BARRIERS TO EARLY IDENTIFICATION AND TREATMENT

There are many barriers that prevent impaired nurses from seeking help. Rarely do they seek help on their own because of fear, embarrassment, and concerns over losing their nursing license (Cares et al., 2015). Nurses also often lack knowledge about SUD as a chronic progressive disease, and they may have limited knowledge about treatment and the process for obtaining help and advocacy. Likewise, nursing colleagues face similar barriers, and they are often reluctant to report suspected impairment.

Reluctance to Seek Help

Nurses avoid seeking help for a number of reasons:

Denial is the chief characteristic of substance use disorder. It is a psychological defense mechanism that tells the nurse “I’m okay” even when disruptions in family, personal health, and social life are evident. Nurses with a substance use disorder have difficulty seeking help because they deny they have a problem or hold on to the false belief that they can “stop using” on their own.

While SUD is acknowledged as a chronic disease that can be identified and successfully treated, this does not eliminate the social stigma surrounding it, which may be even more pronounced in the nursing profession. Concern for being labeled an “addict” prevents nurses who need help from seeking help, and stereotypes, prejudice, and discrimination reduce opportunities for assistance and for re-entry.

Nurses often lack knowledge about the signs and symptoms of SUD. Many do not recognize SUD as a disease, and when they are afflicted, they believe they can stop on their own. They may also be unaware of alternative-to-discipline programs and treatment options, which contributes to their unwillingness to reach out for help.

Nurses who are afflicted fear losing their job and their license to practice as a nurse. They may also fear criminal prosecution or may have concerns about decreased employment opportunities once a diagnosis is made.

Reluctance to Report

Signs and symptoms of impairment in the workplace are often subtle, making it very difficult to differentiate them from stress-related behaviors. Colleagues and supervisors can easily “explain away” behaviors that are consistent with impairment in the workplace, often making early recognition and intervention dangerously delayed.

Negative attitudes and beliefs about addiction also prevent nurses from intervening. Many nurses still believe addiction is a moral issue rather than a primary disease that requires intervention and treatment. Some nurses hold on to stereotypes about what a typical “addict” looks like, making it easy to deny the existence of such a problem in the healthcare setting.

Nurses often lack knowledge about SUD as a primary disease with signs and symptoms that can be identified and treated. They may not know risk factors, signs that are identifiable in the workplace, or the resources available and steps to take to properly report or refer a colleague.

There are many other reasons why peers are reluctant to report suspected impairment, including:

• Uncertainty about reporting requirements
• Uncertainty of consequences to their peer, such as loss of license and job
• Concern about retaliation by peer
• Fear of social stigma of reporting a peer
• Not being 100% sure