In states across the country, the board of nursing or otheradministrative agency is charged with ensuring the nurs-ing practice act is upheld by those possessing a registerednurse (RN) license (Russell, 2017). The board of nursingacts to enforce standards to ensure nurses are competent,provide care within the scope of practice, and are freefrom impairment due to substance use (SU), and therebyprotect patients who receive nursing care. The rate ofnurses’ SU is normative with the general population esti-mates of SU; that is, between 6% and 8% (Kunyk, 2015;Trinkoff, Eaton, & Anthony, 1991; Trinkoff & Storr,1998; Trinkoff, Zhou, & Storr, 1999). When trackingsuch estimates, there are additional complexities to nurseswho report SU, even when anonymity is assured, thatmay influence full disclosure. Specifically, nurses mayfear SU disclosure could jeopardize their license andemployment status, and therefore, their ability to earn aliving. These hesitations are well-founded historicallydue to the “throw away” culture that permeated nurseswhen confronted with SU (Curtin, 1987). Today, due tothe National Council of State Boards of Nursing (NCSBN)and industry partners, the alternative-to-discipline pro-grams, which include nurse-accountability, the nurse maybe given the option of a monitoring program versusemployment termination (NCSBN, 2011).Others argue, however, that SU in nurses continues tobe surrounded by a discourse of “personal choice, as afailure of moral character” rather than a disease (Kunyk,Milner, & Overend, 2016, p. 315). When confronted withsuspected SU and/or diversion, nurses will often be askedto submit a urine sample for SU screening. Often, policiesin health care organizations require termination ofemployees who refuse to submit to such screenings.When a nurse is punitively discharged for refusing to886369JAPXXX10.1177/1078390319886369Journal of the American Psychiatric Nurses AssociationFoli et al.research-article20191Karen J. Foli, PhD, RN, FAAN, Purdue University, West Lafayette,IN, USA2Blake Reddick, RN, BSN, Purdue University, West Lafayette, IN, USA3Lingsong Zhang, PhD, Purdue University, West Lafayette, IN, USA4Kathryn Krcelich, RN, BSN, Purdue University, West Lafayette, IN, USACorresponding Author:Karen J. Foli, Purdue University School of Nursing, Johnson Hall ofNursing, Room 234, West Lafayette, IN 47907, USA.Email: kfoli@purdue.eduSubstance Use in Registered Nurses:“I Heard About a Nurse Who . . .”Karen J. Foli1 , Blake Reddick2, Lingsong Zhang3,and Kathryn Krcelich4AbstractBACKGROUND: Estimates of substance use (SU) in nurses is on par with that of the general population: between6% and 8%. However, collecting sensitive information such as SU is difficult based on social desirability and fearsof disclosure. AIMS: Part of a larger study surrounding nurses’ self-reports of SU (n = 1,478), the purpose wasto explore open-ended responses of nurses (n = 373) who were invited to “Please add any additional commentsrelated to substance or alcohol use that you have experienced or witnessed in registered nurses.” METHOD: Thisqualitative study employed a content analysis of 373 nurses’ open-ended responses collected via an online survey.RESULTS: The majority of nurses (n = 250) forwarded comments that described SU in other nurses, while 24comments reflected the nurse’s past or current SU. Content analysis revealed the following four themes: (1) differingsocial network proximity to SU; (2) individual process: vulnerability to adaptive/maladaptive coping resulting in positiveand negative outcomes; (3) bedside, system, and organizational spaces and effects; and (4) there are no SU issues innursing. CONCLUSIONS: Although direct reports of SU constitute approximately one quarter of the commentsforwarded, nurses reported peers’ struggles with SU, including observing nurses working in patient care while impairedand the use of substances to cope with work and personal stressors. Individual factors and system-related failuresappear to be contributors to SU in nurses.Keywordsnurses, substance use, qualitative