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

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

Nursing Student with Substance Abuse, Characteristics of Students with Chemical and Alcohol Impairments, Faculty Responsibilities Related to Students with Impairments.

Nursing Student with Substance Abuse 

    Determining the number of nursing students who may be impaired by drug or alcohol use is difficult. However, substance abuse has been found in college students. Results of the 2012 National Survey on Drug Use and Health showed that 22% of college students aged 18 through 22 had used illicit drugs in the past month (Substance Abuse and Mental Health Services Administration, 2013). 

    This same survey showed that among persons aged 18 through 25, 39.5% reported binge drinking at least once in the last month. Binge drinking was defined as consuming five or more drinks at one time. Other studies have confirmed the extent of college student substance abuse. 

    The college environment does provide students with easy access to alcohol and drugs, including prescription stimulants, such as methylphenidate (Ritalin), and can expose students to situations in which alcohol and drug use is considered an acceptable activity. A study by Garnier Dykstra, Caldeira, Vincent, O’Grady, and Arria (2012) conducted a longitudinal study of nonmedical use of stimulants such as methylphenidate. 

    The study enrolled 1253 students. Students were followed over a 4-year period. By the fourth year, 61.8% had been offered stimulants and 45.8% had used the stimulants for nonmedical purposes in the year they had been exposed to the drugs. The authors noted that illicit use of drugs was often tied to lower grade point averages.

    All college students experience academic pressures, and nursing students have additional stressors. Often nursing programs have retention and dismissal policies that put pressure on students to do well in their studies. Dealing with patients with a variety of complex health problems adds additional stress. 

    Graduate students also have substance abuse problems. For example, Bozimowski, Groh, Rouen, and Dosch (2014) examined the prevalence of substance abuse in nurse anesthesia students over a 5- year period; 23 out of 111 programs responded to a survey. 

    Of the data reported on 2439 students, 16 students were identified as having a substance abuse problem and opioids were the most commonly abused substance. Of note was the fact that 23 programs had drug testing for cause and 7 conducted random drug screenings throughout the program.

Characteristics of Students with Chemical and Alcohol Impairments

    The potential for substance abuse obviously exists among nursing students. Substance abuse, if not dealt with, can affect a student’s professional practice after graduation. Monroe, Kenaga, Dietrich, Carter, and Cowan (2013) estimated the number of practicing nurses who had been enrolled in a substance abuse monitoring program during a 1-year period. 

    Using survey data from boards of nursing disciplinary actions, reports of alternatives to discipline programs, and the 2009 National Sample Survey of Registered Nurses, they demonstrated that nationwide 0.51% of employed nurses appeared to have a substance use problem. 

    To help students deal with potential substance abuse problems that could persist after graduation, faculty need to have an understanding of this issue so they can assist students in receiving the appropriate professional support. Hensel, Middleton, and Engs (2014) investigated the relationship between professional identity, defined as “selfconcept,” and drinking patterns in undergraduate nursing students. 

    The survey included 333 students across all 4 years of a baccalaureate nursing program. Of these, 33% of the students were classified as heavy drinkers, or more than 7 drinks per week for women and 14 drinks per week for men. Lower grades caused by drinking occurred in 5.1% of the sample. 

    A statistically significant relationship was found between total weekly alcohol consumption and negative general self concept, but the relationship was weak. Faculty also have a responsibility to ensure that students deliver safe patient care, which includes protecting clients from the actions of a potentially unsafe student whose clinical performance has been compromised. 

    Faculty should be aware of the characteristics of students who may be chemically dependent, knowledgeable about the policies and procedures within their institution that relate to students who are chemically dependent, and familiar with the support services that are available to students who have a chemical dependency problem. 

    Common signs of substance abuse include slurred speech, smell of alcohol, constricted pupils, sleeping during class, and frequent absences or tardiness. Other signs could include change in dress and convoluted excuses for behavior (Cotter & Glasgow, 2012).

