorder as a career-ending catastrophe, it will just push them further into secrecy, delaying treatment and further endangering patients.

Employers and coworkers alike have the opportunity to end stigma by taking an empathetic, non-punitive approach and encouraging nurses to seek help rather than hide their problem.

Take it from me, a survivor of the opioid crisis: With early identification, proper interventions and holistic treatment, it is possible for nurses with substance abuse problems to recover and successfully — and safely — reenter the workforce.


3 Steps to Take When You Suspect Substance Abuse or Diversion
  1. Contact Management
    Your initial step should be to alert supervisors. However, when deciding whom to approach, consider the managerial structure you’re dealing with. You don’t want to hand off a problem of this magnitude to a relief charge nurse who is unfamiliar with appropriate procedures or who won’t take the matter seriously.If necessary, move up the chain of command, communicating with senior supervisors or administration.  Review your workplace’s employee handbook and other policy documents to see if there are guidelines for reporting a coworker you suspect of diversion, substance abuse or otherwise posing a risk to patients. Many organizations have an anonymous hotline you can use in these situations.
  2. Talk to the Nurse 
    Confronting a coworker about a serious problem is awkward and complicated. You may not feel qualified for the discussion. (If you want to expand your skills in this area, check out the courses offered by Mental Health First Aid by visiting www.mentalhealthfirstaid.org). Your coworker might get defensive and lash out. There’s also a danger of self-harm as he or she anticipates impending discipline.If you choose to confront your coworker yourself, do so privately, in a compassionate, curious manner. You might say something like, “I notice you seem not yourself — tired, erratic, absent from your patients, red-eyed — and I‘m concerned. Do you need help?”This is what happened with one nurse I know who was given an ultimatum by her friend, a fellow nurse. “I care about you so much that if you don’t call and report yourself to get help, I’ll need to make the call for you,” the friend said.  They sat together tearfully as she dialed the phone, her friend’s arm wrapped supportively around her shoulders. She is now successfully graduated from treatment.
  3. Notify the BRN
    If you’ve reported your concern through the appropriate channels and the problem continues, it’s time to call the state agency that oversees nursing licensure, which in California is the Board of Registered Nursing. Patient safety is paramount.

Read Part 1 of this story on Working Nurse

TIFFANY SWEDEEN, RN, BSN, CPRC/CPC, works in critical care and as a clinical instructor. She is a mom, writer, meditator and VW van road-tripper. She proudly lives “sober out loud.” Follow her on Instagram @scrubbedcleanrn or www.recoverandrise.com.

JASMIN MORA is a Los Angeles-based illustrator. Reach her at www.jasminmora.com.

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