Impaired Nurse Assignment Guideline

This article covers impairment caused by drug and substance abuse in nurses. The article was authored by two nursing assistant professors from Ball State University in Muncie Indiana. According to the authors of this article, drug and substance abuse in nurses is a complicated matter. This is because nurses have better and sometimes unlimited access to some of these drugs (Thomas & Siela, 2011). The article poses several questions nurses ought to ask themselves about a coworker’s drug-caused impairment. Throughout the article, examples of nurses’ workplace scenarios are used.

According to the article, nurses should be on the lookout for coworkers whose appearances change drastically. This is because drug and substance abuse is easily manifested in a person’s outward appearance. In addition, nurses should avoid making excuses for colleagues whose personal appearance suddenly changes. The articles then explore the issue of a nurse reporting a coworker he/she suspects of diverting drugs. This is because nurses are always afraid of getting their fellow workers into trouble or the tensions that may arise from such accusations. The article cites alcohol abuse in the workplace as the main indicator of substance abuse in a nurse.

A nurse should be able to point out alcohol-caused impairment in a coworker. The article then lists myths and truths associated with drug and substance abuse impairment. One myth is that impairment can only be caused by street-sourced drugs. According to the authors, even prescription drugs like pain pills may be a source of impairment. The other listed myth is that impairment can only be caused by prolonged drug and substance abuse. The truth is that even a recent traumatic or unpleasant event may trigger impairing drug and substance abuse habits. Several other myths are listed including the one that addiction is voluntary. The truth is that addiction is an involuntary habit that can be triggered by several factors.

The signs of substance abuse in a nurse according to the article include; unexplained absences, mood changes after breaks, frequent errors, isolation, decreasing patient care among others. Physically, one may notice a nurse shaking, watery eyes, dilated pupils, change in grooming, and body weight fluctuations among others. Behavioral changes may include outbursts of anger, defensiveness, lack of concentration, problems in personal relationships, inappropriate laughter among others.

The article suggests closer attention because those who suffer from such problems are good at covering their tracks. In case a nurse notices any of the following signs in a coworker, the article advises against ignorance. It is also suggested that the affected nurse’s duties should not be altered in line with these new behaviors. The one in charge of the nurses should not accept any excuses from possible victims of substance abuse. One should also not be afraid of confrontation and the well-being of patients should be considered.

If it has been established that a nurse is experiencing impairment as a result of drug abuse, the next step is treatment. The article advocates for alternative treatment as opposed to drastic measures such as sacking. All nursing stakeholders should also take part in preventing the vice. After treatment, the affected nurses should be effectively inducted back to work (Baldisseri, 2007). The article concludes by stating that substance and drug abuse comes at a high cost to an individual, family, and friends, as well as the health organizations.


Baldisseri, M. (2007). Impaired healthcare professional. Crit Care Med 35(2), 106-116.

Thomas, C. M. & Siela, D. (2011). The impaired nurse: Would you know what to do if you suspected substance abuse? American Nurse Today, 6(8), 9-11.

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NursingBird. "Impaired Nurse Assignment Guideline." May 4, 2022.