LEGAL MAT TER S
The sneaky prevalence of substance
Downloaded from https://journals.lww.com/nursing by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3JIQl/9XFzqR6QlRfdlCjMqOE1IF2EplEzMZtDfGwR9bXhT+us0qCBQ== on 07/06/2019
abuse in nursing
By Kristopher T. Starr, JD, MSN, RN, FNP-C, CEN, CPEN
IN ONE OF MY DEBUT pieces
for this journal, I wrote about the
24/7 RN and the nature of nursing
licensure—the fact that while you
may leave work, your license doesn’t
have an on/off switch. You’re respon-
sible for behaving professionally and
meeting your state board of nursing
continuing-education requirements
on your own time throughout your
career.
If one takes a stroll through the
continuing-education requirements
for professional nurses state by state,
you find some interesting mandatory
education requirements. For instance,
Kentucky requires education on pe-
diatric abusive head trauma, while
Texas mandates tick-borne illness
education. The most fascinating
for me was Nevada’s requirement for
4 hours of bioterrorism education.
So, why the litany of education
issues? Well, I found it revealing
what Delaware and West Virginia
have come to recently require of
their RNs (and I do so enjoy sin-
gling out my home state). The
focus of these two jurisdictions’
continuing-education goals is
“substance abuse.”
Now, for two states to address
mandatory education on substance
abuse, one might conclude some
emerging drug or alcohol problem
among RNs in these two states or,
worse yet, nationally. So let’s have a
look at the evidence.
16 l Nursing2015 l March
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Using 2009 captured data,
Monroe et al. suggested that less
than 1% of employed RNs were
working with a known substance
abuse problem and that less than
1% of RNs were in active substance
abuse treatment programs or alter-
native to discipline (ATD) diver-
sionary programs.1
Less than 1% nationally doesn’t
immediately strike one as a bur-
geoning problem, does it? But recall
that the data presented are based
on reported cases. What’s the evi-
dence for unreported or suspected
cases?
The American Nurses Association
suggests that up to 10% of the RN
work force may be dependent on
drugs or alcohol.2 So these figures
are a little more concerning.
The most disturbing statistical
“potential” comes from Monroe and
Kenaga, who suggest that between
14% and 20% of all RNs in the Unit-
ed States may have a problem with
dependence or abuse of drugs and/or
alcohol, which likely addresses the
suspected prevalence of unreported
substance dependence cases.3 One
out of every 5 to 7 RNs is affected by
substance abuse—now that grabs
your attention.
Interested in what’s happening
here in my home state (remember,
one of two that mandate substance
abuse continuing education for RNs),
I spoke to the executive director of
the Delaware State Board of Nursing
about substance abuse. She suggest-
ed that up to 35% of all new com-
plaints to the Board for discipline
center on substance use, depen-
dence, or abuse issues.4 Thirty-five
percent!
What does the addicted or divert-
ing RN look like? Are there certain
tell-tale signs that say “ah-ha, that RN
has a substance dependence issue”?
Here are some common concerns
that should raise the red flag:
• a staff member who looks dishev-
eled or doesn’t seem to care about
his or her appearance, or who’s “late,
lazy, not timely, in a daze”5
• opioid shift count errors that arise
repeatedly when the same RN is on
duty
• an RN who often can’t be located
in his or her assigned area
• an RN whose patients are sched-
uled for pain medication but fail
to get them despite their being signed
out of stock. Also consider the pos-
sibility of drug diversion if an RN’s
patients repeatedly fail to achieve the
expected level of pain relief from
their prescribed analgesics.5
So, why the doom and gloom
about substance abuse? The reason
is simple. Given the statistics present-
ed, from 1 in 10 to 1 in 5 RNs may
suffer from substance dependence or
abuse issues.
Have you observed behaviors
that concern you about one of your
www.Nursing2015.com
colleagues? And what about your-
self—Do you need that drink or
medication to get through to the
next day, shift, moment? If you
know any RNs who you suspect may
have a problem, lead them to help if
you can, or offer support and give
guidance. Make sure you understand
the mandatory reporting laws in
your jurisdiction—you may be re-
quired to report any licensed health-
care professional you suspect is im-
paired from substance use.
If you recognize yourself in
this article or someone has brought
a concern about you to your atten-
tion, here’s your chance to take hold
of a situation that only promises to
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
destroy the career that you’ve
worked very hard to achieve and
maintain.
Many state Boards of Nursing
have ATD programs if the RN self-
reports a substance dependence or
abuse issue before a formal disci-
plinary complaint is filed. Urge
those you’re concerned about to
take control of the situation before
the issue winds up controlling
them. Consider reporting yourself
if the many pressures of life have
steered you to an unhealthy, sub-
stance driven outlet. The power
to change your life for the better,
or for one of your colleagues, is all
yours. ■
REFERENCES
1. Monroe TB, Kenaga H, Dietrich MS, Carter
MA, Cowan RL. The prevalence of employed
nurses identified or enrolled in substance use
monitoring programs. Nurs Res. 2013;62(1):10-15.
2. American Nurses Association. Position
statements on abuse of prescription drugs and
random health care worker drug testing. http://
www.nursingworld.org.
3. Monroe T, Kenaga H. Don’t ask don’t tell: substance
abuse and addiction among nurses. J Clin Nurs. 2010;
20(3-4):504-509.
4. Zickafoose P. Personal communication. December
3, 2014.
5. Thomas CM, Siela D. The impaired nurse: would
you know what to do if you suspected substance
abuse? Am Nurse Today. 2011;6(8):e1.http://www.
americannursetoday.com.
Kristopher T. Starr is an Attorney at Law, Ferry Joseph,
P.A., Wilmington, Del.; Nurse Manager, Wilmington
Hospital Emergency Department, Christiana Care
Health System, Wilmington, Del.; and a member of
the Nursing2015 editorial board.
DOI-10.1097/01.NURSE.0000460727.34118.6a
March l Nursing2015 l 17