The business of managing nurses’ substance‐use problems

Abstract

Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs.

Predictors of Substance Use in Registered Nurses: The Role of Psychological Trauma

“…The regression model for other SU risk also included religiosity as well as perceived organizational support as buffers. The role of nurse supervisors, human resources, and other organizational personnel to understand the trajectory of recovery from SU in the workplace (Monroe et al, 2011(Monroe et al, , 2013 and avoid negative discourses (Kunyk et al, 2016;Ross et al, 2018aRoss et al, , 2018bRoss et al, , 2020) cannot be understated. The practice of terminating nurses rather than offering treatment only perpetuates concerns of nurses' reporting SU and the public safety.…”

“…Western Journal of Nursing Research 43(11) 2017). Participants in an alternative-to-discipline program in Canada were interviewed, and individualized treatment for nurses, whose experiences were often subordinated to prevailing treatment approaches, was lacking (Ross et al, 2020). Findings from a study conducted by Cares et al (2015) provided data from 302 nurses who had been involved with peer health assistance programs and found 68% thought their problem could have been recognized sooner.…”

Voices from the COVID‐19 frontline: Nurses’ trauma and coping

“…Recent literature, albeit pre‐pandemic, describing nurses’ substance use has been through a critical lens of the high‐pressured, high‐stakes environments in which nurses work, certainly amplified during the COVID‐19 pandemic. The work of Ross and colleagues (Ross, Berry, et al, 2018, Ross et al, 2019; Ross, Jakubec, et al, 2018) speaks to how discourses have framed the approach to nurses with substance use issues, approaches that employ individual culpability that ignore broader factors impacting nurses’ well‐being. Kunyk et al (2016) echo an informed approach to nurses’ substance use that includes contextualizing the work environment stressors faced by nurses such as higher patient acuities and budget cuts.…”