title: The prevalence of employed nurses identified or enrolled in substance use monitoring programs.
abstract: BACKGROUND
  For over 100 years, nurses' particular work conditions have been anecdotally associated with increases in substance abuse. Reasons include job-related stress and easy access to medications. Current research has suggested that prevalence of nurses with substance use problems is actually similar to, if not less than, that seen in the general population. However, given nurses' proximity to critical patient care, the potential threat to public health, as well as the current shortage of practitioners and problems related to retention, the lack of research on the effectiveness of the two existing treatment protocols (disciplinary and alternative-to-discipline [ATD]) is a pressing issue of concern to the nursing profession.
  
  
  OBJECTIVE
  The aims of this study were to estimate the 1-year prevalence of employed nurses requiring an intervention for substance use problems in the United States and the 1-year prevalence of nurses enrolled in substance abuse monitoring programs and to compare the sum total of nurses identified in disciplinary and alternative programs with the general population.
  
  
  METHODS
  This was a balanced stratified sampling design study. Measurements included the National Council of State Boards of Nursing 2010 Survey of Regulatory Boards Disciplinary Actions on Nurses, the 2009 annual reports of alternative programs, the 2008 National Sample Survey of Registered Nurses, and the 2009 National Survey on Drug Use and Health.
  
  
  RESULTS
  The 2009 1-year prevalence of employed nurses identified with substance use problems in the United States and its territories was 17,085 or 0.51% of the employed nursing population. The 1-year prevalence of nurses newly enrolled in substance abuse monitoring programs in the United States and its territories was 12,060 or 0.36%. Although every National Council of State Boards of Nursing jurisdiction has a disciplinary monitoring program, only 73% (n = 43) of these jurisdictions have alternative programs. Despite this, on average, alternative programs had nearly 75% more new enrollees (9,715) when compared with disciplinary programs (2,345). The prevalence of nurses identified with a substance use problem requiring an intervention (and likely treatment) is lower than the prevalence of those who report receiving substance abuse treatment in the general population (0.51% vs. 1.0%).
  
  
  CONCLUSIONS
  The ATD programs potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more nurses with substance use problems, thereby initially removing more nurses with substance use problems from direct patient care.
authors.affiliation: School of Nursing, Vanderbilt University, Nashville, TN 37209, USA. todd.b.monroe@vanderbilt.edu
authors.forename: Todd B
authors.initials: TB
authors.lastname: Monroe
authors.forename: Heidi
authors.initials: H
authors.lastname: Kenaga
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carter
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Cowan
mesh_terms: D000328:Adult; D004647:Employee Discipline; D005260:Female; D006801:Humans; D008297:Male; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data*; D015995:Prevalence; D062707:Return to Work; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology