Don't ask don't tell: substance abuse and addiction among nurses

Evaluation of nurses' attitudes and behaviors regarding narcotic drug safety and addiction: a descriptive cross-sectional study

BACKGROUND

By evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction, effective strategies need to be developed for combating addiction in healthcare institutions. This study, aimed at providing an insight into patient and staff safety issues through the formulation of health policies, aimed to evaluate nurses' attitudes and behaviors regarding narcotic drug safety and addiction.

METHODS

The study was conducted in a descriptive cross-sectional design. It was carried out with 191 nurses in a public hospital between March 2023 and August 2023. Data were collected through face-to-face interviews, gathering socio-demographic information and utilizing the Addictive Substance Attitude Scale. The data were analyzed using independent sample t-tests, one-way ANOVA tests, and regression analysis (P < .001 and p < .05).

RESULTS

The average age of the participants was determined to be 36.58 ± 8.40. It was reported by 85.3% of nurses that narcotic drug follow-ups in their units were conducted according to procedures. In the study, it was found that 63.9% of nurses did not know the procedure to be followed towards a healthcare professional identified as a narcotic substance addict. The total mean score of the Addictive Substance Attitude Scale of nurses participating in the study was 74.27 ± 14.70. A significant difference was found between the total scores of the scale and the level of education of nurses, the follow-up status of the drugs in the unit where they work, their status of receiving narcotic drug addiction training, and their routine use of the half-dose drug disposal form (p < .05).

CONCLUSIONS

The findings of this study underscore the importance of evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction. These results indicate the need for nursing administrators, particularly in terms of patient and staff safety, to adopt more effective policies and strategies.

Comparing nurses attending a specialised mental health programme with and without substance use disorder: a retrospective, observational study in Spain

OBJECTIVES

To analyse the differences between nurses with and without substance use disorders (SUDs) admitted to a specialised mental health programme.

DESIGN

Retrospective, observational study.

SETTING

Specialised mental health treatment programme for nurses in Catalonia, Spain.

PARTICIPANTS

1091 nurses admitted to the programme from 2000 to 2021.

INTERVENTIONS

None.

PRIMARY AND SECONDARY OUTCOMES

Sociodemographic, occupational and clinical variables were analysed. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision criteria.

RESULTS

Most nurses admitted to the programme were women (88%, n=960) and came voluntarily (92.1%, n=1005). The mean age at admission was 45 (SD=10.4) years. The most common diagnoses were adjustment disorders (36.6%, n=399), unipolar mood disorders (25.8%, n=282), anxiety disorders (16.4%, n=179) and SUDs (13.8%, n=151). Only 19.2% (n=209) of the sample were hospitalised during their first treatment episode. After multivariate analysis, suffering from a SUD was significantly associated with being a man (OR=4.12; 95% CI 2.49 to 6.82), coming after a directed referral (OR=4.55; 95% CI 2.5 to 7.69), being on sick leave at admission (OR=2.21; 95% CI 1.42 to 3.45) and needing hospitalisation at the beginning of their treatment (OR=12.5; 95% CI 8.3 to 20).

CONCLUSIONS

Nurses with SUDs have greater resistance to voluntarily asking for help from specialised mental health treatment programmes and have greater clinical severity compared with those without addictions. SUDs are also more frequent among men. More actions are needed to help prevent and promote earlier help-seeking behaviours among nurses with this type of mental disorder.

Labeled as "drug-seeking": nurses use harm reduction philosophy to reflect on mending mutual distrust between healthcare workers and people who use drugs

Introduction

Over 50 years of approaching drug use from the "War on Drugs" has led to ignoring the systemic structural and social determinants of health, enforced drug use stigma, and damaging stereotypes of people who use drugs or are labeled as "drug-seeking," and sorely failed to support those needing assistance.

On philosophy of harm reduction and power

People who use drugs are often disenfranchised and pathologized by being labeled as "a drug addict," which then serves as a rationalization for mistreatment by healthcare providers. This is in opposition to a harm-reduction approach. Harm reduction philosophy is an epistemic valuation necessary for drug use stigma and our moral obligation to reduce harm from interlocking systems of power that perpetuate harm.

