A nurse manager is reviewing a recent client report related to a staff nurse. Which of the following behaviors by a nurse at work might be red flags for a substance use disorder?

A. The behaviors described—volunteering for overtime continually, avoiding witnesses when wasting narcotics, and insisting on being alone in the medication room when preparing medications—are classic red flags for a substance use disorder in healthcare professionals, especially involving controlled substances like opioids. These actions suggest the nurse may be attempting to divert medications for personal use. Such behaviors are particularly concerning because they can jeopardize patient safety, compromise the integrity of medication administration, and violate legal and professional standards. Early identification is crucial to prevent harm to patients and provide intervention for the nurse. Hospital protocols often include reporting these concerns to a supervisor, initiating a formal evaluation, and possibly referring the nurse to a nurse assistance program for treatment and monitoring. B. Crying, sharing personal issues, and monopolizing conversations are signs of emotional distress or difficulty with interpersonal communication. While these behaviors may impact workplace functioning, they are not specific indicators of substance misuse and do not suggest diversion of medications. C. Increased irritability, being outspoken about workplace issues, or attending more staff meetings may reflect dissatisfaction, stress, or personality changes, but these are not specific red flags for a substance use disorder. D. Increased cheerfulness, energy, or willingness to help colleagues are positive workplace behaviors and are not indicative of substance misuse.