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1. Substance Use Disorder M2 A2 DB
Substance use disorder (SUD) in nurses poses a serious threat to not only the effected
nurses, but to the patients they serve (Griffith et al., 2021). Unlike the general public, whose
substance of choice is alcohol, nurses’ substance of choice are narcotics (National Council of
State Boards of Nursing [NCSBN], 2014). A nurse suffering from SUD is liable to under
medicate a patient in order to divert their narcotic to themselves, or over medicate a patient with
incorrect dosing due to their altered mental state. Supervisors and coworkers of a nurse with
possible SUD are the first line of defense in recognizing SUD and getting that nurse help
(NCSBN, 2014). One change in job performance for colleagues to look out for is excessive
absenteeism in a nurse who rarely, if ever, calls out, especially if the absences are without timely
notice or reason (Griffith et al., 2021).
When a nurse is suspected of SUD coworkers or supervisors may notice certain
behavioral or physical changes, including but not limited to: extended periods of absenteeism
from their unit, taking frequent trips to the bathroom, or increased isolation from their colleagues
(NCSBN, 2014). When nurses are unable to get narcotics legally, such as from a doctor, they
abuse their position to access narcotics from their places of employment, which is called
diversion. Two behaviors a coworker might notice that would make them suspect diversion is a
nurse frequently wasting narcotics or constant volunteering to pass pain meds to patients that
were not their own (Trinkoff et al., 2021).
In the event that a nurse is suspected of diverting drugs or having a SUD, the coworker
should report their suspicion to the nurse manager or supervisor. The sooner intervention occurs,
the quicker the nurse can get help as well as patients become protected (Griffith et al., 2021).
After review of my own employer’s Employee Handbook, I did not note a specific policy on
SUD. However, drug or alcohol use while on the job, or off the job that interferes with
employee’s performance of their duties, is subject to investigation leading up to possible
termination. In the event that an employee is suspected of drug or alcohol use, the suspicious
employee should make a report to the charge nurse (CN) or director of nursing (DON)
Griffith, S. A., Parris, M. K., Griswold, B., Go, R. A., Matthes, A., & VanHouten, M. (2021).
Investigating a nurse with suspected substance use disorder: Guidance for Nurse Leaders
and Hospital Administration. Journal of Nursing Regulation, 12(3), 61–
67. https://doi.org/10.1016/s2155-8256(21)00117-4
National Council of State Boards of Nursing, Inc. (NCSBN®). (2014). A Nurse’s Guide to
Substance Use Disorder in Nursing. [Brochure] Chicago, IL; NCSBN. Retrieved
September 1, 2022, from https://www.ncsbn.org/SUD_Brochure_2014.pdf.
Trinkoff, A. M., Yoon, J. M., Selby, V. L., Storr, C. L., Edwin, H. S., & Baek, H. (2021).
Registered nurses’ awareness of workplace signs, actions, and interventions for nurses with
substance use disorder. Journal of Nursing Regulation, 12(3), 20–
29. https://doi.org/10.1016/s2155-8256(21)00113-7
2. DB: Legal Considerations for SUD in Nursing
Substance use disorder (SUD) is a difficult and complicated problem that nurses may
have to face in the work environment. SUD has many signs and symptoms and should be
reported immediately. I have not personally experienced this in the workplace, but the facility I
will start working on next week has policies for reporting suspected SUD. First, I will discuss the
signs and symptoms.
SUD can be detected through job performance, behavior changes, and drug diversion. If a
nurse is making too many errors, specifically with medications, it may be because SUD is
influencing their job performance. Actions connected to SUD include: growing seclusion,
improper reactions, and reduced watchfulness, disorientation or gaps in recollection. Drug
diversion could be occurring if a nurse continues to administer pain medications to other nurse’s
patients and if they are changing medication orders given over the phone (The National Council
of State Boards of Nursing, 2018).
When a nurse suspects another nurse of possibly having SUD, they need to report it
immediately to their supervisor. The National Council of State Boards of Nursing (2018) states
that nurses have a licensed and moral obligation to communicate an associate’s questionable
behaviors to their supervising administrator, and in some cases, to the board of nursing. The
process does not stop from there. Foli et al. (2020) continue that supervisors need to take notice
to nurses who address coworker’s deterioration and digression and make inquiries in an orderly
process. In the facility I will be working on, nurses need to report any suspected SUD to their
manager. The manager then may require an incident report to be filled out. By quickly
addressing SUD, nurses can get the care they need and hopefully return to work and the
environment for patients is safer.
Foli, K.J., Reddick, B., Zhang, L., & Krcelich, K. (2020). Substance use in registered nurses: “I
heard about a nurse who . . .”. Journal of the American Psychiatric Nurses Association,
65-76. https://doi.org/10.1177/1078390319886369
National Council of State Boards of Nursing. (2018). A nurse’s guide to substance use disorder
in nursing.https://www.ncsbn.org/SUD_Brochure_2014.pdf

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