North Carolina Board of Nursing

Discipline & Compliance

Chemical Dependency Resources

Warning Signs

Identifying Substance Use Disorders (National Council State Boards of Nursing)

Behavioral Signs:

  • Tends to administer more medications, always uses the maximal dose
  • Volunteers to give medications
  • Demonstrates patterns of excessive wastage and breakage
  • Increasing discrepancies in management of controlled substances
  • Complaints from patients reporting ineffectiveness of pain medication
  • Requests to work evenings, nights, week-ends when there is generally less activity and less supervision
  • Exhibits increased anxiety, sudden mood swings, inappropriate anger or crying
  • Demonstrates problems interacting with peers and supervisors
  • Exhibits forgetfulness or memory lapses
  • Makes frequent trips to the bathroom or has other unexplained absences
  • Demonstrates patterns of absenteeism, tardiness, and sick calls especially following days off
  • Sloppy or illogical documentation

Physical Signs:

  • Shakiness, tremors of the hands
  • Slurred speech
  • Falling asleep
  • Watery eyes, dilated or constricted pupils
  • Diaphoresis
  • Unsteady gait or staggering
  • Runny nose
  • Nausea, vomiting, diarrhea
  • Weight loss or gain
  • Change in dress or grooming – ie suddenly wears long sleeves/lab coats