Modifiable Factors Associated With Substance Use Disorder Screening by Nurses: A Cross-Sectional Survey

To identify the training, organizational, attitudinal and competence factors associated with how frequently nurses screen patients for substance use disorder, and to determine which remain associated after demographic and structural characteristics are taken into account.

Cross-sectional online survey of a national sample of licensed nurses in the United States.

A total of 1365 licensed nurses completed the survey in October 2025. The outcome was self-reported screening frequency over the previous 12 months. Hierarchical regression entered demographic and structural variables, then training and organizational variables, then attitudinal and competence variables, with categorical predictors dummy coded. Findings were confirmed with robust standard errors and an ordinal logistic model.

Recent continuing education, supportive organizational policy, harm reduction readiness and professional competence each independently predicted more frequent screening. Nurses unsure whether their organization supported screening screened least. Nurses in outpatient, long-term care and other non-hospital settings screened less than hospital-based nurses. Opioid stigma was not independently associated with screening; concern about patient trust and confidentiality was. Role, race, gender and experience showed no independent association.

Screening was associated less with who nurses are than with what they had recently learned, how ready and competent they felt and whether their organization clearly expected screening.

Pairing recurring education with explicit policy, referral pathways and workflow support is more promising than one-time training or attitude-change efforts.

The study addressed why screening is inconsistent. Recent education, competence, readiness and clear policy were the operative factors, not stigma. Findings apply to nurses, educators and health system leaders across settings.

STROBE checklist for cross-sectional studies.

No patient or public contribution.