Diane, a mother of two, has been a nurse for eight years and has a consistently excellent record of performance at work. She seems to have it all together in both her work and family life. At home, she cares for her 5-year old son, who has Attention Deficit Hyperactivity Disorder (ADHD), and a toddler attending daycare. At night, she works in a nearby hospital. Coworkers and patients have high opinions of Diane, because she always has an energized “Hello!” for everyone, all the way until morning, when everyone else is feeling beat. She also looks underweight, and others speculate it is because she frequently skips her breaks. Everyone was shocked when they learned that her RN license was revoked because she had been abusing Ritalin, a drug prescribed for her son, and which has similar effects to cocaine. Diane’s Ritalin abuse started out for a seemingly harmless reason, to keep her up when her then newborn was sick. However, her drug use spiraled out of control and she started looking for reasons to take the drug. Substance abuse is a huge social problem, and it is present in healthcare as well as the general public. An estimated 10%-15% of all healthcare professionals abuse substances, such as drugs and alcohol, in their lifetime. According to the American Nurses Association, these numbers are also true for nurses, meaning that for every ten nurses, one of them is likely struggling with addiction.Impaired nurses are a danger to themselves, their coworkers, and especially their patients. As an RN yourself, it is your duty to look after patients' safety at all times, so be wary of nurses who may be abusing drugs or alcohol. Remember that these nurses will do their best to conceal their addiction and appear normal, but there will usually be indications that give them away. Be alert for these physical signs of substance abuse:1. Unsteady movement or gait2. Tremors of the hands3. Slurred speech4. Pupil dilation or constriction5. Sudden loss of consciousness6. Rhinorrhea 7. The smell of alcohol, possibly disguised by breath mintsNurses who abuse substances will also exhibit changes in behavior. Behavioral manifestations of substance addiction are usually observed earlier than the physical signs. Changes in behavior may include:1. Frequent tardiness and absenteeism2. Frequent bathroom breaks3. Taking breaks alone, in isolation4. Concealment of needlestick marks by wearing long sleeves5. Unusually high or low energy in doing tasks6. Increased instances of errors7. Lack of focus8. Lying or defensive and aggressive behavior9. Patients reporting little or no improvement in pain, even at higher doses of prescribed narcotics10. Insisting on taking shifts or caring for patients where there is access to prescribed narcotics11. Discrepancies in narcotics counts and signing out of wasted narcoticsWhat should you do if you suspect that a colleague is abusing substances?When you highly suspect that a coworker is abusing substances while rendering patient care, do not condone the behavior. Stop them from performing care procedures, especially if they are about to administer medications. Sometimes, nurses will cover up for their impaired colleague, particularly if they are friends, but this enabling behavior will lead to more harm for the coworker and more danger for patients. Report your observations to the head nurse immediately. Make sure to follow organizational policies regarding reporting nurses who provide care under the influence of illicit substances.