Are there any concerns presented about the results? Yes, as indicated in the article, there is concern that the nature of the study caused reluctance to participant. In addition to substance use being a generally difficult topic to discuss, the participants in the study only had to respond if they felt comfortable doing so, and did not have requirements for responding. The self-reporting aspect of this study along with the possible fear of self-reporting or reporting a colleague may lead to underrepresentation of substance use in registered nursing due to omission or miscontrued information.