Substance Use Disorders Among Registered Nurses


Impaired nursing practice occurs when a nurse cannot provide adequate patient care due to being under the influence of chemical substances, such as drugs or alcohol (Thew, 2017). Impaired practice is often viewed in relation to drug diversion, as nurses might use addictive drugs that are prescribed to patients (Thew, 2017). As nurses have easier access to drugs than the majority of the population, the problems of substance use and impaired practice are crucial to ensuring patient safety and promoting the well-being of nurses. The present paper will describe and evaluate the issue and its influence on nursing while also recommending ways of lobbying local legislators for funds to support interventions and policies for impaired nursing.

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Current Relevance

The problem of impaired nursing practice due to substance use disorder was chosen as the focus of the paper, as it is a significant issue affecting the contemporary healthcare environment. According to Worley (2017), 10% of nurses have a substance use disorder, which means that there are over 300,000 impaired nurses in the United States alone. Impaired nursing practice places patients at risk by increasing the incidence of medical errors, reducing hospital staffing, and promoting noncompliance with procedures. Strobbe and Crowley (2017) state that nursing students are also at risk for substance abuse and impaired practice as a result of chemical dependency. Thus, the problem also affects future nurses and may have serious consequences in the long term.

Aside from prevalence, another vital aspect of impaired practice in the United States is the lack of adequate policies to address the root of the problem. For instance, Kunyk (2015) explains that nurses with substance use disorders continue nursing practice as usual in order to avoid disciplinary action, including fines, license suspension, and monitoring. Indeed, for many nurses, their clinical practice is the only source of income, and thus the possibility of being suspended or losing the license causes fear and anxiety. As noted by researchers, “Students whose substance use is discovered may be expelled without receiving appropriate treatment or follow-up, denying them a path to recovery, and eventual safe entry into the profession” (Strobbe & Crowley, 2017, p. 105). Therefore, for nursing students, the consequences of substance abuse are even worse, and the impairment might affect their chances of ever returning to the profession.

The problem with disciplinary action is that it prevents nurses and nursing students from seeking help. Research shows that a staggering 77.7% of nurses who identified as having a substance use disorder did not participate in recovery or intervention programs and refused to contact a professional for help (Kunyk, 2015). Impaired nurses who avoid seeking help and continue nursing practice may face health consequences of long-term substance use while also compromising their patients’ safety.

Risk Factors

There are a number of risk factors that must be considered while designing efforts to address the problem of impaired nursing practice. Occupational factors that are the same for most nurses are access to drugs, fatigue, and stress (Huston, 2013). Nevertheless, there are also demographic and individual factors that affect a nurse’s risk of developing an impairment. For example, women are more prone to substance use disorders, as they progress from first use to chemical dependency at a quicker pace than men (Worley, 2017). The lack of knowledge about substance use disorders and impaired practice, as well as ineffective coping strategies and loneliness, are also risk factors for impaired nursing practice (Huston, 2013). Thus, nurses should be aware of their risks and prevention programs in order to take action for preventing professional impairment.

Effect on Clinical Practice

Impaired nurses affect clinical practice by compromising patient safety, increasing the workload of other staff, and damaging workplace environment. Nurses who experience impairment due to substance use suffer from memory loss, poor concentration, and confusion, which could result in medical errors and threaten the life and health of their patients (American Association of Nurse Anesthetists, 2018). Moreover, impaired nurses often fail to perform some of their duties, which results in patients not receiving scheduled services or procedures. This can influence patients’ treatment and result in poor patient outcomes in the unit.

Additionally, impaired nurses may have unexplained work absences and frequent sick leaves, as well as unexplained accidents or injuries (AANA, 2018). The effects of these symptoms on clinical practice are evident, as absent or underperforming nurses increase the workload of other staff, who have to take on more patients or work additional shifts. As a result, impaired nurses could affect the performance of an entire unit or department if they are frequently absent from work or fail to perform their duties correctly.

