As nurses struggle to cope with staffing and workload pressures, professional expectations, traumatic work events and toxic environments, some resort to harmful behaviours to self-manage stress, anxiety or poor mental health. One study estimates rates of substance misuse, abuse and addiction are as high as 20% among nurses. We explore reasons why nurses hesitate to seek help, and what happens if a nurse is referred to the profession’s regulator the Nursing and Midwifery Council for addiction-related issues.