Occupational stress in nursing is a reality. To identify traits observed in impaired nurses, the SHUNT Self-Survey for Nurses™ was developed in order to reduce the occupational hazard of addiction in nurses.
The SHUNT Self-Survey For Nurses™ Scoring Sheet Copyright © 2008-2017 Paula Davies Scimeca, RN, MS. All Rights Reserved, except as follows:
The author gives permission for the SHUNT Self-Survey™ scoring sheet to be copied when used solely for a nurse's own personal use AND the author and publisher are held harmless from any and all liability AND any and all copies prominently display this copyright information with the disclaimer: This tool is not intended to diagnose chemical dependency, or any other situation or condition. No score indicates a total absence of risk, nor any certainty that anyone is, or ever will become, chemically dependent.
For more specific information regarding scoring criteria, please refer to the book: Unbecoming A Nurse.
Reply YES or NO to the presence of the following characteristics:
S - Social withdrawal or self-isolative behavior. ______
S - Self-care behaviors beneath societal or professional standards. ________
H - History of chemical dependency in the nurse's immediate family. ________
H - History of negative consequences related to nurse's own substance use. ______
U - Untreated or unremitting emotional or physical pain. _______
U - Using medication for a reason it was not intended or in a manner not recommended. _______
N - Nursing practice routinely in excess of 55 hours per week. _______
N - Nursing duties include frequent access to controlled substances. _______
T - Transitional period requiring major adjustment within the past year. _______
T - Turmoil or tragedy with unresolved conflict. ________
Score each characteristic above with 1 point for every YES or zero for every NO response. Add points for total score.
DATE:________ TOTAL= _______
Just as we periodically track our weight and blood pressure over time to assess our health and well-being, periodically tracking SHUNT Self-Survey scores may help identify a trend towards higher risk characteristics or situations which many nurses have found accompany or precede a problem with alcohol and other substances.