Nurses dedicate themselves to challenging work that benefits the health and wellbeing 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. According to the American Nurses Association, approximately one in ten nurses abuse drugs and alcohol, and six to eight percent of nurses have a substance abuse problem severe enough to hinder their professional performance.
While the rate of alcohol and drug addiction in nurses reflects the same rate seen in the general population, it’s surprising the rate isn’t higher, as there are numerous ways in which the medical profession makes nurses especially vulnerable to substance abuse and addiction.
Why Are Nurses Particularly Vulnerable to Addiction?
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
While nurses are extremely well-educated when it comes to their own field, they are rarely well-educated about substance abuse, i.e. how it 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, 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 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 turn to coworkers and friends who are willing to prescribe drugs on request. This gives many nurses unfettered access to highly addictive drugs.
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. 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 less sleep and poorer 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 sleep debt are rarely able to recognize their own degree of impairment.
Nursing is an inherently high stress profession. Nurses deal with life and death situations on a daily basis, 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. They 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 a number of 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.
There are also four commonplace, problematic attitudes within the profession that 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 see themselves as caregivers only, and not the recipients 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 every day in the workplace all contribute to rampant burnout among nurses. In fact, many nurses suffer symptoms quite similar to individuals with post-traumatic stress disorder.
What is burnout?
Burnout is 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 the quality of patient 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 for the work or for social interaction at work, and negative changes in performance, attendance, punctuality, or the ability to get along with coworkers.
Another way to spot burnout is to conduct anonymous surveys created 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 on a daily basis.
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
Although it can be very difficult for the kinds of nurturing individuals who go into the field of nursing to say no, it is 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 that 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
- 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 longs sleeves when inappropriate (to hide track marks)
- Refusing drug testing
- Increasing interpersonal conflicts
- Significant weight gain or loss
- Neglected appearance
- Signs of drug diversion:
- 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
All addicts 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. Nurses 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, or cancer, or heart disease.
Nurses, and the people around them, need to learn how to move past the stigma of substance abuse in order to facilitate addiction treatment and recovery. Drug addiction changes the brain in ways that make quitting difficult, no matter how much the addict 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 the usual. Nurses need to be allowed to seek treatment without being professionally penalized, and 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. Despite confidentiality measures, many coworkers will be at least somewhat aware of the recovering nurse’s addiction issues due to temporary restrictions that may be placed in regard to dispensing and administering certain kinds of drugs.
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 AANA Peer Assistance Resource Directory.
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.