Nursing Students and Substance Abuse

The statistics are sobering. Substance abuse is rampant in our society, with an estimated 16% of Americans suffering from addiction. up to 20 % of nurses are chemically impaired. Chemical dependency may involve such substances as alcohol, unauthorized use of prescription medications, narcotics, and illicit drugs. Specialties Educators Article

Nursing Students and Substance Abuse

The majority of these impaired nurses also had substance abuse problems as students. For some, their chemical dependency problems actually began in nursing school. Substance abuse among nursing students is a major issue as it can place vulnerable patients at risk, as well as compromise the integrity of the learning environment.

Nursing students are at high risk for developing substance abuse behaviors due to the inordinate levels of stress, burn-out, and the high demands of nursing school. Personal risk factors for the development of chemical dependency include a history of substance abuse within the family (especially parental alcoholism and drug abuse), abuse or victimization as a child, depressive and other mental illness, sexual trauma, and an extensive medical history.

Students with substance abuse problems typically exhibit a pattern of observable objective behaviors that the vigilant nursing instructor must be able to recognize. These behavioral "red flags" include the following:

  • Frequently being absent or tardy
  • Late assignments accompanied by a peculiar or improbable excuse
  • Avoiding peers, faculty, or group work
  • Unsafe performance in the clinical area
  • Poor judgment in the clinical area
  • Frequently leaving the clinical area
  • Deteriorating class and clinical performance
  • Smell of alcohol or marijuana (may be masked by breath mints or febreze spray)
  • Slurred speech, sleepiness, nervousness, excessive giddiness or talkativeness
  • Red eyes and inappropriate use of sunglasses (such as in a dark classroom setting)

Surprisingly, students with substance abuse issues are often academically in the top third of their class and many hold advanced degrees.

if a student is suspected of having a substance abuse problem, the nurse educator needs to carefully review the nursing school's policies and procedures. Meticulous documentation of the suspect behaviors and prompt reporting to the proper channel of authority is critical. The student should be required to leave the clinical site area, as patient safety is always paramount. if permissible under the school's policy, a drug screen should be obtained following official protocols, for objective evidence. The student should also be referred for substance abuse counseling and treatment.

Primary and secondary prevention strategies for substance abuse among nursing students include social support, the availability of counseling, encouraging dialogue, teaching methods to successfully manage stress, and peer-student-faculty activities. A safe, supportive environment for student "whistle-blowers" should also be encouraged.

References

Clark, c. m. (1999). substance abuse among nursing students: establishing a comprehensive policy and procedure for faculty intervention. nurse educator, 24(2), 16-19.

Coleman, e. a., honeycutt, g., ogden, b., mcmillan, d. e., o'sullivan, p. s., light, k., et al. (1997). substance abuse among health care students. journal of professional nursing, 13(1), 28-37.

Monroe, t. (2009). addressing substance abuse among nursing students: development of a prototype alternative to dismissal policy. journal of nursing education, 48(5), 272-278.

Policy and guidelines for prevention and management of substance abuse in the nursing education community

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VickyRN

About VickyRN, MSN, DNP, RN

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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Specializes in Cardiac step down unit.

This is a phenominal article! I have a family history of alcoholism. It never in a million years crossed my mind that I would add myself to that history. I never/rarely drank, until I started nursing school. I am blessed that I never drank during school/clinicals, and it did not affect my grades, however; just before my final exam during my second semester, I took an incomplete and checked myself into IOP treatment. I am happy to say that I am 1 year and 7 months sober, and will graduate with my ADN in May.

Thank you so much for this article. It means so much to read something so close to my heart, and if even one person out there benefits from it, it is worth it. :yeah:

Kelly

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Wow, that is a sobering article. So oddly different from my experience. The only substance my hard-working nursing class is abusing is COFFEE!!!

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Specializes in ER.
Wow, that is a sobering article. So oddly different from my experience. The only substance my hard-working nursing class is abusing is COFFEE!!!

You wouldn't believe what your hard working nursing class is abusing behind closed doors.

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Specializes in Gerontological, cardiac, med-surg, peds.
You wouldn't believe what your hard working nursing class is abusing behind closed doors.

Very true.

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Specializes in Gerontological, cardiac, med-surg, peds.
This is a phenominal article! I have a family history of alcoholism. It never in a million years crossed my mind that I would add myself to that history. I never/rarely drank, until I started nursing school. I am blessed that I never drank during school/clinicals, and it did not affect my grades, however; just before my final exam during my second semester, I took an incomplete and checked myself into IOP treatment. I am happy to say that I am 1 year and 7 months sober, and will graduate with my ADN in May.

Thank you so much for this article. It means so much to read something so close to my heart, and if even one person out there benefits from it, it is worth it. :yeah:

Kelly

Congratulations, Kelly. May you have a long and prosperous career as a nurse! :)

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Specializes in Nephrology, Cardiology, ER, ICU.

You are so right. I personally have been involved (unknowingly) with a nurse that was diverting meds so it is very sobering.

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Specializes in Hospice / Ambulatory Clinic.

