Do nurses pay a "well-being" tax?

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According to Choflet et al.(2022), the academic literature for nurses describes symptoms that articulate and define a nurse's traits and behaviors with an impassioned nonverbal declaration of drudgery, lack of energy, despair, and pessimism as what is commonly known as "burnout." In addition, the literature suggests that secondary causes of the feelings associated with the work involved in caring for society's most ill patients adversely affect the mental health of nurses.

Along with that, literature abounds on the mental health of leaders' wellbeing, with a broad definition that defines three components of health: the individual's mental wellness, their physical or biological personal wellness, and the overall wellness of their interpersonal support systems (Oc & Chintakananda, 2025). How do nurses take care of themselves?

"Burnout" or "compassion fatigue" is a common term found in the healthcare literature, but hearing about it, speaking about it, or talking openly about it is somewhat taboo. Nurses are not alone in experiencing burnout at work. It is common among physicians, who may also describe feelings of patient and provider withdrawal, isolation from other healthcare team members, a loss of purpose in helping and caring for others, and a disconnect from one's calling (Longo, 2018).

Other authors acknowledge drug use and dependency in nurses and forecast chilling insights for those of us who have professional caring careers. Gabele et al. (2023) signal an alarming statistic that roughly just under 20% of practicing nurses in the U.S. have a dysfunctional relationship with alcohol and other substances.

To the extent that nurses choose coping mechanisms of alcohol and other substances to manage symptoms of nurse-patient tensions and worry, nervousness and agitation, sadness, melancholy, and, unfortunately, the temptation to take one's own life (Choflet et al., 2022) how can those charged with stewarding others help, support and empower nurses and other members of the healthcare team to promote wellbeing and seeking help? Awareness conversations and measures to reduce stigma are needed.

Psychological Safety

Academics have written extensively in the healthcare literature regarding workplace environments where speaking up without fear of being embarrassed, humiliated, or accused of expressing how one feels about any given situation at work is what is known as a psychologically safe workplace. In other words, Camilleri et al. (2023) explain the type of workplace climate where all staff can discuss topics of misunderstanding, miscalculations, and clarification seeking without again being ridiculed. Often, psychologically safe environments are touted as best practice for staff to speak up, for instance, in preventing medication errors (Camilleri et al., 2023) for patient safety.

How do workplaces morph to follow a psychologically safe workplace where topics, as mentioned before, for mental health and alcohol and/or drug dependency, can be brought up ethically and morally in appropriate manners to help those suffering ultimately? Again, it begins with awareness, education, assessment, and knowing when to intervene.

Recognize and Empathize

Nurse leaders can take an assessment of staff behaviors and share with others attitudes that could red flag a potential staffer who is struggling, such as tardiness, increased absenteeism, tired and fatigued work habits, as well as the most apparent signs as anyone demonstrating characteristics of being under the influence of mood-altering substance would present such as altered alertness and speech variations, increased irritability at work, avoidance behaviors, and out of the regular personal behavior shift disappearances (Gabele et al., 2023).

In addition, since nurses are the frontline administrators and dispensers of patient medication, mainly controlled substances, and have medication dispensing equipment user access, nurse leaders and colleagues can be watchful and attentive to medication distribution processes.

Pharmacy equipment, syringes, hypodermic needles, and intravenous access kits, such as tourniquets, alcohol swabs, and gauze sponges, in conjunction with empty used medication vials, empty medication packaging, and other paraphernalia surrounding the work environment, such as oral and intravenous narcotics and benzodiazepines, that are left unattended in areas where they are atypical should raise caution (Gabele et al., 2023). Examples include restroom trash, coffee and soda lounges, and areas for break time and workstations.

Gabele et al. (2023) also caution the new nurse leader and the seasoned nurse manager to pay attention to instances where medication variances are increasing, such as documented narcotic administrations in the EMR but diminished waste documentation in medication dispensing reservoirs. These highlight unaccounted-for discrepancies and variances indicating potential medication diversion activity.

Courageous Support

Understanding that each organization has its policy and procedures for dealing with situations such as an altered employee or when it is discovered that drug diversion is suspected and confirmed, corrective measures must be followed according to institutional policy. Although never an easy encounter, Gabele et al. (2023) remind the nurse leader to help the staff individual be dismissed and immediately help them seek professional help through intervention, counseling, and recovery sources.

Supporting a psychologically safe work environment that fosters a speak-up culture in support of nurse wellbeing is one of those elements that leaders can promote through staff engagement, especially during the post-pandemic period when nurses are listed as at risk for self-harm resulting in death due to alcohol dependence and recreational and pharmaceutical dependency on drugs adversely affecting there physical and psychological health (Choflet et al., 2022). 

Engagement huddles and conversational rounding regarding delicate, intricate, and high-risk conversations about alcohol and substance use in the workplace are hard to navigate. However, with visibility, open access to leadership, and intentional listening (Camirelli et al., 2023), leaders can help support those who may need it most during their most demanding and vulnerable time.

References:

Camilleri, M. A., Allegra, M., & Kearney, J. (2023). Answering the wake-up call to nurse leaders: Five practices to restore psychological safety after the Vaught case. Nurse Leader, 21(2), 213–217. https://doi.org/10.1016/j.mnl.2022.12.020

Choflet, A., Barnes, A., Zisook, S., Lee, K. C., Ayers, C., Koivula, D., Ye, G., & Davidson, J. (2022). The nurse leader's role in nurse substance use, mental health, and suicide in a peripandemic world. Nursing Administration Quarterly, 46(1), 19–28. https://doi.org/10.1097/naq.0000000000000510

Gabele, D., Keels, K. M., & Blake, N. (2023). Out of the Shadows and into the Light: Destigmatization of substance use disorder in Nursing. Nurse Leader, 21(4). https://doi.org/10.1016/j.mnl.2023.04.003

Longo, Dan L. (2018). Approach to the patient with cancer. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's principles of internal medicine (pp. 435-443). McGraw-Hill Education.

Oc, B., & Chintakananda, K. (2025). Wellbeing of formal leaders: A critical and interdisciplinary review of predictors shaping leader wellbeing. The Leadership Quarterly, 36(1), 101842. https://doi.org/10.1016/j.leaqua.2024.101842