On drug-seeking mistrust and human rights

We have encountered many clients who use drugs that report harmful interactions with healthcare providers. Harm reduction is an issue of health equity, social justice, and fundamental human rights. This paper presents three vignettes, the author's experiences of being labeled as-and advocating for family members labeled as "drug-seeking."

Discussion

To better serve as healthcare providers, workers must be equipped to work with people who use drugs and reinforce the social justice commitment against medical stigma, neglect, racism, and inadequate pain coverage and withdrawal treatment. Nurses and our epistemic lens can meet the challenge of complex intersectional issues affecting our use of power to develop more just and equitable health systems and advance our rebuilding of a trusting relationship with the people we serve.

A mixed-methods exploration of nurse loneliness and burnout during COVID-19

AIM

This study investigated the phenomenon of nurse loneliness as a potential contributor to burnout.

BACKGROUND

Nurse wellbeing is critical for safe and efficient healthcare delivery. However, evidence indicates nurses' wellbeing is at risk. The levels of burnout, the most commonly measured symptom of suboptimal wellbeing, are rising and may relate to a largely unexplored phenomenon: loneliness.

METHODS

A mixed-methods approach was used to investigate burnout and loneliness in direct-care nurses in four diverse hospitals in the midwestern and southeastern United States. Burnout and loneliness were measured, prevalence was estimated, and correlation was examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. While this study did not explicitly explore the impact of the global pandemic, data was collected in late 2021 and early 2022, during the Delta variant wave.

RESULTS

In the study population (n = 117), rates of burnout are high and positively correlate with loneliness. Qualitative interviews (n = 11) revealed that nurses feel unseen, emotionally detached from their work, and dehumanized. However, social connection with peers is protective and nurses still report a strong sense of devotion to the profession and solidarity with peers.

CONCLUSIONS

This study offers insight into nurse loneliness, highlighting the importance of social connectedness to improve nurse wellbeing.

Psychosocial ergonomics of the workplace of medical staff during the COVID-19 pandemic in three risk's dimensions: working hours, violence and the use of psychoactive drugs-a prospective pilot study

Introduction

Workplace ergonomics should also be considered in the context of psychosocial factors affecting the worker, which have a real impact on occupational risk. The present study examined psychosocial risk factors in medical personnel in three domains: working hours, violence and substance abuse.

Methods

The purpose of the present study is to assess the current state of psychosocial ergonomics of medical personnels by measuring occupational risks in the domains of: working hours, violence and psychoactive substance abuse. The survey is consisted of two parts: socio-demographic information of participants and participants' assements of psychosocial risk factors.

Results

In more than half of the respondents (52%), increased risk was identified in the domain of working hours. Nearly half of the respondents (49.6%) have an identified high risk in the domain of violence, and more than half of the respondents (52%) are at high risk in the domain of psychoactive substance abuse.

Discussion

Our findings show that the present psychosocial ergonomics of the Polish health system must be improved. The COVID-19 pandemic has been a compelling test to assess the current state. Our findings highlighted the fact that HCWs often worked overtime and that many cases of workplace violence and substance abuse were reported.