Faculty Responsibilities Related to Students with Impairments

    What are the responsibilities of faculty if they suspect that a student is displaying characteristics that are indicative of chemical dependency? Faculty have ethical responsibilities toward the student and the student’s patients and therefore should not ignore or make excuses for such behavior. 

    While the ADA considers substance abuse a disability, unsafe clinical practice is not protected under the law (Menendez, 2010). Mandatory drug testing of nursing students has become more widespread, probably in response to clinical agency requirements. Cotter and Glasgow (2012) discussed the legal and ethical implications of mandatory drug testing. 

    They noted that faculty have the responsibility for seeing that students give safe care. Therefore monitoring for signs of substance abuse is a must. What is not clear is who has the right to know whether a student has tested positive for substance abuse. According to Cotter and Glasgow (2012) policies should be established that protect the rights of all involved, including students, faculty, administrators, and patients. 

    For example, policies need to address whether students can be dismissed from the nursing program for substance abuse. Before taking any measures, faculty need to clearly understand the policies and procedures for assisting chemically dependent students that are in place within their institution. 

    Behavior must be documented and written policies followed (Cotter & Glasgow, 2012). A faculty member might have to take immediate action if, for example, a student appears impaired in the clinical area, and remove the student from the clinical setting. 

    In cases in which the student does not impose an immediate danger to clients but is suspected of substance abuse, an appointment might be made with the student for the purpose of taking appropriate action. In addition to the faculty, a second person such as an administrator should be present to ensure that the student is dealt with according to policy and due process is not denied.

    Written policies about chemical impairment that include the institution’s definition of chemical dependency, the nursing faculty’s philosophy on chemical dependency, and student and faculty responsibilities related to suspected chemical dependency should be clearly stated in the student handbook. 

    Furthermore, adhering to the institution’s established policies helps ensure that the student’s right to due process is not denied and protects faculty from possible legal action by the student. The National Student Nurses Association (2009) supports policies that promote treatment and rehabilitation for students with substance abuse problems. 

    In addition, the National Council of State Boards of Nursing (2011) “alternative to discipline policy” model includes student nurses. However, not all states include students in their programs for helping nurses with substance abuse. 

    Some schools of nursing have formulated their own intervention program for nursing students who are impaired. The following are key considerations: 

(1) ensuring the confidentiality of students who access the program

(2) clarifying the responsibilities of individuals associated with the program (i.e., faculty, students, administrators, alumni, counselors, and substance abuse professionals)

(3) orienting the student population to the purpose, activities, and responsibilities of the program (Monroe, 2009). 

    Whether a school should institute a policy for random drug testing is controversial. Although athletes are subject to random testing and most agencies have preemployment drug screening, the extent to which nursing students are required to undergo random screening is unknown. 

    Although schools may not have policies requiring drug testing, students should be made aware that clinical agency policies may require blood or urine testing of individuals, including students, suspected of chemical dependency or as a requirement for engaging in clinical experiences within the agency. 

    Nevertheless, some schools are instituting policies for drug screening prior to admission because of clinical agency requirements, and schools will require a drug screen if chemical impairment is suspected. Much more research is needed to determine the extent and nature of drug screening policies within nursing programs.

    Many colleges and universities are attempting to deal with this problem by increasing student awareness of the effects of substance abuse through campus educational programming. Bozimowski et al. (2014) recommended that studies be done to evaluate wellness programs that include drug abuse prevention strategies. 

    One such study was conducted by Cadiz, O’Neill, Butell, Epeneter, and Basin (2012), in which they designed a seminar for students to promote awareness of impaired practice. The seminar included content on the school’s substance abuse policy and how confidentiality should be maintained so the stigma of seeking help could be reduced. 

    Pretest and posttest comparisons demonstrated that seminar participants’ perceived ability to intervene with students who had substance abuse problems increased. The rating of stigma associated with substance abuse did not increase following the seminar possibly because the seminar was only 2 hours long. 

    Cadiz et al. (2012) suggested that this type of seminar has potential for preventing substance abuse among nursing students and is in line with the recommendations from the National Council of State Boards of Nursing (2011).