Thou Shall Not Steal: The Dilemma of Addicted Nurses in the Hospital
Substance Abuse in Nurses
Substance abuse is a major concern among the nursing profession. Estimates show that nearly 1 in 10 nurses has an alcohol or drug abuse problem.1-2 Although nurses generally abuse drugs at nearly the same rate as the rest of the population, their overall pattern of dependency is unique because they have greater drug accessibility through their work environment. Not surprisingly, nurses are more likely to abuse prescription medications, with high rates of abuse associated with opioid painkillers such as Fentanyl.3-4
Signs, symptoms, and behavioral changes that are indicative of substance abuse in nurses include:
- Mood swings
- Hand tremors
- Bloodshot eyes
- Runny nose
- Complaints of physical pain
- Untidy appearance
- Panic attacks
- Memory lapses
- Difficulty following through on work assignments
- Decreased productivity
- Sleeping on the job
- Negligence in patient care
- Frequent bathroom trips
- Unexcused tardiness or absences from work
- Forging prescriptions
Nurses endure extreme work-related stress, with daily exposure to death, illness, and trauma. A study published in Depression and Anxiety found that 22% of nurses display symptoms of post-traumatic stress disorder (PTSD).5 This may lead to nurses turning to prescription drugs accessible at work for coping and self-medication. Previous studies indicate a link between workplace access to drugs and substance abuse, with nurses more likely to use drugs when their access to these substances is increased.6 This can have devastating effects, as many of these drugs are very potent. Recently, two nurses were found dead in bathrooms of the same Dallas hospital within 16 months of each other.7 Both had died from Fentanyl overdose.
Signs that a Nurse is Stealing Drugs
There should be concern if a nurse repeatedly volunteers to work at times when there is minimal oversight by colleagues or management (such as holidays, weekends, and overnight shifts). This behavior may suggest an intention to steal or divert prescription drugs. Other signs that a nurse may be stealing drugs from clinical supplies include:
- Volunteering for overtime
- Coming to work on days off
- Missing or broken vials
- Medication and charting errors
- Discrepancies in narcotic and/or patient records
- Failure to document wastage
- Paying extra attention to patients receiving opioids
- Assigned patients frequently report a lack of pain relief
- Altered verbal or telephone medication orders
- Volunteering to count narcotics
- Volunteering to administer narcotics to patients
- Signing out more narcotics than co-workers
Consequences of Drug Theft and Diversion
Substance abuse among nurses has far-reaching negative consequences. The American Nurses Association estimates that 6-8% of nurses use alcohol or drugs to an extent that impairs their professional performance.8 Nurses with an untreated addiction can jeopardize patient safety because of impaired judgment, slower reaction time, patient neglect, and increased mistakes and errors.2 Cases of drug diversion, where drugs prescribed to a patient are stolen by a healthcare worker for their own personal use, pose additional risks to patients. According to the Centers for Disease Control and Prevention, as many as 30,000 people may have been exposed to hepatitis C over a 14-year period by infected nurses and other hospital employees using stolen narcotics that were intended for patients.9
- Baldisseri, M.R. (2013). Impaired healthcare professional. Critical Care Medicine, 35(2 Suppl), S106-S116.
- Dunn, D. (2005). Substance abuse among nurses: Defining the issue. AORN Journal, 82(4), 573-596.
- 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.
- National Council of State Boards of Nursing. (2011). Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs.
- Mealer, M., Burnham, E.L., Goode, C.J., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depression and Anxiety, 26(12), 1118-1126
- Trinkoff, A.M., Zhou, Q., Storr, C.L., Soeken, K.L. (2000). Workplace Access, Negative Proscriptions, Job Strain, and Substance Use in Registered Nurses. Nursing Research, 49(2), 83-90.
- Ambrose, S., & Hacker, H.K. (2018). Two nurses died of overdoses inside a Dallas hospital. What went wrong?
- Naegle, M.A. (2003). An overview of the American Nurses’ Association’s action on impaired practice with suggestions for future direction. Journal of Addictions Nursing, 14(3),145-147.
- Schaefer, M.K., & Perz, J.F. (2014). Outbreaks of infections associated with drug diversion by US health care personnel. Mayo Clinic Proceedings, 89(7), 878-87.