Workplace programs and approaches

Substance use disorders (SUD) have been shown to be a significant category of health care worker impairment. McCabe, Cranford & West (2008) estimate 90% of all nurses with substance use disorders are likely to be unidentified, unreported, untreated and continuing to care for patients.

The National Council of State Boards of Nursing (NCSBN, 2016) encourages Nurse managers to ensure that staff receive educational programs that:

    1. Inform staff of the manager’s responsibility to identify nurses with signs of SUD
    2. Dispel myths and misconceptions surrounding SUD
    3. Identify SUD as a treatable disorder and our impaired colleagues as being entitled to confidentiality, respect and treatment.
    4. Encourage constructive discussions regarding professional performance
    5. Identify the performance issues that indicate impairment, including the warning signs of SUD
    6. Identify the legal responsibility of employer and staff to report colleague impairment
    7. Discuss the process of reporting suspected impairment and whether reporting is mandatory in your state.
    8. Discuss disciplinary process and specific requirements for reporting
    9. Discuss types of discipline and alternative discipline
    10. Discuss the fitness for duty evaluation and return-to-work monitoring

Employers often find it cost effective to provide Employee Assistance Programs (EAP) that help employees deal with life problems which could include impairment issues or those that may lead to impairment.

EAP services should be confidential. Such counseling may include:

    1. Juggling work and life issues
    2. Anger management
    3. Experiences with violence in the workplace
    4. Lateral/horizontal bullying
    5. Health issues
    6. Legal and financial counseling
    7. Child care help
    8. Stress and anxiety
    9. Relationship issues at home and/or work
    10. Grief and loss
    11. Substance use disorders

Americans with Disabilities Act of 1990 (ADA)

The managers should also be aware of the ADA requirements that relate to nurses with substance abuse disorders, mental health disorders and physical disabilities. These issues can be complicated.

According to the government’s Equal Employment Opportunity Commission (EEOC), a person is an individual with a disability under the ADA when he or she: (1) has a physical or mental impairment that substantially limits one or more major life activities; (2) has a record of a substantially limiting impairment; or (3) is regarded (treated by an employer) as having a substantially limiting impairment.

One of the examples the EEOC describes is the question of whether individuals who are alcoholics or engage in illegal drug use considered to have a disability. Here is their response about someone with alcoholism.

Under the ADA, someone with alcoholism is an individual with a disability if the alcoholism currently substantially limits a major life activity, was substantially limiting in the past, or is regarded as substantially limiting. An employer may not discriminate against, and may need to accommodate, a qualified applicant or employee with past or present substantial limitations relating to alcoholism who can competently perform his job and can comply with uniformly-applied employer conduct rules prohibiting employees from drinking alcohol at work or being under the influence of alcohol at work.

Drug use

However, someone who is currently engaged in using illegally obtained drugs is not an individual with a disability. That person can be denied employment, disciplined or fired. That would include nurses who are diverting drugs from patients. Someone not using illegal drugs but a history of past drug use is an individual with a disability if the disability limits a major life activity. If the nurse can competently perform the job and comply with drug use policies of the institution and state, the employer may not discriminate against her or him.


Throughout the course there have been numerous articles and websites referenced for additional information. This EEOC website is an additional one for more information about specific situations that do or do not quality under the ADA and amendments.



McCabe, S. E., Cranford, J. A. & West, B. T. (2008). Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: results from two national surveys. Addict Behav.33(10),1297-305.

National Council of State Boards of Nursing (NCSBN). (2016). A Nurse Manager’s Guide to Substance Use Disorder in Nursing. Accessed 8/12/2017

National Council of State Boards of Nursing (NCSBN). (2011). Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs. Chicago, IL: National Council of State Boards of Nursing, Inc.