The very real issue of substance-use disorder among nurses isn’t something that gets talked about all that much in nursing schools. A new curriculum created by the University of Minnesota School of Nursing and made available to nursing schools around the state is trying to get that timely conversation started.
It’s almost as though the profession has been avoiding talking about the issue, said Christine Mueller, RN, Ph.D., associate dean of academic programs at the U of M School of Nursing.
“If substance-use disorder gets talked about in nursing programs at all, it is usually very superficial,” she said. “At the University of Minnesota, prior to the development of this curriculum, we had not been intentional about making sure that this was an official part of the conversation. But now we’ve created a way to devote an entire class session or online module to the topic. ”
This focus is important, Mueller added: “At the end of the day, substance use disorder among nurses is a quality and safety issue for patients, and we have a big focus on patient quality and safety in our program.”
With high-stress jobs and access to sometimes-addictive medications, some nurses are at elevated risk of developing substance-use disorder, Mueller said. Though at an estimated 10 percent, the rate of addiction among nurses is no higher than in the general population, the risks of coming to work impaired or diverting patient medication could put lives on the line.
Jace Gilbertson, a senior in the U of M’s BSN program, said that nurses with addiction issues sometimes find themselves in a particularly tough spot. And it’s not something they warn you about in school.
“As nurses, we are right there on the front lines,” Gilbertson said. “When I finish my degree, I’ll be working in an emergency department. That is a chaotic environment where things happen fast and the stress levels are high. In the nursing profession, there is that stigma and shame around the idea of substance use, but by just being a nurse we put ourselves at a higher risk of coping with stress by using medications and alcohol. Being open about that risk could help stop a lot of problems before they get out of hand.”
Designed to respond
The curriculum, which was developed by Mueller and Dina Stewart, a University of Minnesota doctor of nursing practice (DNP) candidate, was “prompted by the fact that there had been some press about nurses who have substance-use disorder and the role of the Board of Nursing plays in this issue,” Mueller explained. “Our school decided to be proactive and work with the Board of Nursing and others to think about what we could do together to address the issue of substance-use disorder in nurses. One very obvious thing that a school of nursing could do is to ensure that our students are knowledgeable about the topic. That’s where our new curriculum came in.”
The curriculum was added to the University’s degree program this semester. Other nursing schools around the state are also in the process of incorporating it into their programs.
The curriculum’s goal, Mueller explained, “is for students to develop an awareness about substance-use disorder in nurses and about the risks that substance use creates.”
Mueller said that she and Stewart designed the module in part to provide answers to common questions that nursing students ask, including “Why are nurses more at risk for substance-use disorder? What can nurses do to mitigate that risk? What can a nurse do if they come in contact with colleagues that have substance-use disorder? How can you recognize the problem? What is your responsibility if you suspect diversion?”
The format worked well for Gilbertson.
“In this module, we learned how to recognize the signs and symptoms of an impaired nurse,” he said. “We learned it is not a punitive thing to report a colleague if you suspect substance use — it is for the benefit of that nurse to help them get he help they need and put the patient first. It puts the integrity of the profession front and center.”
Real risks — and help
The curriculum also provides important information and warnings about the real risks of substance-use disorder for nurses and their patients.
“We try to help students understand the consequences,” Mueller said. “If you come to work impaired, you could lose your job or you may not be able to work until you deal with the problem. If you get to the point where you divert medication, that is a felony, and you can’t practice in this state if you have been convicted of a felony.”
This information hit home with Gilbertson, who sometimes struggles with what he sees as a pressure for perfection within the profession.
The curriculum helps nursing students step away from the myth of the “perfect nurse,” he said: “As nurses we re not immune to suffering from substance-use disorder, even though we are some of the most trusted people in the hospital. As our patients’ advocates, we have to be strong all the time and not show any weakness. Because there is a stigma around substance use and addiction problems, nurses try to hide their addictions. That’s when things can get dangerous.”
The course also includes a recorded interview with University of Minnesota School of Nursing graduate and substance-use disorder advocate Marie Manthey. In the interview, Manthey tells the story of her own struggle with substance use when she was a practicing nurse.
“Marie’s story really brings it home for students,” Mueller said. “She does a great job explaining how substance use can be so insidious in the profession.”
Through Manthey, students also learn about the Nurses Peer Support Network, a program designed to help nurses recover from substance-use disorder and support them in their recovery.
“One of the most important things for new nurses to understand it that substance-use disorder is a disease, not a moral deficit,” Mueller said. “People can recover from this. We try to make that point clear in the curriculum.”
Realizing that it is possible to recover from substance use disorder and continue working in the nursing profession was an important realization for Gilbertson.
“There are steps a nurse can take to be rehabilitated from substance-use disorder,” he said. “It is reassuring as a nurse going into the profession to know that there is a safety net and there are people out there caring for you.”
Part of closing course
At the U of M, the new curriculum is now a required element of the program’s final “Transition to Practice” course. Mueller explained that the placement was intentional, serving as a key introduction to the realities of life as a working nurse — and as a reminder of the importance of being aware of the risks that substance-use disorder creates.
“It made a lot of sense to place it in our curriculum in the last semester or the last year of the program when students are beginning to think about transitioning to practice,” she said.
“I think the curriculum is placed well,” he said. “It’s a good reminder of how we should be taking care of ourselves as we go into the profession of nursing, a good call to action for nurses just entering the workplace, a good opportunity to teach nurses early on that this is a reality that they may face during their careers.”