Prescription Stimulant Misuse Among Nursing Students: A Systematic Review

ABSTRACT

Nonmedical prescription stimulants are used to reduce symptoms of inattention, impulsivity, and hyperactivity in children and adults with attention-deficit hyperactivity/disorder. They are Schedule II controlled substances because of their high potential for dependence, and individuals who misuse them without a valid prescription are subject to criminal charges. Stimulant medications are also associated with common side effects (e.g., insomnia) as well as more serious but less common side effects (e.g., arrhythmias). Despite the potential health and legal consequences, misuse of prescription stimulants has become a public health crisis on college campuses in the United States. Neurocognitive enhancement is the primary reason that college students report misusing prescription stimulants, despite no enhancement of cognitive functioning when taken by healthy adults. Nursing students may be at risk for misuse because of their high levels of academic and clinical demands and because many start misusing in nursing school. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the databases PubMed, Science Direct, EBSCOhost, and Academic OneFile were systematically searched to investigate the (a) percentage of prescription stimulant misuse studies that have included nursing students, (b) prevalence of prescription stimulant misuse among nursing students, (c) motivations for prescription stimulant misuse among nursing students, and (d) demographic factors associated with increased use among nursing students. Results revealed that of the 197 studies conducted within the past decade (2010-2021), only 1.02% (two) included nursing students. Future studies must investigate the prevalence and nature of prescription stimulant misuse among nursing students.

Psychiatric Issues Among Health Professionals

COVID-19 has increased the interest in the wellbeing of health professionals (HPs) as they have experienced stress, loss, and fatigue-related symptoms. Research evidence from previous epidemics points to an increase in the prevalence of affective, anxiety, and addictive disorders among them. HPs are trained to care for others and to recover from severe stressors. However, they tend to neglect self-care and have difficulties in seeking appropriate help when need it. This new scenario becomes an opportunity to promote a new culture of professionalism whereby caring for the caregivers becomes a priority both at a personal and institutional level.

An Integrative Review of Programs for Managing Nurses' Substance Use Disorder in the Workplace

BACKGROUND

Nurses' substance use disorder (SUD) endangers patient safety and decreases nurses' work ability and health. To better understand the methods, treatments, and benefits of the programs used to monitor nurses with SUD and promote their recovery, a systematic review of international research is needed.

AIM

The aim was to gather, evaluate, and summarize empirical research on programs for managing nurses with SUD.

DESIGN

An integrative review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis instructions.

METHOD

Systematic searches were conducted in the CINAHL, PsycInfo, PubMed, Scopus, and Web of Science databases between 2006 and 2020, complemented with manual searches. Articles were selected based on inclusion, exclusion, and method-specific evaluation criteria. The data were analyzed narratively.

RESULTS

The review identified 12 studies of which nine focused on recovery and monitoring programs for nurses with SUD or other impairment and three concerned training programs for nurse supervisors or worksite monitors. The programs were described in terms of their target groups, goals, and theoretical basis. The programs' methods and benefits were described together with challenges in their implementation.

CONCLUSION

There has been little research on programs for nurses with SUD, the programs that exist are heterogenous, and the evidence available in this field is weak. Further research and developmental work are needed on preventive and early detection programs as well as rehabilitative programs and programs supporting reentry to workplaces. In addition, programs should not be restricted to nurses and their supervisors; colleagues and work communities should also be involved.

Disciplinary processes for nurses, from organizational supervision to outcomes: A document analysis of a regulatory authority's decisions

AIM

To explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority.

BACKGROUND

Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses.

METHODS

A retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007-2016. The data were analysed using a quantitative design with descriptive statistics.

RESULTS

We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5 years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under one month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety.

CONCLUSION

This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organizations ensure patient safety when unprofessional conduct is suspected.

IMPLICATIONS FOR NURSING MANAGEMENT

Retaining nursing professionals is vital due to global shortages and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

Nurse admissions at a specialized mental health programme: A pre-Covid-19 retrospective review (2000-2019)

AIMS

Nursing is a stressful and emotionally demanding profession. To date, few mental health treatment interventions have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer specialized mental health programme in Europe from 2000 to 2019.

DESIGN

A retrospective observational study of 1297 medical e-records of nurses with mental health disorders admitted to the Galatea Care Programme in Barcelona was conducted.

METHODS

Three periods were analysed: 2000-2006, 2007-2012 and 2013-2019. Socio-demographic and clinical variables were compared. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria.

