1. Ethical Dilemma: Substance Abuse Among Nurses
NURS 362: Cody Gibo
Sylvia Lee
Meagan Kubo
Janalynn Rollins

2. Introduction - The Issue -
-Substance abuse is high among nurses.
-Stealing patients’ medications
-Approximately 10% of the nursing
population has alcohol or drug abuse
problems.
-The American Nurse Association (ANA)
estimates approximately 6% to 8% of
nurses has problems serious enough to
interfere with their ability to practice.
Substance
abuse

3. Introduction - Why? - Burnout Occupational
-Nursing jobs are stressful and can
be isolating.
-Some nurses turn to substance
abuse in an attempt to cope.
-The availability and accessibility
of medications also has been
linked.
Burnout
Occupational

4. Introduction - The Issue -
-Nurses who divert drugs pose significant
threats to patient safety, but also become
a liability to healthcare organizations and
the nursing departments where the
the diversion occurred.
-Nurses are morally obliged to report
colleagues suspected of stealing drugs at
work, but only 37 % of nurses actually
report because of “negative stigma.”
-Fear of retribution, creating problems in
the work environment, or being labeled as
a whistle-blower, which can be an obstacle.
-Friendships also can be an obstacle.

5. Signs and Symptoms Patient safety may be compromised
Signs and symptoms may often be subtle, but if left unrecognized,
Patient safety may be compromised
-Increased absenteeism.
-Frequent disappearances from the
department or unit.
-Excessive amounts of time spent in
medication rooms or near medication carts.
-Work performance that alternates
between high and low productivity.
-Inattention or poor judgement.
PATIENT SAFETY
NURSING PRIORITY

6. The goal is to protect the patient,
FYI
-Nurses in the past has “Throwaway Nurse
Syndrome,” which was to punish their colleagues
who violated the rules, including those with and
addiction and steal meds from patients.
-Addiction was dealt with using harsh discipline.
where nurses lost their jobs and their licenses
-Harsh discipline is not effective for stopping
addiction behavior and is a barrier against
seeing management.
-Now, addiction is seen as a
sickness and treated as such.
The goal is to protect the patient,
Not to punish the nurse

7. Legal -Diversion of drugs is defined as the unlawful
channeling of regulated pharmaceuticals,
including the misuse of prescription
medications.
-Request for confidentiality applies only to
personnel without vested involvement in the
situation.
-Mandatory reporting and disciplinary
actions are required in many states,
and penalty and other proceedings are
dependent on the investigation.

8. Legal addiction is a treatable disease Be aware that drug diversion is
A symptom of the disease of addiction and that
addiction is a treatable disease
-If the nurse executive (NE) fails to disclose the information or resolve the
problem, further legal quandaries could result the NE being accused of
maleficence for failing to protect patients from a potentially unsafe nurse.
-Negligent supervision could be charged.
-The NE has an obligation to ensure nurses provide safe and prudent patient
care and failure to report or resolve the situation would be negligent and
potentially subject the nurse and patients to further harm.

9. Ethical -Nurses have an ethical duty to protect patients,
colleagues, the profession, and community.
-This ethical responsibility extends to nursing
leaders and executives to report an impaired
professional and ensure he/she receives the
appropriate treatment.
-More than 39 states have developed programs
to promote treatment and rehabilitation of
impaired or addicted nurses.
-Nurse diversion programs are critical for the
profession and healthcare organizations must
ensure nurses are treated, and a safe return to
the workplace is facilitated.

10. Ethical Lower -The ANA supports alternative-to-discipline programs.
-The ANA’s Code of Ethics additionally advocates for the promotion
of nurses’ well-being and rehabilitation to preserve the nursing
workforce and the profession.
-Drug diversion in a nursing department affects not only the
involved employ and organization, but also the employees within
the department.
-The NE can facilitate the grief process brought on by the diversion
to peers of the impaired employee who could be suffering from
betrayal, anger, guilt, and loneliness.
Research has shown that relapse rates by nurses from
diversion and rehabilitation programs are when compared
Lower
with the general population

11. Treatment -Nurses in rehab for addiction may be enrolled
in a long term program.
-The program will monitor their progress
through rehab and identify early signs of relapse.
-Nurses can be visited when they return to work
to monitor attendance or subject to random
drug tests – This can last for 5 years.
-The aftercare programs have been recommended
by the American Nurses Association,
the International Nurses Society on Addiction, and
the National Council of State Boards of Nursing.

12. American nurses association States that
“the nurses promotes, advocates
For, and strives to protect the
Health, safety, and rights
Of the patient.”

13. References
American Nurses Association (2015). Code of ethics for nurses with interpretive
statements. Retrieved from
Kunyk, D. & Austin, W. (2010). Nursing under the influence: A relational ethics
perspective. Nursing Ethics, 19(3),
doi: /
Talbert, J. J. (2009). Substance abuse among nurses. Clinical Journal of
Oncology Nursing, 13(1), doi: /09.CJON.17-19
Tanga, H. Y. (2011). Nurse drug diversion and nursing leader’s responsibilities:
Legal, regulatory, ethical, humanistic, and practical considerations.
JONA’s Healthcare Law, Ethics, and Regulation, 13(1),