Nurses dedicate themselves to the health and well-being of other people, while too often neglecting their own self-care. When fatigue and symptoms related to burnout start becoming more than they can manage with coffee or a good night’s sleep, many nurses turn to substance abuse to cope.
You might think that nurses are less likely to abuse drugs or alcohol, but the truth is, substance abuse in nursing is quite common. Research shows there are around 3.1 million nurses in the U.S., and an estimated 8% of them struggle with substance use disorder (SUD).
Why Are Nurses Particularly Vulnerable to Addiction?
1. Access
Drug addiction in nurses can be partly linked to the widespread access to drugs that nurses have on the job. To some extent, this is an unavoidable occupational hazard in the health profession. Medications need to be readily available to nurses so that patients can promptly receive the treatments they need. On the other hand, some medical facilities have insecure or poorly managed systems for administering narcotics, which only exacerbates the problem.
2. Lack of Substance Abuse Education
Nurses are extremely well-educated when it comes to their own fields, but they may not know as much about substance abuse unless they work in this specific sector. For instance, they might not know exactly how SUD is defined, the risk factors, how to recognize the signs and symptoms, and the best way to intervene and help.
Not only does this mean that substance abuse among nurses can be easily overlooked, but the lack of understanding also contributes to the negativity and stigma associated with drug addiction in nurses. Medical professionals are generally held to a higher standard when it comes to substance abuse, and nurses who struggle with addiction are often judged most harshly by their colleagues.
3. Self-Diagnosis and Inadequate Medical Care
Another occupational-specific risk factor for substance abuse among nurses is widespread self-diagnosis compounded by the overly casual prescribing practices of the doctors and physician assistants they work with. Nurses have a great deal of medical knowledge that they often use to diagnose their own health problems without seeking a full workup from their personal GPs. Instead they might turn to coworkers and friends who are willing to prescribe drugs on request. This gives many nurses unfettered access to highly addictive drugs.
4. Fatigue
Substance abuse in nursing can also be linked to fatigue, which almost all nurses experience as a side effect of their jobs. Long hours have always been commonplace in nursing, but the overall nursing shortage has intensified the problem. In a recent study of around 1,300 nurses, approximately 22% said they lived in a state of excessive fatigue.
Rotating shifts and working nights are also usual for the profession. Nurses could easily wind up taking lunch breaks at 6 a.m., 5 p.m., and midnight, all in the same week. These kinds of schedules result in poor quality sleep. By the end of such a week, sleep debt will result in a significant impairment of cognitive function, which not only hurts job performance but also puts nurses at still greater risk of succumbing to substance abuse. Unfortunately, individuals suffering this sort of fatigue are rarely able to recognize their own degree of impairment.
5. Stress
Nursing is an inherently high stress profession. Nurses deal with life and death situations daily, jumping from one physically and emotionally demanding situation to another without sufficient time to process emotions, rest their minds and bodies, recover from physical pain and injury, or carefully transition into the next task.
These medical professionals are expected to give considerable emotional support to their patients and patients’ families without having resources of their own to help them replenish emotional reserves or process the intense stress and range of feelings they experience while doing their jobs. Nurses today are also responsible for several tasks that would have been performed by doctors in years past, so that a greater portion of patient care falls to nurses than ever before.
6. Misconceptions
Four commonplace, problematic misconceptions within the profession can also increase the odds of substance abuse among nurses. These are:
Reliance on drugs for treatment
By virtue of their profession, nurses are trained to put their faith in drugs and have personally witnessed the positive effects that drugs can have on their patients. This can instill an unrealistic sense of optimism about drugs and taking drugs.
The end justifies the means
Since nursing is an important job, it is easy for nurses to view substance abuse as justified because it enables them to continue working and helping others. Before long, many nurses can be caught in an addiction that started as an attempt to keep up with their workload of helping others.
Nurses are caregivers, not recipients of care
Health care workers like nurses often see themselves as invulnerable to illness. They might think that their role is to be a caregiver only, and not the recipient of care. Nurses will often push through stress, illness, and even addiction to keep doing their jobs.
Recreational drug use can be the solution to fatigue
With stress, fatigue, and physical pain being an everyday part of the nursing profession, drug use can start to seem like a natural solution to a standard workplace hazard.
Burnout Among Nurses
Physical and emotional fatigue, chaotic and unhealthy schedules, a lack of support, short staffing, and the stress and emotional fatigue of dealing with painful and traumatic life situations all contribute to rampant burnout among nurses. In fact, many nurses suffer symptoms quite similar to individuals with post-traumatic stress disorder (PTSD). Throughout the course of their careers, about 62% of nurses will experience burnout.
What Is Burnout?
Burnout is a form of mental, physical, and emotional exhaustion. Most cases of drug addiction in nurses can be linked to burnout. Burnout not only affects a nurse’s quality of life, but also the quality of care they are able to provide.
How to Spot Nurse Burnout
The fact that nurses usually try to hide their symptoms of exhaustion out of a fear of endangering their careers can make it quite difficult to spot burnout on the job. However, there are some signs to look out for such as declining enthusiasm or social interaction at work and negative changes in performance, attendance, and punctuality. They may also lose the ability to get along with coworkers.