RESULTS

Gender and age at referral did not change over time. Self-referrals grew from 85.1% in the first period to 95.3% in the last period; inpatient admissions decreased from 24.1% to 18.2%, although this was not significant; nurses were less frequently on sick leave on admission over time (59.1% vs. 45.7%); they were more likely to have a temporary contract in the second period (9.5% vs. 4.8% and 4%) and prevalence of main diagnosis changed with a considerable decrease in affective and substance use disorders after 2006 and a progressive increase in adjustment disorders during the whole period.

CONCLUSION

Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings. WHAT PROBLEM DID THE STUDY ADDRESS?: Nursing is a stressful and emotionally demanding profession. To date, few specialized mental health services have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer programme in Europe, the Galatea Care Programme in Barcelona, from 2000 to 2019. WHAT WERE THE MAIN FINDINGS?: The number of referrals to the programme grew especially after the first 7-year period. Admissions were more likely to be voluntary during the last period. Prevalence of substance use disorders at admission dropped steadily while prevalence of adjustment disorders progressively increased over the two decades. Nurses were also less likely to be on sick leave at admission. WHERE AND ON WHOM WILL THE RESEARCH HAVE IMPACT?: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings.

Unprofessional conduct by nurses: A document analysis of disciplinary decisions

Background:

A small minority of nurses are investigated when they fail to meet the required professional standards. Unprofessional conduct does not just affect the nurse but also patients, colleagues and managers. However, it has not been clearly defined.

Objective:

The objective was to identify unprofessional conduct by registered nurses by examining disciplinary decisions by a national regulator.

Design:

A retrospective document analysis.

Data and research context:

Disciplinary decisions delivered to 204 registered nurses by the Finnish national regulatory authority from 2007 to 2016. The data were analysed with quantitative statistics.

Ethical consideration:

The study received permission from the Finnish National Supervisory Authority for Welfare and Health and used confidential documents that were supplied on the basis of complete anonymity and confidentiality.

Findings:

The mean age of the registered nurses who were disciplined was 44 years and 81% were female. Two-thirds had worked for their employer for 5 years or less, 53% had two or more employers and 18% had a criminal history. All the decisions included a primary reason for why the nurses were investigated, but there were also 479 coexisting reasons. In most cases, unprofessional conduct was connected to substance abuse (96%). In addition, stealing of medicine, a decreased ability to work and neglect of nursing guidelines were reported.

Discussion:

We found that the nurses were investigated for unprofessional conduct for complex combinations of primary and coexisting reasons. Our study highlighted that more attention needs to be paid to the key markers for unprofessional conduct.

Conclusion:

Unprofessional conduct is a complex phenomenon that is connected to nurses’ individual and working backgrounds and has an impact on their work performance. More research is needed to identify how nursing communities can detect, manage and limit the serious effects and consequences of unprofessional conduct.

A Qualitative Exploration of Addiction Disclosure and Stigma among Faculty Members in a Canadian University Context

Addiction is one of the most stigmatized public health issues, which serves to silence individuals who need help. Despite emerging global interest in workplace mental health and addiction, scholarship examining addiction among university faculty members (FMs) is lacking, particularly in a Canadian context. Using a Communication Privacy Management (CPM) framework and semi-structured interviews with key informants (deans and campus mental health professionals), this qualitative study aimed to answer the following research questions: (1) What is the experience of key informants who encounter FM addiction? (2) How may addiction stigma affect FM disclosure and help-seeking? and (3) What may help reduce addiction stigma for FMs? Thematic analysis was used to identify three main themes: (1) Disclosure was rare, and most often involved alcohol; (2) Addiction stigma and non-disclosure were reported to be affected by university alcohol and productivity cultures, faculty type, and gender; (3) Reducing addiction stigma may involve peer support, vulnerable leadership (e.g., openly sharing addiction-recovery stories), and non-discriminatory protective policies. This study offers novel insights into how addiction stigma may operate for FMs in relation to university-specific norms (e.g., drinking and productivity culture), and outlines some recommendations for creating more recovery-friendly campuses.