When I was in nursing school I picked up a classmate for clinicals and she jumps into my car with a plastic cup full of wine. I was floored I didn't know what to say. I reported her and nothing happened directly. She showed up several times drunk to class but left as the teacher was approaching her to check her out. Eventually they just dealt with it buy kicking her out after she failed a module rather than letting her repeat.

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wow, this article really hit home for me. i wish...could of only wished someone would of caught me in nursing school and smacked me down. would of prevented so much grief later on. But ya know what they say...each one has to go thier own path. Like the article said, some of us were very academically prepared, which i was. caught up to me later in my nursing career and crashed burned hard. Just now coming out the other side of treatment, recovery, reinstatement, and got a whole lot of gratitude...that i made it.

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Hello,

This article is relevant to me and I would value any input on my situation. I am 25 and have a BA in Geography. Lately, I have been considering going back to school to obtain the pre-requisites necessary to become a nurse. However, I am also struggling with occasional binge drinking and excessive marijuana use. I have been hospitalized twice before, once when I was 17 - more for being suicidal than substance abuse, and once when was 21 for substance abuse. After this second hopitalization I was completely sober for almost 1 year. I just started seeing a therapist again and am considering hospitalization to stabilize myself and become more functionable and ultimately stay sober forever. It would be over a year and a half, maybe more like 2.5 before even being accepted into a nursing program because of the need to take pre-reqs, etc. But I am worried that a hospitalization for substance abuse when I am 25 would jeopardize my chances in the nursing field when I would be looking for a nursing job in 5 years or so, or any entry level job in the healthcare field which hopefully I could get prior to becoming a nurse. When I was 17 I was diagnosed with PTSD after a car accident for which I was charged with negligent homicide but all the charges were dismissed and I have one count of wreckless driving (not a felony) and 2 minor in possessions of alcohol. I don't know if these would show up on a background check or not, but if I am able to sober up and decided to pursue nursing, I am just afraid that a 3rd hospitalization will be one too many and prevent me from entering the field. When you interview for nursing jobs, apply to the board, etc. are you required to divulge all hospitalizations?

I also have a really hard time lying because it makes me feel horrible. Essentially I am just wondering if I can / do sober up would I still have a shot as a nurse or is it futile to even think about this as a future option? If I had been sober for a significant amount of time I wouldn't have a problem disclosing my addiction, but I am afraid that the fact that its there may be a reason for me to forget any type of nurisng career.

Thanks so much for any comments / suggestions.

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Specializes in Med Surg, Ortho.
Hello,

When you interview for nursing jobs, apply to the board, etc. are you required to divulge all hospitalizations?

I also have a really hard time lying because it makes me feel horrible. Essentially I am just wondering if I can / do sober up would I still have a shot as a nurse or is it futile to even think about this as a future option? If I had been sober for a significant amount of time I wouldn't have a problem disclosing my addiction, but I am afraid that the fact that its there may be a reason for me to forget any type of nurisng career.

Thanks so much for any comments / suggestions.

In the state of TX, the nursing student/graduate must petition the Board of Nursing if there are any arrests, you may only exclude misdemeanor Class C traffic violations. This process is called a "Declaratory Order", and must be completed before one can be approved to sit for the NCLEX examination. Any misdemeanor, felony, DWI, etc must be reported to the board, whether you've been convicted or not; the key term here is 'arrested.' If it's not reported on your application, you can be sure that it will show up on the FBI background check. You can not lie to the board of nursing, they will find you out.

Going through this process is advised before one even starts nursing school. Depending on the severity of the criminal record, a nursing student could go all the way through nursing school only to be turned down when it's time for licensure. I knew of some one at my school that went all the way through the nursing program and didn't petition the board regarding her arrest record until after graduation, unfortunately, this person did not get approved to sit for the NCLEX. This is why it is extremely important to go through this process before starting nursing school.

You need to look up your states nursing board website and educate yourself with this process. I will also add that when applying, the nursing board will also ask if you have ever been addicted to or received treatment for drugs or alcohol within the last 5 years. This same question also applies to mental illness.

http://www.bne.state.tx.us/exam-eligibility.htm

I knew of some one in nursing school that went through this DO process, he had a couple of arrest records from when he was younger and was approved to sit for the NCLEX. The Nursing Board looks at each case individually. I've heard that certain factors that surround the circumstances, like the age of when you were arrested, the seriousness of the crime, make a difference in whether or not you're approved.

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Specializes in Gerontological, cardiac, med-surg, peds.
wow, this article really hit home for me. i wish...could of only wished someone would of caught me in nursing school and smacked me down. would of prevented so much grief later on. But ya know what they say...each one has to go thier own path. Like the article said, some of us were very academically prepared, which i was. caught up to me later in my nursing career and crashed burned hard. Just now coming out the other side of treatment, recovery, reinstatement, and got a whole lot of gratitude...that i made it.

Wishing you health and wholeness in every way, gr8fulnrs. Thank you for sharing your story with us. So glad you are now coming out into the light at the other side.

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