Introduction 
Nurses may have substance use problems similar to the general population (Worley, 2017). Underreporting makes it hard to estimate the number of nurses with substance use issues. The US has 18% of nurses with substance abuse issues (Trinkoff et al., 2022), whereas Ardabil City in Iran has 20.3%, with critical and emergency nurses having higher rates (Mohammadi et al., 2008). This issue causes cognitive deficits such as drowsiness, which can negatively impact the healthcare system (Foli et al., 2020). It also contradicts nurses’ duty to protect patient interests, preventing them from providing safe and effective care (Candilis et al., 2019). 
Among the challenges in addressing the issue is the inaction or reluctance of affected nurses to acknowledge their problems. In one study, almost 90% of nurses who self-identified as having substance use disorders were practicing and had not sought treatment (Kunyk, 2015). The notion that nurses develop coping methods to hide their impaired patient care or avoid detection puts patients at risk. 
Next comes the unwillingness to criticize coworkers for fear of misjudging and the difficulty in distinguishing substance abuse symptoms and stress-related behaviors. Nurses may feel obligated to help each other, too. Since they already have labor shortages and challenging work environments, they may be unwilling to abandon their “clan” (Zolkefli, 2021). Therefore, some are unwilling to judge their coworkers’ care delivery or practices. They are encouraged to “put yourself in their shoes” to show empathy. 

Responding to the challenge
It is crucial to acknowledge that when addressing the challenge, it is necessary to consider each respective country’s legal and cultural dimensions. Certain nations, including Iran, consider substance dependence to be a criminal offense that carries legal consequences (Ahmadi et al., 2004). Accordingly, clear written policies are required on substance abuse and the suspected nurse, coworkers, and managers’ obligations. At the same time, policies must explicitly state what occurs if a nurse is impaired and wants to return to work (Mumba, 2018). Most importantly, institutions need to recognize the prevalence of substance abuse and provide nurses with fair, non-judgmental, and empathetic support, such as by adopting a priority approach with uniform policies to enable quick intervention and support (Foli et al., 2020). 
Meanwhile, nurses compromised by substance abuse may struggle to recognize their limitations. Still, nurses are morally responsible for their professional behavior by recognizing that substance abuse may impair their professional performance. Possible interventions include aid from current resources, self-reporting, and voluntary withdrawal from practice. 
In addition, the healthcare community should be valued for its shared responsibilities. One responsibility is to notice any suspected care compromise. It requires coworkers to act quickly, such as asking nurses to leave patient care immediately if impaired or alerting management. Managers must provide a safe atmosphere by monitoring for indicators of substance misuse and eliminating the stigma associated with substance abuse in nursing (Foli et al., 2020). Additionally, they must maintain confidentiality and anonymity and schedule a consultation to ensure the impaired nurse receives due process and is treated according to policy. 

Conclusion 
Addressing healthcare practice, which is compromised by substance abuse, demands an emphasis on the impaired nurses’ moral obligations and the healthcare community and institution’s accountability. As they endeavor to keep everyone safe, especially patients, the healthcare community must be able to detect and address impaired practice. Impaired nurses must receive help at all levels to protect their well-being and detect risk early. 

Ethical Considerations

Compliance with ethical guidelines
The paper is based only on the author’s reflections and does not include hospital data.

Funding
The author received financial support through the Government of Brunei Darussalam In-Service Training Scheme. 

Conflict of interest
The author declared no conflict of interest.

 
References