Interprofessional teamwork is the foundation of effective psychosocial work in organ transplantation

Interprofessional teamwork (IPT) is a well-established idea spanning multiple professional fields and supported by decades of literature. IPT is underemphasized in the medical literature despite its known impact on patient safety and care delivery. While many transplant teams adeptly work together, little has been written about team dynamics in organ transplantation and less on how IPT principles apply to transplant psychosocial clinicians. This editorial summarizes IPT principles, extrapolates key elements to psychosocial work in organ transplantation, flags potential barriers, collates practical strategies for teamwork enhancement, and identifies areas for future study.

A systematic integrative review of the literature on midwives and student midwives engaged in problematic substance use

OBJECTIVE

The objective of this systematic integrative review was to review the literature in relation to problematic substance use (PSU) in midwifery populations. Associated aims were to aggregate existing knowledge about midwives and student midwives' personal engagement in PSU, to generate a holistic conceptualisation and synthesis of the existing literature regarding midwives and student midwives personally engaged in PSU and to present new understandings and perspectives to inform the development of future research questions. This review is the first of its kind.

DESIGN

Systematic searches were conducted in CINAHL, Academic Search Complete, MEDLINE, PSYCInfo, Scopus and the Cochrane Library. Findings were grouped into themes and subthemes relating to both midwives and student midwives and then analysed critically in relation to the wider literature. A quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). The PRISMA statement was used to guide reporting.

SETTING

Included studies were conducted in Scotland, Ireland, Australia and New Zealand.

PARTICIPANTS

Studies included a total of 6,182 participants.

FINDINGS

A total of 3 studies were included. All included study types comprised quantitative survey designs, yet one also included a mixed methods design with the use of semi structured interviews. Two overarching themes emerged relating to both midwives and student midwives engaged in problematic substance use. For midwives, three subthemes are described: harmful daily alcohol consumption, working hours and harmful daily alcohol consumption and features associated with harmful daily alcohol consumption. For student midwives, two subthemes are presented: escape avoidance and alcohol, tobacco and cannabis use.

KEY CONCLUSIONS

There is limited evidence available in relation to problematic substance use in midwifery populations in comparison to that available for other healthcare populations. Further research is required, and could usefully focus upon midwives and student midwives as distinct professions to be separated out from the wider healthcare workforce.

IMPLICATIONS FOR PRACTICE

Problematic substance use among the healthcare workforce is associated with an increase in medical errors and inadequate care. Those affected can be reluctant to seek help, experience psychological distress and even contemplate suicide. Whilst evidence remains lacking for midwifery populations, they form a part of the general healthcare workforce and are exposed to similar workplace stressors. As such, it is likely that they too would be affected in similar ways.

Substance Use in Registered Nurses: "I Heard About a Nurse Who . . ."

BACKGROUND: Estimates of substance use (SU) in nurses is on par with that of the general population: between 6% and 8%. However, collecting sensitive information such as SU is difficult based on social desirability and fears of disclosure. AIMS: Part of a larger study surrounding nurses' self-reports of SU (n = 1,478), the purpose was to explore open-ended responses of nurses (n = 373) who were invited to "Please add any additional comments related to substance or alcohol use that you have experienced or witnessed in registered nurses." METHOD: This qualitative study employed a content analysis of 373 nurses' open-ended responses collected via an online survey. RESULTS: The majority of nurses (n = 250) forwarded comments that described SU in other nurses, while 24 comments reflected the nurse's past or current SU. Content analysis revealed the following four themes: (1) differing social network proximity to SU; (2) individual process: vulnerability to adaptive/maladaptive coping resulting in positive and negative outcomes; (3) bedside, system, and organizational spaces and effects; and (4) there are no SU issues in nursing. CONCLUSIONS: Although direct reports of SU constitute approximately one quarter of the comments forwarded, nurses reported peers' struggles with SU, including observing nurses working in patient care while impaired and the use of substances to cope with work and personal stressors. Individual factors and system-related failures appear to be contributors to SU in nurses.

