Nurses’ stigmatizing attitudes toward patients with substance use disorders and their impact on care quality

BACKGROUND: Stigmatizing attitudes among nurses toward patients with substance use disorders (SUDs) and Opioid Use Disorder (OUD) represent a significant and pervasive barrier to equitable, patient-centered care. Despite growing recognition of addiction as a chronic, relapsing brain disease, nurses across diverse healthcare settings continue to exhibit negative perceptions, moralistic judgments, and stigmatizing language that compromise care quality, therapeutic relationships, and patient outcomes. METHODS: A scoping review was conducted following the Arksey and O'Malley framework, refined by Levac and colleagues, and reported in accordance with PRISMA-ScR guidelines. Four electronic databases PubMed, Scopus, ScienceDirect, and CINAHL were searched from January 2018 to January 2026. Following systematic screening and full-text assessment, 12 peer-reviewed primary studies were included and synthesized thematically. RESULTS: Five overarching themes were identified: (1) the pervasiveness of nursing stigma across individual, professional, organizational, and structural levels; (2) knowledge deficits and negative professional socialization as primary antecedents of stigmatizing attitudes; (3) the direct impact of stigma and clinical language on care quality, with person-first documentation language independently associated with a fivefold increase in the odds of a documented OUD treatment plan (AOR = 5.21; 95% CI: 2.28-11.89); (4) patient-reported experiences of dehumanization, eroded trust, and treatment avoidance; and (5) evidence-based educational interventions demonstrating significant improvements in nursing attitudes and clinical role adequacy. CONCLUSIONS: Nursing stigma toward patients with SUDs is a systemic, structurally embedded problem with measurable adverse consequences for care quality. Effective mitigation requires a multilevel response integrating addiction education reform, person-first language standards, implicit bias training, institutional-level policy and electronic health records reform to ensure equitable, evidence-based care for this vulnerable population.