Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more than 2 times the national average in 2017. The purpose of this descriptive cross-sectional non-experimental study was to examine how formal SUD nursing education, personal experiences, and participant characteristics predict attitudes and knowledge of nursing students and practicing perinatal nurses in Tennessee toward pregnant and perinatal women with an SUD. The sample consisted of 262 nursing students and 99 perinatal nurses across the west, middle, and eastern regions of Tennessee. A linear multiple regression showed that having a personal experience with a close friend with an SUD was predictive of improved knowledge scores of pregnant and perinatal SUDs. Independent samples t-tests were non-significant between formal SUD nursing education and attitudes and knowledge. Additionally, non-significant findings were seen between having a personal experience with a family member with an SUD and attitudes and knowledge. The findings suggest that Tennessee nursing education efforts were not influential in positively affecting attitudes and knowledge scores toward pregnant and perinatal women with an SUD. Future studies focused on exploring various educational interventions to promote knowledge, improve attitudes, and empathy in nursing populations toward pregnant and perinatal women with an SUD are warranted.