Impairment prevalence in
health care workers and nurses

Impairment in the workplace may involve: a) Substance use disorder (SUD), i.e., illicit drugs, prescription medicines, or alcohol, b) diminished or dangerous physical condition, and c) mental health issues. The impairment may be temporary, chronic, or escalating.

Substance use disorder

A diagnosis of SUD is based on evidence of the following four factors;

• impaired control
  
• social impairment
  
• risky use
  
• pharmacological criteria.

These findings result in alcohol and drugs causing failure to meet primary responsibilities at work, school, or home (APA, 2015).

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 4.4% of health care workers engage in the heavy drinking of alcohol, and 5.5% use illicit substances (SAMHSA, 2014). Unfortunately, there are no definitive statistics on the use of drugs and alcohol amongst nurses.

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 4.4% of health care workers engage in the heavy drinking of alcohol, and 5.5% use illicit substances (SAMHSA, 2014). Unfortunately, there are no definitive statistics on the use of drugs and alcohol amongst nurses.

The American Nurses Association (ANA) estimates 10% of nurses have a substance use disorder roughly equal to the general population cited by the National Institute on Drug Abuse. The American Nurses Association (ANA) reported there were 2,860,000 employed nurses in 2012. If the 10% estimate of SUD nurses is correct, 286,000 nurses will fall in the category of having a SUD issue.

A comprehensive landmark study about substance use (Trinkoff & Storr) was published in 1998 in the American Journal of Public Health. Unfortunately, it has not been replicated recently. The researchers found that in a stratified sample of 4438 registered nurses, 3.6% used illicit drugs, marijuana, cocaine, and 6.6% prescription narcotics or sedatives. 16% engaged in binge drinking, defined as drinking five or more alcoholic drinks in one limited period.

The study also found that emergency nurses were 3.5 times more likely to use marijuana or cocaine than nurses in women's health, pediatrics, and general practice. The nurses working in anesthesia, critical care, oncology, and psychiatry also reported higher drug use (Trinkoff & Storr, 1998).

Nationally, substance abuse in the general population varies from state to state. Since the rate of substance abuse in the nursing profession is reflective of the general population, the rate of use by nurses will also vary from state to state. Here are the statistics on U.S. states from the most significant incidence of drug use to the smallest from ages 26 and older described by SAMHSA in 2018 and 2019.

This report is based on data from 67,791 completed interviews from 2018 NSDUH respondents aged 12 or older.

See other maps with state data about specific drug use.
https://www.samhsa.gov/data/sites/default/files/reports/
rpt32803/2019NSDUHsaeMaps/2019NSDUHsaeMaps/
2019NSDUHsaeMaps.pdf

The prevalence reported for disciplinary action

Zhong (2016) reports substance abuse as the most common reason for disciplinary action against a nurse by state boards.

Data from the 2010 National Council of State Boards of Nursing (NCSBN) disciplinary programs reported an average of 128 nurses (total of 6400 plus) from each State Board of Nurses were disciplined for substance use issues in one year (Monroe et al., 2013).

For example, 53% of disciplinary actions taken by the Mississippi Board of Nursing in April 2017 were drug-related. 33% of the Nevada State Board of Nursing corrective actions, from February 6, 2017, through April 5, 2017, were drug-related.

Mumba et al. (2019) reported that from 2010 to 2016, 1,553 nurses were referred to the Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. The average age of participants was 40.1 years. The majority of the nurses obtained drugs, primarily opioids diverting them from patients. Alcohol and stimulants were used by the nurses leading to impairment.

According to the bureau of labor, in 2020, there were 183,130 registered nurses employed in Florida. Given the estimate that 10% of these R.N.s had a substance abuse problem, that means 18,000 should be reported. Check the number of nurses in your state! https://www.bls.gov/oes/current/oes291141.htm

A review of the complaints about registered nurses to the Florida Board of Nursing, only some of which were for substance abuse, showed there were slightly less than 600 registered nurses discussed for disciplinary hearing (some names were brought up more than once) in 2018, 580 in 219, and 660 in 2020. An increase possibly from the stress caused by the pandemic. https://mqa-internet.doh.state.fl.us/MQASearchServices/EnforcementActionsPractitioner/

Collectively the Boards of Nursing are only monitoring or disciplining about .02% of the ANA estimated 320,000 impaired nurses. It is unlikely that the vast majority of the remaining 99.08% of SUD impaired nurses are enrolled in private and confidential treatment programs. Substance use disorder amongst nurses is an underreported and undertreated problem in the U.S.

Impact of COVID-19

CDC reported as of June 2020, 13% of Americans increased or started substance use to cope with stress from COVID-19. The incidence of substance abuse is predicted to be higher than the typical 10% in nursing. Here are the conclusions from a report on mental health, substance use, and suicidal ideation based on data collected in June 2020 (Czeisler et al., 2020).

Adults in the United States reported elevated levels of adverse mental health conditions, substance use, and suicidal ideation in the United States in June 2020. The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%)

References

Czeisler, M.É ., Lane, R.I., Petrosky, E. et al. (2020). Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States. MMWR Morb Mortal Wkly Rep 69,1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.

Mumba, M. N., Baxley, S. M., Snow, D. E. & Cipher, D J. (2019). Retrospective Descriptive Study of Nurses With Substance Use Disorders in Texas, Journal of Addictions Nursing: 30(2), 78-86.

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Zhong, E., Mccarthy, C. F. & Alexander, M. (2016).A Review of Criminal Convictions Among Nurses 2012–2013. Journal of Nursing Regulation. 7(1), 27-33.