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Medically Reviewed

What to do if You Suspect a Nurse of Substance Abuse

Stress and Substance Abuse in the Nursing Profession

Nursing is high-pressure occupation characterized by heavy workloads and long hours of continuous patient care. These working conditions contribute to the development of job stress,1 and like anyone else nurses may turn to substances for coping and self-medication. Current estimates show that 1 in 10 nurses suffer from alcohol or drug addiction.2-3

Although nurses aren’t at a higher risk than the rest of the population, their overall pattern of dependency is unique because they have greater access to prescription drugs through their workplace.4-5 The most commonly abused medications obtained through drug diversion are opioids, with several recent cases of drug overdose deaths in nurses linked to the potent painkiller fentanyl.6

Signs and Symptoms of Substance Abuse in Nurses

According to the American Nurses Association, some of the signs, symptoms, and behavioral changes to look for if you suspect a nurse of substance abuse include:7

  • Brief, unexplained absences from the nursing unit
  • Performing patient rounds at odd hours
  • Discrepancies with the narcotic record and or the patient record
  • Medication errors
  • Weight gain or loss
  • Watery or bloodshot eyes
  • Slurred speech
  • Shakiness
  • Tremors
  • Fatigue
  • Frequent mood changes
  • Lack of concentration
  • Cold weather clothing in warm weather (to hide track marks)
  • Frequent bathroom breaks
  • Lack of care concerning appearance and hygiene

How to Confront an Addicted Nurse

In their Code of Ethics for Nurses with Interpretive Statements, the American Nurses Association states that any nurse who is aware of “incompetent, unethical, illegal, or impaired practice” has an ethical obligation to report it.8 The code also states that “concerns should be expressed to the person carrying out the questionable practice.” The recommended course of action is for nurses to confront colleagues directly about their substance abuse before reporting them to a higher authority, such as the nurse manager.

Although it may be difficult to report a colleague out of fear of the potential reprisal, it is important that this practice is encouraged. A nurse’s peers are often the first to recognize their impairment, and it is best to address any issues of substance abuse immediately before the addiction escalates out of control, putting the life of the nurse and the patients under their care in danger.

An impaired colleague should be confronted directly and caringly. It is also recommended to express compassion in a firm manner, as this helps to set the stage for an intervention.9 Any subsequent intervention should not be viewed as a confrontation, instead those who come together to address the nurse should do so in an act of compassionate peer support.10

Treatment Options

Instead of drastic actions such as termination, most states currently offer some form of an alternative-to-discipline program (also referred to as nurse assistance programs) that directs nurses to treatment, provides support and advocacy, monitors reentry to clinical practice, and maintains their license according to the National Council of State Boards of Nursing.11 Nurses who undergo treatment for addiction have a good chance for successful recovery. Treatment has proven to be very effective at helping nurses overcome substance abuse, leading to improved health and occupational well-being.12


  1. Roberts, R.K., & Grubb, P.L. (2014). The consequences of nursing stress and need for integrated solutions. Rehabilitation Nursing, 39(2), 62-69.
  2. Baldisseri, M.R. (2013). Impaired healthcare professional. Critical Care Medicine, 35(2 Suppl), S106-S116.
  3. Dunn, D. (2005). Substance abuse among nurses: Defining the issue. Association of Operating Room Nurses Journal, 82(4), 573-596.
  4. Kunyk, D. (2015). Substance use disorders among registered nurses: prevalence, risks and perceptions in a disciplinary jurisdiction. Journal of Nursing Management, 22(1), 54–64.
  5. National Council of State Boards of Nursing. (2011). Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs.
  6. Becker’s Hospital Review. (2019). 2 nurse overdose deaths prompt investigation at UT Southwestern.
  7. Thomas, C.M., & Siela, D. (2011). The impaired nurse: Would you know what to do if you suspected substance abuse? American Nurse Today, 6(8).
  8. American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements.
  9. Dunn, D. (2005). Home study program: Substance use among nurses-intercession and intervention. Association of Operating Room Nurses Journal, 82(5), 777–804.
  10. Bettinardi-Angres, K., & Bologeorges, S. (2011). Addressing Chemically Dependent Colleagues. Journal of Nursing Regulation, 2(2), 10-17.
  11. National Council of State Boards of Nursing. (2011). Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs.
  12. Hastings, J., & Burn, J. (2007). Addiction: A nurse’s story. American Journal of Nursing, 107(8), 75–77, 79.
Last Updated on October 30, 2019
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