I never dreamed I would be an impaired nurse. There have been times over my twenty-year nursing career I would think "how could that nurse ever come to work altered?" But I did clock in to work impaired and another nurse was faced with the dilemma of "if" and "how" to confront me, Nurse Jane. The disease of addiction knows no bounds when it comes to who it affects - regardless of age, race, sex, financial status and even occupation. If you are like me, you too have had in-services and possibly CEUs on the issue of substance abuse among nurses. I would like to share parts of my lived experience to hopefully bring new insight to previous training. The American Nurses Association (ANA) estimates the prevalence of addiction among nurses is consistent with the U.S. population at ten percent. The stigma of addiction as moral failure instead of a disease flows against the high moral and ethical standard set for nurses. As a person, I felt unbearable shame and guilt and feared losing my family. As a healthcare professional, my disease progressed to a point I unethically continued to practice and place patients at risk. I think many of us could identify at least 5-10 signs of impairment caused by a chemical substance in the workplace. As an alcoholic (I will focus on alcoholism), most of my signs were caused by withdrawal. As my drinking progressed, evidence of my alcoholism became more noticeable. It is easy to read a list of signs, but I would like to share the experience behind the behavior. Arriving late, leaving work early or calling out sick I used to never call out sick and would just "work through it". As my drinking progressed, so did my tardiness and absence from work. It is easy to assume I was out all night on a bender and I just did not want to stop the party for work. In reality, I would drink in isolation on my days off and when I would sober up for work- withdrawal kicked in. Early in my alcoholism, I would be nauseated with diarrhea. Getting ready for work in the morning was miserable and once I made it to work, I spent a lot of time in the bathroom. Some days, I came up with an excuse to leave early. As my disease progressed, I had profound nausea, loss of balance, difficulty concentrating and withdrawal so severe, only more alcohol could ease the physical suffering. Unkempt physical appearance Initially, I had fine hand tremors in the mornings and because of sickness, spent little time getting ready for work. I was always red-faced, flushed and sweating. Again, my appearance was symptoms of withdrawal. I was quick with an explanation for my embarrassing appearance- hormones, taking steroids, medication causing sweating. I no longer cared enough to maintain my usual professional appearance. Declining work performance It is actually difficult at times to type this article. I had always taken pride in my work performance and the care I provided. I had worked hard over my twenty-year nursing career to obtain my BSN, MSN degree and 60 hours into a doctorate program. My job as a nursing instructor was one of my most rewarding career tracks, but the disease steered me away from what I valued most. Initially, I would be slow to document, forget documentation details and difficulty concentrating. I became easily emotional, tearful and frequently had labile mood swings while working. Withdrawal caused my thinking to be less clear and slowed. I am sure my co-workers noticed I was struggling and conversations took place to hypothesize what was going on with me. My peers may have thought I couldn't get any worse, but I could, and this is the progressive nature of addiction. I look forward to sharing what lead up to a co-worker confronting me, Nurse Jane, in the next Confronting Jane article. Would you like more information on substance abuse in the nursing profession? Drug addiction among nurses: Confronting a quiet epidemic | Modern medicine Nursing Continuing Education- Addressing Chemically Dependent Colleagues, available at https://www.ncsbn.org/Addressing_Chemically_Dependent.pdf