Barriers in Returning to Work for U.S. Nurses Following Substance Use-Related Discipline

The United States is currently amidst a substance use epidemic, with overdose deaths rising significantly over the last decade. Substance use disorders are prevalent among nurses, mirroring general population rates, and pose significant risks to both personal and patient safety. Regulatory bodies impose monitoring and disciplinary actions on nurses identified with substance use disorder, which, while effective, present various barriers to return-to-work.

This study employed group concept mapping methodology to identify and prioritize barriers faced by nurses returning to work under monitoring agreements following substance use-related licensure discipline. Registered nurses who had undergone such monitoring participated in the study, providing data through brainstorming, sorting, and rating exercises conducted online. Point and cluster maps were created, as well as evaluation of barriers in terms of participants' perception of each barrier's impact and stressfulness.

Participants identified 48 barriers that were categorized into 5 thematic clusters: work-related challenges, financial burden, administrative challenges, impact on mental health, and peer/coworker support. The most impactful and stressful barriers were related to mental health and the visibility of disciplinary actions. Financial and administrative challenges also featured prominently.

Findings highlight the significant mental and socioemotional challenges faced by nurses in recovery. There is a need for better support systems, including nurse-specific support groups and accessible mental health resources. Policy changes to reduce public visibility of disciplinary records and financial support during recovery could facilitate a smoother return-to-work process. Further research should explore facilitators and support mechanisms from the affected nurses' perspective.