Impairments In Students with Substance Abuse and Role of Faculty In Nursing Education

Substance Abuse and Role of Faculty In Nursing Role of Faculty in Nursing Education: Impairments in Students with Substance Abuse

Nursing Students with Substance Abuse

Determining the exact number of nursing students impaired by drug or alcohol use is difficult. However, substance abuse is prevalent among college students. According to the 2012 National Survey on Drug Use and Health, 22% of college students aged 18-22 had used illicit drugs within the past month (Substance Abuse and Mental Health Services Administration, 2013). Additionally, 39.5% of people aged 18-25 reported binge drinking at least once in the last month, where binge drinking is defined as consuming five or more drinks at one time.

Studies confirm the extent of substance abuse among college students. The college environment often provides easy access to alcohol and drugs, including prescription stimulants like methylphenidate (Ritalin). A longitudinal study by Garnier Dykstra et al. (2012) followed 1,253 students over four years, focusing on nonmedical use of stimulants. By the fourth year, 61.8% of students had been offered stimulants, and 45.8% had used them for nonmedical purposes. The authors noted a strong correlation between stimulant misuse and lower grade point averages.

Nursing students, like their peers, face academic pressures, but also endure additional stressors. Nursing programs often have strict retention and dismissal policies, adding to the stress of dealing with patients facing complex health issues. Graduate students are also not immune to substance abuse. Bozimowski et al. (2014) studied nurse anesthesia students over a five-year period, finding that 16 out of 2,439 students had substance abuse issues, with opioids being the most commonly abused drugs. Several programs conducted drug testing for cause, and seven conducted random drug screenings throughout the program.

Characteristics of Students with Chemical and Alcohol Impairments

The potential for substance abuse exists among nursing students and, if not addressed, may affect their future professional practice. In a study by Monroe et al. (2013), 0.51% of employed nurses were estimated to have a substance use problem based on data from substance abuse monitoring programs and disciplinary actions.

Faculty play a crucial role in identifying substance abuse in students and ensuring they receive appropriate support before these issues persist into their careers. Hensel, Middleton, and Engs (2014) investigated the relationship between professional identity and drinking patterns among undergraduate nursing students. Of 333 students surveyed, 33% were classified as heavy drinkers (more than 7 drinks per week for women and 14 for men). A significant, albeit weak, relationship was found between total weekly alcohol consumption and negative self-concept.

Faculty must be attentive to warning signs of substance abuse in students, which may include slurred speech, the smell of alcohol, constricted pupils, frequent absences, sleeping in class, and poor hygiene. Other behavioral changes may include dramatic shifts in dress and convoluted excuses for poor performance (Cotter & Glasgow, 2012).

Faculty Responsibilities Related to Students with Impairments

If faculty members suspect a student of substance abuse, they have ethical responsibilities toward both the student and their patients. They must not ignore or excuse suspicious behavior. Although the Americans with Disabilities Act (ADA) considers substance abuse a disability, unsafe clinical practice is not protected under the law (Menendez, 2010).

Mandatory drug testing has become more widespread, often due to clinical agency requirements. Cotter and Glasgow (2012) discussed the legal and ethical implications of mandatory drug testing in nursing programs. Faculty have a responsibility to ensure students provide safe patient care, which includes monitoring for signs of substance abuse. However, privacy concerns arise regarding who has the right to know if a student tests positive for substance abuse. Policies should clearly define the rights of all parties, including students, faculty, administrators, and patients.

If a student is suspected of chemical dependency, faculty need to follow their institution’s policies and procedures carefully. Behavior must be documented, and any immediate action—such as removing a student from a clinical setting due to impairment—should be taken to protect patient safety. If the student does not pose an immediate danger but substance abuse is suspected, faculty should arrange a meeting to address the issue. A second person, such as an administrator, should be present to ensure the student receives due process.

Institutions should have clearly written policies about substance abuse, including definitions of chemical dependency and expectations for student and faculty behavior. These policies should be stated in the student handbook. Adhering to these policies protects the student’s right to due process and shields faculty from potential legal action.

The National Student Nurses Association (2009) supports policies promoting treatment and rehabilitation for students with substance abuse problems. The National Council of State Boards of Nursing (NCSBN, 2011) has also implemented an “alternative to discipline” policy model, which includes student nurses. However, not all states extend this policy to students, meaning that some schools have developed their own intervention programs to help impaired students.

Key considerations for these programs include:

Ensuring confidentiality for students who seek help.
Clarifying the responsibilities of faculty, students, and administrators.
Orienting students to the purpose of the program.

Random Drug Testing in Nursing Schools

The question of whether schools should implement random drug testing policies remains controversial. While random testing is common among athletes and some employers, the extent to which nursing students are subject to this type of screening varies. Some schools have implemented random drug testing policies in response to clinical agency requirements, particularly if substance abuse is suspected. However, more research is needed to determine the prevalence of drug screening policies in nursing programs.

Many colleges and universities have increased student awareness of substance abuse through educational programs. For instance, Cadiz et al. (2012) designed a seminar for students aimed at raising awareness about impaired practice. The seminar covered the school’s substance abuse policies and the importance of confidentiality. The results showed that students’ confidence in intervening with peers increased, though the stigma associated with substance abuse did not diminish significantly, likely due to the short length of the seminar.

Cadiz et al. recommended that wellness programs with drug abuse prevention strategies be further studied and expanded to prevent substance abuse among nursing students, a recommendation aligned with the NCSBN’s guidelines.

Conclusion

Faculty in nursing education have a critical role in identifying, addressing, and supporting students with substance abuse issues. By understanding the signs of substance abuse, adhering to institutional policies, and promoting awareness programs, faculty can help students receive the support they need before their impairment affects their professional practice. Establishing clear policies around substance abuse and maintaining a balance between confidentiality and accountability is essential to protect students, patients, and faculty alike.