Nurses' stigmatizing attitudes toward patients with substance use disorders and their impact on care quality

Stigmatizing attitudes among nurses toward patients with substance use disorders (SUDs) and Opioid Use Disorder (OUD) represent a significant and pervasive barrier to equitable, patient-centered care. Despite growing recognition of addiction as a chronic, relapsing brain disease, nurses across diverse healthcare settings continue to exhibit negative perceptions, moralistic judgments, and stigmatizing language that compromise care quality, therapeutic relationships, and patient outcomes.

A scoping review was conducted following the Arksey and O'Malley framework, refined by Levac and colleagues, and reported in accordance with PRISMA-ScR guidelines. Four electronic databases PubMed, Scopus, ScienceDirect, and CINAHL were searched from January 2018 to January 2026. Following systematic screening and full-text assessment, 12 peer-reviewed primary studies were included and synthesized thematically.

Five overarching themes were identified: (1) the pervasiveness of nursing stigma across individual, professional, organizational, and structural levels; (2) knowledge deficits and negative professional socialization as primary antecedents of stigmatizing attitudes; (3) the direct impact of stigma and clinical language on care quality, with person-first documentation language independently associated with a fivefold increase in the odds of a documented OUD treatment plan (AOR = 5.21; 95% CI: 2.28-11.89); (4) patient-reported experiences of dehumanization, eroded trust, and treatment avoidance; and (5) evidence-based educational interventions demonstrating significant improvements in nursing attitudes and clinical role adequacy.

Nursing stigma toward patients with SUDs is a systemic, structurally embedded problem with measurable adverse consequences for care quality. Effective mitigation requires a multilevel response integrating addiction education reform, person-first language standards, implicit bias training, institutional-level policy and electronic health records reform to ensure equitable, evidence-based care for this vulnerable population.