A critical review of knowledge on nurses with problematic substance use: The need to move from individual blame to awareness of structural factors

Abstract

Problematic substance use (PSU) among nurses has wide-ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use.

The business of managing nurses’ substance‐use problems

“…Current public health theories emphasize the central role of the environment in the development and continuation of substance‐related harms (Rhodes, ). Yet, the only work environmental factor that we saw attended to in The Program and others like it in the literature (Ross, Berry, et al, ) was the restriction of individual nurses’ access to drugs. Other relevant working conditions, such as understaffing and workplace violence, among others, were not assessed and addressed in organizing the nurses’ return to work arrangements.…”

“…ATD programs have consistently demonstrated much higher service uptake and program completion rates than the historical punitive approaches (College of Registered Nurses of British Columbia, ; Kunyk & Austin, ; Monroe et al, ; Monroe & Pearson, ; National Council of State Boards of Nursing, ; Smith, Krinkle, & Barnett, ). However, although the ATD approach is well supported, the nursing literature has continued to focus ongoing efforts and research in this area on persuading reluctant regulatory bodies to shift from punitive to ATD models (Ross, Berry, Smye, & Goldner, ). Meanwhile, the foundational premises, structure, and overall effectiveness of the standardized and compulsory treatment regime within these ATD programs have not been critically scrutinized (Astrab Fogger & McGuinness, ; Monroe et al, ).…”

“…Conflicts of interest inherent in the evaluation studies were also noted (Lawson & Boyd, ). To date, no studies have been found (Lawson & Boyd, ; Ross, Berry, et al, ) that compared these nurse or physician substance‐use treatment regimes to any other treatment modalities. We found very few studies of the experiential perspectives of nurse participants in ATD programs (Astrab Fogger & McGuinness, ; Darbro, ; Horton‐Deutsch, McNelis, & O’Haver Day, ; Strom‐Paikin, ).…”

“A Two Glass of Wine Shift”: Dominant Discourses and the Social Organization of Nurses’ Substance Use

“…Our next step was to review scholarly literature ( Ross, Berry, Smye, & Goldner, 2018 ). Dominant concepts used to explain nurses’ perspectives of substance-use problems, such as stigma ( Darbro, 2005 ), negative attitudes ( Howard & Chung, 2000 ), and the culture of the nursing profession ( Darbro & Malliarakis, 2013 ; Solari-Twadell, 1988 ) permeated much of the existing research.…”

“…We also felt a disjuncture 3 arising from what we saw as the decontextualization of the issue in the extant scholarly works. Nurses’ problems with substance use have been principally framed in neoliberal terms of individual shortcomings ( Kunyk, Milner, & Overend, 2016 ), whereas broader institutional and organizational conditions have neither been critiqued nor researched ( Ross et al, 2018 ). This trend conflicted with what we knew experientially about the interconnections between nurses’ substance-use practices and their workplaces.…”