Substance abuse is the number one most preventable health problem in the United States. Nurses represent a unique high-risk population, demonstrating distinctive risk factors and subsequent consequences that are very different from the general population. While the prevalence of substance abuse in the nursing profession is thought to mirror the general population, the consequent public safety concerns that arise are quite different. A nurse with substance use disorder who is unrecognized and untreated poses a serious threat to public safety.