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Finally, impaired nurses influence the workplace environment by contributing to conflict and showing a lack of compliance with orders or procedures. As outlined by the AANA (2018), impaired nurses may experience severe mood swings, personality changes, difficulties with authority, aggression, and communication issues. Therefore, the behavior of an impaired nurse could damage workplace environment and create additional concerns for the management. This, in turn, affects the functioning of the unit, thus decreasing the rate of positive outcomes in clinical practice.

Using Information in Clinical Setting

The information about impaired nursing practice has been used in clinical settings to address the problem. For instance, the knowledge of risk factors and barriers to treatment helps to improve prevention and intervention schemes. The main barrier to seeking help that was identified in research is the fear of disciplinary action (Kunyk, 2015; Strobbe & Crowley, 2017; Worley, 2017). Therefore, it is essential to change the approach to interventions for nursing impairment, and view it as a medical problem instead of a criminal or an organizational one. A successful approach to helping impaired nurses would be to establish free programs for substance abuse recovery and reduce or eliminate disciplinary action for nurses who developed impairment for the first time and agree to go through with the program (Strobbe & Crowley, 2017; Worley, 2017). For nurses who relapse, intervention programs should be supported by moderate disciplinary action, such as fines or temporary license suspension.

Additionally, it would be critical to focus on preventing impaired nursing practice by addressing its risk factors. The main risk factors that should be targeted as part of prevention programs are poor coping mechanisms and low risk awareness (Huston, 2013). Nursing students and working nurses alike should receive education about the problems of impairment and substance use in order to understand their risks, as well as information about the available sources of help. Nurses should also be aware of the damage associated with impaired practice, including poor patient outcomes, ineffective management, and negative workplace environment. In addition, nurses should receive training on identifying and reporting their impaired colleagues to evaluation and intervention programs. This could help to minimize the share of impaired nurses who continue nursing practice without receiving professional help.


Developing adequate prevention and intervention projects requires funding, which is why it is essential for nurses to lobby legislators or local government for funds. To obtain funds for successful intervention and prevention programs targeting impaired nursing practice, I would arrange a telephone call followed by a face-to-face meeting with a legislator. I would choose a local legislator who has connections to the healthcare sector and has already taken the initiative to improve health care policy, as they would be more likely to understand the importance of the problem.

I would first offer a short introduction to the issue of impaired nursing practice on the phone and then arrange a face-to-face meeting where I would deliver the information presented in this assignment, including prevalence, risk factors, and proposed programs. I would also support this information with examples from my organization or area of practice in order to stress that the problem is evident in a variety of institutions and settings. Overall, providing the key information in support of the cause, as well as establishing the importance of the problem would help to obtain the required funding and raise awareness of the need for policy changes.


Impaired nurses have a significant influence on the functioning of the healthcare sector, as they could compromise patient safety and affect the work of other staff members. There are a number of important risk factors and barriers to action that often remain unaddressed by organizational and state policies, thus preventing impaired nurses from seeking help. Using information about the problem, Florida healthcare institutions could contribute to solving it by implementing effective prevention and intervention programs. Lobbying efforts could help to generate additional funding and administrate support for these programs, thus increasing their use and efficiency.


American Association of Nurse Anesthetists (AANA). (2018). Signs and behaviors of impaired colleagues. Web.

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Huston, C. J. (2013). Professional issues in nursing: Challenges and opportunities. Philadelphia, PA: Lippincott Williams & Wilkins.

Kunyk, D. (2015). Substance use disorders among registered nurses: Prevalence, risks and perceptions in a disciplinary jurisdiction. Journal of Nursing Management, 23(1), 54-64.

Strobbe, S., & Crowley, M. (2017). Substance use among nurses and nursing students: A joint position statement of the Emergency Nurses Association and the International Nurses Society on Addictions. Journal of Addictions Nursing, 28(2), 104-106.

Thew, J. (2017). Impaired nurses benefit from alternative-to-discipline approach. Health Leaders. Web.

Worley, J. (2017). Nurses with substance use disorders: Where we are and what needs to be done. Journal of Psychosocial Nursing and Mental Health Services, 55(12), 11-14.

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