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.
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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.
