Impairment prevalence in
health care workers and nurses

Impairment in the workplace may involve: a) Substance use disorder (SUD), i.e., illicit drugs, prescription medicines, or alcohol, b) diminished or dangerous physical condition, and c) mental health issues (Salani, 2022; Mumba, 2019).

The impairment may be temporary, chronic, or escalating.

Percentages of substance use

Nationally, substance abuse in the general population varies from state to state. Since the rate of substance abuse in the nursing profession is reflective of the general population, the rate of use by nurses will also vary from state to state.

The 2022 NSDUH report includes the following key findings:

• Among people aged 12 or older in 2022, 59.8% (or 168.7 million people) used tobacco products, vaped nicotine, used alcohol, or used an illicit drug in the past month (also defined as “current use”).
• In 2022, 70.3 million people aged 12 or older (or 24.9%) used illicit drugs in the past year. Marijuana was the most used illicit drug, with 22.0% of people aged 12 or older (or 61.9 million people) using it in the past year.
• In 2022, 48.7 million people aged 12 or older (or 17.3%) had a substance use disorder (SUD) in the past year, including 29.5 million who had an alcohol use disorder (AUD), 27.2 million who had a drug use disorder (DUD), and 8.0 million people who had both an AUD and a DUD.

Here are the statistics on U.S. states from the most significant incidence of drug use to the least for ages 26 and older as provided by SAMHSA for the years 2021 and 2022. https://www.hhs.gov/about/news/2023/11/13/hhs-samhsa-release-2022-national-survey-drug-use-health-data.html

Actual study of nurses

Trinkoff at al. (2022) carried out a survey of 1,215 randomly selected nurses in nine states to assess substance use and other issues.

The authors noted that the prescription-type drug misuse in nurses exceeded the U.S. population rates and that rates varied by specialty.

Here are the results of their study:

• 18.0% of nurses screened positive for SU problems
• Past year illicit drug use was 5.7%
• prescription-type drug misuse was 9.9%
• nurses working in home health/hospice (19%) and nursing homes (15.8%) having the highest rates.
• Energy drink use was reported by 23.7% of nurses younger than 45 years
• Overall, 18.0% of nurses screened positive for SU problems
• Staff, charge nurses/coordinators/nurse managers, and other administrators had 9 to 12 times the odds of having a SUD as opposed

Collectively the Boards of Nursing are only monitoring or disciplining about .02% of the ANA estimated 320,000 impaired nurses. It is unlikely that the vast majority of the remaining 99.08% of SUD impaired nurses are enrolled in private and confidential treatment programs. Substance use disorder amongst nurses is an underreported and undertreated problem in the U.S.

Code of ethics

The Code of Ethics for Nurses with Interpretive Statements from the ANA states it is our profession's promise to provide and advocate for safe, quality care for all patients and communities. Unfortunately, impaired colleagues are not providing safe care and need to be reported and offered assistance. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/

References

American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR®). Arlington, VA.

Assistant Secretary for Public Affairs (ASPA). (2023, November 13). HHS, Samhsa Release 2022 National Survey on Drug Use and Health Data. HHS.gov. https://www.hhs.gov/about/news/2023/11/13/hhs-samhsa-release-2022-national-survey-drug-use-health-data.html

Foli, K.J., Reddick, B., Zhang, L. & Krcelich, K.(2020). Substance Use in Registered Nurses: “I Heard About a Nurse Who . . .”. Journal of the American Psychiatric Nurses Association. 26(1), 65-76.

Mumba, M. N., Baxley, S. M., Snow, D. E. & Cipher, D J. (2019). Retrospective Descriptive Study of Nurses With Substance Use Disorders in Texas, Journal of Addictions Nursing: 30(2), 78-86.

National Council of State Boards of Nursing. (2022). The Prevalence of Substance Use and Substance Use Problems in Registered Nurses: Estimates From the Nurse Worklife and Wellness Study.

Salani, D., Goldin, D., Valdes, B. & McKay, M. (2022). The Impaired Nurse. AJN, American Journal of Nursing. 122(10), 32-40. Trinkoff, A.M., et al. (2022). The prevalence of substance use, and substance use problems in registered nurses: Estimates from the Nurse Worklife and Wellness Study. J Nurs Regul. 12(4), 35–46.