Differences between Licensed Healthcare Professionals with Substance Use-Related Licensure Discipline

Substance Use Disorder (SUD) is a significant public health concern in the United States and healthcare providers are not immune to this disease. The potential for patient harm presented by an impaired provider is the reason SUD in licensed healthcare professionals is a regulatory issue. Aim: This research study seeks to identify the differences in the disciplinary action taken among pharmacists, physicians, and nurses (LPN & RN) in 24 states. Methods: A retrospective secondary data analysis was performed using the public use data file of the National Practitioner Data Bank (NPDB). Inclusion data were grouped and recoded to analyze using Chi-square to compare differences between groups. Results: Nurses are revoked and fined at much higher rates than medicine. Nurses and pharmacists are placed on probation at higher rates than medicine, and medicine was censured more than their nursing and pharmacy colleagues. Conclusions: Licensed healthcare professionals are punished differently for similar SUD-related offenses. Further research should explore these differences to identify evidenced based ways to protect the public while assisting this special at-risk population to recover from SUD.

A review of literature on substance abuse among anaesthesia providers

Background

Research has demonstrated that anaesthesia providers are susceptible to substance abuse. Several preventive measures are being implemented in certified registered nurse anaesthetist programmes to educate future providers about substance abuse. Given the continued prevalence and impact of the problem, more research is needed about the prevalence of substance abuse among student registered nurse anaesthetists and the implementation of preventive strategies in the educational setting.

Aims

The purpose of this narrative literature review was to examine the state of the science related to substance abuse among US certified anaesthesia providers. This literature review covered abuse of alcohol, tobacco, recreational drugs, opioids and anaesthetic agents.

Methods

This narrative review was conducted using the following search terms: anaesthesia, student, wellness, stress, substance abuse, satisfaction, personality, depression, nurse, nurse anaesthetist, propofol, isoflurane and fentanyl. References were identified using PubMed, CINAHL, Google Scholar, and the American Society of Anesthesiologists and American Association of Nurse Anesthetists websites. A total of 36 articles were identified as relevant to this literature review based on content and country of publication. This literature review was limited to articles published in the past 15 years. With one exception, our search was limited to manuscripts from the US.

Results

The literature underscored that various risk factors contribute to substance abuse. Board-certified anaesthesia providers fall prey to substance abuse due to ease of access, the high stress associated with administering anaesthesia, and the propensity to become addicted to opioids and other anaesthetics. A gap in the science exists about the prevalence of substance abuse among student registered nurse anaesthetists and the effectiveness of preventive strategies in the educational setting.

Conclusions

Anaesthesia providers are at high risk of abusing substances. To create a safer environment, future research should explore the prevalence of substance abuse among student registered nurse anaesthetists and emphasise the integration of effective preventive strategies in the educational setting.

Partially Filled Vials and Syringes in Sharps Containers Are a Key Source of Drug Diversion

Leftover or improperly discarded drugs are easy prey for diversion and are fueling the opioid abuse epidemic. ISMP offers safe practice recommendations to prevent drug misuse.

"A Two Glass of Wine Shift": Dominant Discourses and the Social Organization of Nurses' Substance Use

We undertook an institutional ethnography utilizing the expert knowledge of nurses who have experienced substance-use problems to discover: (a) What are the discourses embedded in the talk among nurses in their everyday work worlds that socially organize their substance-use practices and (b) how do those discourses manage these activities? Data collection included interviews, researcher reflexivity, and texts that were critically analyzed with a focus on institutional features. Analysis revealed dominant moralistic and individuated discourses in nurses’ workplace talk that socially organized their substance-use practices, subordinated and silenced experiences of work stress, and erased employers’ roles in managing working conditions. Conclusions included that nurses used substances in ways that enabled them to remain silent and keep working. Nurses’ education did not prepare them regarding nurses’ substance-use problems or managing emotional labor. Nurses viewed alcohol as an acceptable and encouraged coping strategy for nurses to manage emotional distress.

Alcohol use and health behavior among nursing professionals

OBJECTIVE

To evaluate the problematic use of alcohol and health behavior among the nursing staff of a general hospital.