Another way to spot burnout is to conduct anonymous surveys to locate areas that need improvement. For more consistent monitoring, some employers provide nurses with game-based apps designed to examine energy and stress levels.
What to Do About Nurse Burnout
Administrators need to take measures against burnout such as adjusting schedules, increasing staffing, and providing on-the-job support to their employees, while nurses need to apply proactive strategies to avoid burnout, such as:
1. Setting Boundaries
It can be very difficult for the kinds of nurturing individuals who go into the field of nursing to say no. However, it’s crucial that nurses limit the number of commitments they take on, both inside and outside the workplace.
2. Putting Themselves First
Another challenge for professional caregivers is taking the time to care for themselves. It is important for all nurses to practice good self-care, including scheduling time to relax, getting enough sleep, and doing things they enjoy just because they enjoy it.
3. Processing Emotions
Nurses are expected to be shoulders to cry on, but are rarely given the same consideration in return. This is to be expected at work, where the needs of patients dealing with life-threatening illnesses must be prioritized, but after work, nurses should seek out people whom they can confide in.
4. Managing Stress
Taking deliberate actions to relieve stress instead of attempting to “tough it out” is very important. Mediation, exercise, deep breathing, and deliberate positive thinking are all excellent ways for nurses to avoid burnout.
5. Creative Outlets
Engaging in creative expression through activities such as writing, cooking, sewing or playing music can help nurses to work through difficult emotions while also replenishing their depleted reserves.
When Burnout Leads to Addiction
Burnout damages both job performance and quality of life. To many individuals, substance abuse may feel like a viable antidote at first, but drug addiction in nurses has even more devastating consequences for nurses and their patients.
Signs and Symptoms of Addiction in Nurses
Taking measures against substance abuse in nursing requires being able to identify when someone is suffering from addiction. Look out for signs such as:
- Poorly explained accidents or injuries
- Underperformance
- Frequent or unexplained absences, lateness, illnesses or physical complaints
- Mood swings and personality changes
- Elaborate excuses
- Confusion, memory loss, and difficulty concentrating
- Seeming intoxicated
- Wearing long sleeves when inappropriate (to hide track marks)
- Refusing drug testing
- Increasing interpersonal conflicts
- Significant weight gain or loss
- Neglected appearance
It’s also helpful to know the signs of drug diversion that nurses may exhibit. Some of these include:
- Frequently volunteering for cases involving opioids
- Heavy drug wastage
- Carrying drugs or syringes in pockets
- Records that don’t match up to drugs dispensed
- Higher patient pain scores than expected
- Signs of medication tampering
The Stigma of Drug Addiction in Nursing
Most individuals feel guilty and ashamed of their addiction, but nurses face the additional stigma that comes with working in a profession where substance abuse could endanger lives. Nurses also face greater consequences for drug and alcohol abuse than addicts in the general population, such as losing their careers due to addiction.
Nurses work in an environment that makes them especially vulnerable to substance abuse, and yet they are expected to be immune to it. They suffer a double burden of guilt and shame because drug addiction in nurses is a breach of both personal and professional ethics. However, drug addiction is a disease, no matter who struggles with it.
At one time, depression was viewed as a moral failing, while these days we understand it as a disease that necessitates professional treatment. Addiction is a similar kind of disease, but unfortunately, prevailing attitudes still blame addicts for the condition instead of sympathizing the way they would if an individual were suffering depression, cancer, or heart disease.
Nurses and the people around them need to learn how to move past the stigma of substance abuse to facilitate addiction treatment and recovery. Drug addiction changes the brain in ways that make quitting difficult, no matter how much the person wants to get better. This is why overcoming addiction requires professional medical treatment.
Treatment for Substance Abuse among Nurses
For people in the nursing profession, substance abuse treatment is a little more complicated than usual. Nurses need to be allowed to seek treatment without being professionally penalized, while preserving their dignity and privacy.
Employers should give sufficient time off for a nurse’s recovery treatment. This may begin with the employee taking paid sick leave or vacation time, followed by unpaid leave if necessary. The fact that the employee is undergoing treatment and what that treatment is for should be kept confidential, and should not be disclosed to any person or organization (including state nursing boards) without the employee’s permission.
As soon as a nurse has successfully completed an addiction treatment program, the employer should facilitate a return-to-work plan with the help of the individual and their treatment providers. Efforts should be made to minimize the stigma the nurse in recovery may feel or be subjected to by coworkers.
To ensure long-term sobriety, the nurse in recovery should seek out peer-to-peer support during and after attending a treatment program. If there isn’t a peer support program already established at their workplace or through their rehab facility, they can find help through the American Association of Nurse Anesthesiology (AANA) at the AANA Helpline.
Twelve-step meetings, ongoing counseling, and other types of aftercare support are other ways to keep nurses focused on recovery after transitioning back into a potentially triggering environment. Cognitive Behavioral Therapy, or CBT, may be especially useful for helping nurses replace damaging attitudes and habits related to substance abuse with positive patterns of thought and behavior to help them cope more effectively with triggers.
These resources, combined with a supportive family, workplace, and team of colleagues, can help nurses recover from burnout and any addiciton-related problems it may have caused. Nurses are heroes in the healthcare field, and helping them find the care they need is critically important.