Introduction: of the profession, has cognitive, interpersonal


            The American Nurse Association (ANA) defines an impaired
nurse as a “person unable to meet the requirements of the code of ethics and standards
of the profession, has cognitive, interpersonal or psychomotor skills affected
by psychiatric illness and/ or drugs or alcohol abuse or addiction” (Willis,
n.d). According to Mary Jo Willis, MS; There are more than 2.5 million nurses
employed in the United states, and 10% of them are dependent on chemical substances
such as alcohol and/or drugs (Willis, n.d).

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are the risk of working as a nurse under the influence of alcohol and/or drugs?
What puts nurses at risk for drug and alcohol abuse in the workplace?

            The impaired nurse taking care of patients can jeopardize
patient’s safety by being more self-centered, taking pain medication from
patients, potentially neglecting patient care and at risk of performing medical
errors that could potentially harm his/her patients.

Some of the reasons why a nurse
could be at risk for substance abuse are: fatigue and stress. Nurses often work
12 hour shifts which can be physically, mentally and emotionally exhausting; and
in turn self-medicate to relieve headaches or reduce insomnia which can in the
long run lead to substance abuse (Gonzalez, n.d). Stress in another reason as
to why a nurse could be at risk for substance abuse. Nursing jobs tend to be
high stress jobs and a nurse could suffer from insomnia, depression and or
nervousness; which can lead to substance abuse as an unhealthy coping mechanism
(Gonzalez, n.d).



and Behavioral Signs of an impaired nurse:

            Some of the physical signs an impaired nurse might
portray are: fatigue, tremors, dilated pupils, runny nose, nausea and or
vomiting, rapid weight changes and disheveled appearance.

Nurses could also exhibit
behavioral symptoms such as anger, laughing inappropriately, being hyperactive,
unable to concentrate, suffer from insomnia and lying frequently.

Common Substances abused by nurses:

            Some of the common substances abused by nurses are
alcohol, amphetamines, opioids, sedative hypnotics and tranquilizers and they
tend to obtain these drugs either “workplace theft” and/or legal prescription (Alcohol
and drug use in the workplace, n.d).

I chose the specific topic of: The impaired Nurse.

            I chose the topic of:
The Impaired Nurse, because drug addiction in a major problem in the United
States. It is estimated that over 20 million people in the United States suffer
or suffered from drug addiction (Drug Addiction in the United States, n.d).

 I found it alarming that according to the
American Nurses Association (ANA), “Approximately 10% of nurses are dependent
on drugs” (Copp, 2009). The impaired nurse is not only putting her life at risk
but that of his/her patients and it is sad that there are so many cases of impaired
nurses. I believe there is a lot one can do to help out an impaired coworker as
well as many programs that the impaired nurse can attend to rehabilitate and be
able to be a safe nurse.

is this topic integrated into the clinical practice and how is the information
used in the clinical setting?

            This topic is integrated into the clinical practice because,
as future nurses we will be working with other nurses who could potentially
suffer from an alcohol/drug addiction and knowing how prevalent it is in our
community makes us more aware of the sign to look for in others in order to
advocate for our patient’s safety and the safety of our coworkers. It is our responsibility
as licensed professionals to report the impaired nurse. As the ANA code of Ethics
mentions in Provision 3.6, “Nurses must be vigilant to protect the patient, the public and
the profession from potential harm when a colleague’s practice, in any setting,
appears to be impaired.” (American Nurses Association, 2015)

            Being able to recognize an
impaired nurse can be the difference between a good or a bad patient’s outcome,
because working under the influence of drugs can be potentially harmful to our

Addiction Treatment for Nurses:

            “Many nurses with substance use
disorders are unidentified, unreported, untreated and may continue to practice
where their impairment may have endangered the lives of their patients” (National
Council of State Board of Nursing, n.d).

nuses rarely self-report for fear of losing their jobs, licenses and
livelihoods (Copp, 2009)” .  It is vital
for employers to create an environment that encourages nurses to self report, a
judge free environment that encourages nurses to seek treatment, before It is
too late.  

nuses will agree to seek treatment in order to same themselves from getting
their licenses revoked (Copp, 2009).


            In order for the impaired nurse to receive
the appropriate treatment plan for her/his addiction, a screening, an
assessment and an interview must be conducted to arrange for the adequate
length of a recovery program. The goal of the programs is to teach nurses
healthy drug free strategies to deal with everyday stress in the workplace and
remain a safe practitioner (Substance use disorder in nursing, 2009).

Process of an impaired nurse
returning to work :

            After the impaired nurse has successfully
completed the rehabilitation program, she/he is ready to return to work. According
to The National Council of State Boards of Nursing (2001) the return to work
contract should include the following:



in practice such as when can the nurse dispense narcotics again

specific policy

drug screening

Daily meeting with supervisor


Relapse prevention strategies


Regular reports from supervisors or
work-site monitor


(Substance Use Disorder in Nursing,


How I would lobby my legislator or
local government for funds to support the issue of impaired nurses.

            As professional nurses we can use
our knowledge and voice to lobby and influence policymakers. The purpose of
lobbying is to get a member of congress to vote for our cause (Phillips, 2012) .

The cause I would lobby for is to get funds to educate nurses about impaired
nurses, as well as funds to treat the impaired nurses. One way one could lobby
for this cause would be to write a letter to congress to explain the prevalence
of addicted nurses and why this cause is so important. In the letter one would
inform congress that 10% of nurses work under the influence of substances and
how that can pose a problem to patient’s care. By educating health care providers
on the signs an impaired nurse can display we are one step closer in recognizing
the substance abuse victims. The faster the victims are recognized the faster
they can get treatment and the better chances at recovering they have.

            Congress needs to be aware that
substance abuse in the nursing profession in a big deal and a public health
concern. Nurses working under the influence of substances tend to make more
medical errors and put patient’s health at risk. As nurses we can convince
congress to help with funds to educate nurses about substance abuse and treat
those impaired nurses by sending them cases of impaired nurses that have posed
a risk to a patient’s health as well as nurses who have had a problem with
substances but after rehabilitation became safe nurses. In addition, thoroughly
explaining why nurse are at risk for substance abuse could potentially get
congress to change policies to make the workplace a little less stressful in
regards, perhaps, to nurses to patient ratio and/or hospital shifts; leading to
a little less stress on the nursing career and therefore one less risk factor
as to why many nurses become addicted.