Warning Signs Of A Substance Use Disorder In A Nursing Colleague

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Did you know 10-15% of registered nurses may be fighting a substance use problem or are in recovery? That’s more than 1 in 10 nurses in the U.S.

Next question: Would you know what to do if you suspected substance abuse among a colleague?

Especially during the extra-stressful times of the coronavirus pandemic, it’s natural to be preoccupied with your own responsibilities and duties. You may not immediately recognize that something is off with a coworker or manager. But since a substance use disorder (SUD) can greatly impact co-worker relationships and patient care, it’s crucial to know what to look for.

When it comes to behavioral and physical warning signs of SUD, the American Association of Nurse Anesthetists (AANA) says to look for:
  • Severe mood swings, personality changes
  • Frequent or unexplained tardiness, work absences, illness, or physical complaints
  • Elaborate excuses
  • Refusing drug testing
  • Deterioration in personal appearance
  • Significant weight loss or gain

You can also look for signs of drug diversion, including:
  • Consistently using more drugs for cases compared to colleagues
  • Frequently volunteering to administer narcotics or relieve colleagues of casework, especially on cases where opioids are used
  • Heavy waste of drugs
  • Drugs and syringes in pockets
  • Inappropriate drug choices and doses for patients
  • Missing medications or prescription pads

Your Role in Identifying Substance Use Disorder in Nurses
In a perfect world, a colleague who is abusing drugs will acknowledge their problem, come forward, and seek help on their own. But this is rarely the case. One study found that 60% of nurses didn’t seek help “out of embarrassment and fear over losing their nursing license.”

It often takes help from a friend, family member, or colleague to raise concerns and begin efforts to get the impaired person help. In workplaces where there is a safe and fair (non-punitive) policy and process to report another nurse for help, co-workers are more likely to raise concerns. This is crucial — the safety of the nurse and patients in their care are the primary concerns. 
The ANA endorses the Emergency Nurses Association and International Nurses Society on Addictions joint position statement published in 2016, advocating that “health care facilities and schools of nursing adopt alternative-to-discipline (ATD) approach.” 

In the ATD approach, the workplace has an established policy to report suspicions to a manager or supervisor and start the process for safe and fair handling. Ideally it uses planned intervention to address the individual, and then safely transitions them to a SUD evaluation and addiction treatment plan. This can be a high-risk time for a nurse who fears loss of employment and licensure, so it’s important to make sure they’re not left alone once confronted.

Keep in mind that some organizations have workplace policies that hold employees accountable for reporting coworkers they suspect may have a SUD. Do some research or contact your human resources department to determine if your organization has such a policy. If it does, those guidelines should help you take the right steps to report an impaired colleague.

Remember: Substance use disorders are neurobiological disorders, the person did not consciously choose to abuse or become dependent on a substance. If you suspect a colleague is abusing drugs in or outside the workplace, remain kind. Turn to your manager, human resources department, or substance use disorder experts for assistance. 

Additional Resources:

Find more mental health help for nurses' resources here.
Posted by Holly E Carpenter, RN, BSN on Aug 31, 2020 3:40 PM America/Chicago

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