American Nurses Association endorses position statement on substance use among nurses and nursing students, authored by UMSN professor

Ann Arbor, Mich. -- The American Nurses Association (ANA) has endorsed a joint position statement from the Emergency Nurses Association (ENA) and the International Nurses Society on Addictions (IntNSA) that encourages a focus on prevention, treatment and recovery for nurses and nursing students with substance use and related disorders, as opposed to punishment.

ANA represents the interests of more than 3.6 million registered nurses in the United States. Its endorsement signals significant potential for changes in national policy and practice in the treatment of nurses with substance use disorders.

Stephen Strobbe, PhD, RN, PMHCNS-BC, CARN-AP, FIAAN, president of IntNSA, authored the position statement with ENA’s Melanie Crowley, MSN, RN, CEN. Dr. Strobbe is a Clinical Associate Professor at the University of Michigan School of Nursing, and Department of Psychiatry, as well as a member of U-M’s Institute for Healthcare Policy and Innovation.

“Patient safety is of paramount importance,” said Strobbe. “One of the best ways to achieve this is through effective prevention, intervention, treatment and recovery, and professional monitoring programs for nurses and nursing students with substance use disorders." 

He added, “Nurses and nursing students are not expendable commodities, and they deserve an opportunity to benefit from these highly successful, evidence-based treatments.”

Nurses are consistently rated by the public as the most trusted profession in the United States, yet they experience substance use disorders at rates similar to the general public. If left untreated, these disorders can lead to serious consequences and place patients, colleagues, and nurses themselves at risk for injury, illness and death.

In contrast, when treated as a chronic medical illness, outcomes for substance use disorders are similar to those of other chronic diseases—such as asthma or diabetes—resulting in lasting benefits. 

Current forms of discipline may include a license revocation and legal proceedings which often result in the loss of the nurse’s livelihood, health insurance and access to treatment. The ENA/IntNSA position statement encourages health care facilities and schools to adopt alternative-to-discipline approaches that focus on retention and rehabilitation.

The statement supports ongoing methods to promote long-term recovery such as therapy, mandatory support group meetings and random drug testing. These methods are in used in certain areas, but vary greatly from state to state and are not always compulsory.

For example, the State of Michigan uses the voluntary Michigan Health Professional Recovery Program (HPRP). It offers healthcare professionals a structured and confidential monitoring process, which creates a safe and supportive environment for early recovery while protecting the public safety. However, nurses and employers may or may not take advantage of this resource.

Nursing students are specifically included in the statement to ensure that those with substance use disorders receive the education and support necessary to initiate and sustain a path to recovery and safe entry into the profession. The statement also encourages increased education on risks, drug diversion (transfer of medications for illicit use) and the means to report concerns.

At UMSN, Dr. Strobbe regularly conducts clinical simulations with senior undergraduate nursing students as part of their Leadership and Management course. After assessing student attitudes related to alcohol and other drug use by health care professionals, and learning about drug diversion, students create and participate in role plays as employees with a possible substance use disorder, concerned coworkers and supervisors. Finally, students work together to design a safe and effective return-to-work monitoring agreement, consistent with the alternative-to-discipline approach used by the Michigan Health Professional Recovery Program (HPRP). 

The statement will be published in the upcoming issues of the Journal of Emergency Nursing and the Journal of Addictions Nursing, published by Wolters Kluwer. In addition, the ANA plans to distribute the statement to all state boards of nursing, colleges of nursing and other professional organizations.