Abstract
The nursing profession should follow what other professions have already done by instituting random drug screening in health care facilities now.
Substance use disorder (SUD) is on the rise across the United States. Experts estimate that SUD affects around 10% of the population, and studies have demonstrated that SUD rates among health care workers mirror those of the general public (Valdes, 2014), and nurses are particularly vulnerable due to their access to narcotics. In 2018, the problem made national headlines when two nurses died of fentanyl overdoses 16 months apart in one Dallas hospital (Ambrose & Hacker, 2018). To help reduce the incidence of SUD within the profession, and to better ensure the safety of patients, nursing leadership should consider instituting random drug screening in hospital facilities.
The transportation industry, well known for its commitment to safety, currently requires random drug screening for truck drivers and airline employees. The nursing profession recognized widely as the most trusted profession should hold itself to a similar standard (Gaines, 2019). Currently, it is the policy of many hospital systems to only conduct drug screens for the purposes of preemployment and suspected impairment (for cause). If hospitals desire to improve patient safety and promote good health among the nurses who care for patients, random drug screens should be implemented to help improve the culture of safety within the hospital. Truck drivers and airline staff are mandated to participate in random drug screenings as a condition of employment (Federal Aviation Administration [FAA], 2019). As much revenue as hospitals generate every year, the investment in taking additional steps to ensure the safety of patients, and the health and safety of nurses should rise to a higher priority.
During the late 1980s and early 1990s, several stories made news headlines involving transportation industry workers’ use of drugs and alcohol while on the job, resulting in the loss of many lives, including two train derailments that involved workers that were under the influence of drugs and alcohol, resulting in 21 deaths (Noble, 1995). These tragedies brought SUD and safety to the forefront. As a result, the Omnibus Transportation Employee Testing Act of 1991 was approved by Congress (FAA, 2019). Prior to this law, mandatory drug testing was not required.
The risk of harm to others by an impaired truck driver is comparable to an impaired nurse delivering patient care. Heaton, Browning, and Anderson (2008) identified factors that contributed to sleepiness in the trucking population, including long and irregular work hours. Nurses also bear the burden of long and irregular work hours as nursing care is a 24-hr operation, which by itself has been associated with errors in patient care (Caruso, 2014). Providing additional measures of random drug screening may decrease the likelihood of injury to patients and increase the health and safety of nurses.
Massachusetts General Hospital instituted a comprehensive drug screening program for their anesthesiology residents over a 13-year period and no illicit substances were detected, as compared to previous years prior to the drug screening program (Fitzsimmons et al., 2018). In a joint position statement with the Emergency Nurses Association and the International Nurses Society on Addictions, the American Nurses Association (2016) describes the susceptibility of nurses to develop SUDs is similar to the public at large, which is estimated around 10% of the population. In the midst of the nationwide opioid crisis, it is time that nursing leadership acts by instituting random drug screening now. Occupational health nurses, in conjunction with the Employee Assistance Program, are key to the implementation of SUD screening and education programs. The nursing profession must follow the example of the transportation industry and commit to making patient and worker safety a priority. If we are truly the most trusted profession, shouldn’t we have some evidence to support our position?