METHOD

Cross-sectional study conducted at a general hospital. A questionnaire with socio-demographic information, the alcohol and substance use screening test, and a questionnaire on health behavior were applied.

RESULTS

A total of 416 professionals participated in the study. In the final model of logistical regression, male professionals (OR 4.3), singles (OR 3.7), those that professed to having other religions (OR 3.8), worked as nursing technician (OR 2.3), did not consume low doses of alcoholic beverages per day (OR 2.0), used tobacco (OR 8.9), avoided consuming beverages with caffeine (OR 1.9) and avoided noisy environments (OR 2.0) showed higher chances of consuming alcohol at a problematic level.

CONCLUSION

Among nursing professionals, the use of alcohol and not engaging in health behavior are strongly associated. These findings have implications for the implementation of strategies for the promotion of health and the prevention of alcohol use in work relationships.

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

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.

Nurses and Health-Promoting Behaviors: Knowledge May Not Translate Into Self-Care

Nurses are knowledgeable regarding the importance of health-promoting activities such as healthy eating, physical activity, stress management, sleep hygiene, and maintaining healthy relationships. However, this knowledge may not translate into nurses' own self-care. Nurses may not follow recommended guidelines for physical activity and proper nutrition. Long hours, work overload, and shift work associated with nursing practice can be stressful and contribute to job dissatisfaction, burnout, and health consequences such as obesity and sleep disturbances. The purpose of this article is to provide an overview of research examining nurses' participation in health-promoting behaviors, including intrinsic and extrinsic factors that may influence nurses' participation in these activities. This article also provides recommendations for perioperative nurse leaders regarding strategies to incorporate into the nursing workplace to improve the health of the staff nurses by increasing health-promoting behaviors.

The mental health of nurses in acute teaching hospital settings: a cross-sectional survey

Background

Nursing is an emotionally demanding profession and deficiencies in nurses’ mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses’ health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals.

Methods

A cross sectional survey design was used.

The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected.

Results

A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month.

Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating.

Conclusion

Nurses and their managers should strive to create workplaces where working practices promote nurses’ health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration.

Common risky behaviours checklist: a tool to assist nurse supervisors to assess unsafe practice

AIM

To describe the development of the Common Risky Behaviour Checklist, a tool to aid nurse supervisors in determining when a nurse may be questionably fit to perform, particularly in cases of substance abuse.

BACKGROUND

A significant number of nurses may have substance use disorders that could manifest as unsafe performance at work, and nurse supervisors lack the tools to assess a nurse's fitness to perform at work.

METHOD

Job analysis techniques were used to identify the critical impairment behaviours for the tool. Job analysis is a legally defensible, multi-stage process used in the organisational psychology field to develop work performance assessments.

RESULTS

A screening tool was developed for nurse supervisors to assess when a nurse may be questionably fit to perform.

CONCLUSION

The development of this checklist is one of several needed advancements in order to address the issue of fitness to perform and patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

The Common Risky Behaviour Checklist offers nurse managers assistance in protecting patient safety by providing a quick (one-page), systematic, behaviour-based method to collect information that can inform urgent decisions, trigger performance corrections and can complement formal organisational documentation processes in cases of unsafe practice due to substance abuse.

How do nursing students perceive substance abusing nurses?

Substance abuse among nurses was recognized by nurse leaders and professional nursing organizations as a growing threat to patient safety and to the health of the abusing nurse more than 30years ago. Although numerous studies on nurse impairment were published in the 1980s and 1990s, there was minimal focus on student nurses' perceptions about impaired nurses and less research has been published more recently, despite a growing rate of substance abuse. A quasi-experimental study to explore the perceptions of student nurses toward nurses who are chemically dependent was conducted using a two-group, pretest-posttest design. The Perception of Nurse Impairment Inventory (PNII) was completed by student nurses at the beginning of their junior course work, prior to formal education about substance abuse. The PNII was repeated after the students received substance abuse education. The PNII was also completed by a control group of sophomore student nurses who did not receive the formal substance abuse education. A repeated measures analysis of variance was used to measure the differences between the two groups of students. Students who received the education chose more compassionate responses on the PNII and were more likely to respond that an impaired nurse's supervisor is responsible for supporting and guiding the impaired nurse to access professional care. Discrepancies in study findings about the efficacy of education for effecting positive attitudes of student nurses toward impaired nurses may be related to the length and type of the education.

