Registered Nurses’ Awareness of Workplace Signs, Actions, and Interventions for Nurses With Substance Use Disorder

Alison M. Trinkoff, Jung Min Yoon, Victoria L. Selby, Carla L. Storr, Hephzibah S. Edwin, Hyang Baek

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Nursing practice is highly demanding and has been related to risk of substance use (SU) and SU disorders (SUDs). Despite this, education on registered nurse (RN) SUDs is extremely limited, and this knowledge gap has been related to nurses’ inability to address SU problems among colleagues. Purpose: We assessed whether practicing nurses recognized signs of SUDs, what actions they would take if a colleague had a SUD, and their knowledge of RN SUDs interventions. We examined these findings in relation to demographic and work characteristics. Methods: A mixed modes survey (online, mailed) was conducted between November 2020 and February 2021, with randomly selected RNs in nine states being contacted up to six times. Balanced stratified sampling (balanced to the U.S. RN population), a technique that aims to obtain a nationally representative sample, was used. Measures of potential workplace signs of SUD (seven items), actions one would take (seven items), and attitudes toward RN SUD interventions (10 items) were assessed, and prevalence of these items is described. Logistic regression models were used to assess associations between each item and demographic and work characteristics. Results: Of the 1,215 surveys returned (31% response rate), 1,170 were included in the analyses. Most RNs (82%) correctly selected frequent medication errors, medication wasting, and frequent absences/breaks as potential signs of SU problems, yet only half felt confident in their ability to identify an colleague with a SUD. Although the majority (93%) would tell a supervisor, higher proportions of younger (aged < 45 years) and Asian nurses reported feeling unsure of what to do and were more afraid to get involved with nurse SU problems than older nurses and nurses of other races/ethnicities. Variation in recognition and actions were also found for workplace factors. Charge nurses were more likely to think that nurses with a potential SUD should have their license revoked than those in the reference group (educators/researchers) (adjusted OR = 1.89; 95% CI = 1.03, 3.49). Conclusions: Findings suggest nurses can benefit from clear guidelines and educational initiatives to address RN SU problems. A culture of safety and accountability could help nurses feel more comfortable addressing these issues.

Original languageEnglish
Pages (from-to)20-29
Number of pages10
JournalJournal of Nursing Regulation
Issue number3
StatePublished - Oct 2021

Bibliographical note

Funding Information:
This study was supported by the National Council State Boards of Nursing CRE Grant (#R19B07).

Publisher Copyright:
© 2021 National Council of State Boards of Nursing


  • education
  • impairment
  • Nurse substance use
  • safety culture
  • substance use disorder
  • workplace


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