Inpatient physicians and nurses with dual diagnosis: an exploratory study

OBJECTIVE

This study explored the clinical features of physicians and nurses with dual diagnosis.  

METHODS

We conducted a retrospective review of 150 medical records of physicians (n = 120) and nurses (n = 30) admitted from February 2008 to February 2011 to the Barcelona Psychiatric Inpatient Unit for Health Professionals. Routine intake included the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and a clinical interview.  

RESULTS

The mean age of participants was 48.59 (SD = 8.9) years and 57.3% were male. Patients experienced substance dependence with alcohol (n = 112, 74.7%), sedatives (n = 59, 39.3%), cocaine (n = 24, 16%), other stimulants (n = 15, 10%), and opiates other than heroin (n = 16, 10.7%). About 41% (n = 61) also met criteria for a mental health disorder, mainly major depressive disorder (n = 42, 28%), while 8% (n = 12) had attention deficit hyperactivity disorder. A high proportion of physicians (n = 95, 79.2%) and nurses (n = 25, 83.3%) had nicotine dependence. The most common comorbidity was alcohol dependence and major depressive disorder. No differences were found between groups in the prevalence of substance use disorders, mental health disorders, and dual diagnosis.  

CONCLUSIONS

Dual diagnosis is a common condition among inpatient physicians and nurses with substance use disorders and its clinical presentation may be similar in both groups.

Can nurses trust nurses in recovery reentering the workplace?

OBJECTIVE

To examine the ability of working direct care nurses to trust nurses in recovery from substance use (or abuse) disorders (SUDs) reentering the workplace.

METHODS

A researcher-designed quantitative survey was used to gather data.

FINDINGS

Nurses said that they've worked with a nurse with SUD at some time in their career. Nurses are willing to trust their recovering colleagues and strongly agree that nurses in recovery should be allowed to return to the healthcare profession. Many nurses don't know how to provide help or where to locate support such as assistance programs or alternative-to-discipline programs for their impaired colleagues.

IMPLICATIONS

This study adds to the body of knowledge in the crucial issue of addiction in nursing. Healthcare institutions struggle with best practices in assisting nurses in recovery. By examining underlying issues such as trust, a better understanding of how to implement educational programs may emerge.

The prevalence of employed nurses identified or enrolled in substance use monitoring programs

BACKGROUND

For over 100 years, nurses' particular work conditions have been anecdotally associated with increases in substance abuse. Reasons include job-related stress and easy access to medications. Current research has suggested that prevalence of nurses with substance use problems is actually similar to, if not less than, that seen in the general population. However, given nurses' proximity to critical patient care, the potential threat to public health, as well as the current shortage of practitioners and problems related to retention, the lack of research on the effectiveness of the two existing treatment protocols (disciplinary and alternative-to-discipline [ATD]) is a pressing issue of concern to the nursing profession.

OBJECTIVES

The aims of this study were to estimate the 1-year prevalence of employed nurses requiring an intervention for substance use problems in the United States and the 1-year prevalence of nurses enrolled in substance abuse monitoring programs and to compare the sum total of nurses identified in disciplinary and alternative programs with the general population.

METHODS

This was a balanced stratified sampling design study. Measurements included the National Council of State Boards of Nursing 2010 Survey of Regulatory Boards Disciplinary Actions on Nurses, the 2009 annual reports of alternative programs, the 2008 National Sample Survey of Registered Nurses, and the 2009 National Survey on Drug Use and Health.

RESULTS

The 2009 1-year prevalence of employed nurses identified with substance use problems in the United States and its territories was 17,085 or 0.51% of the employed nursing population. The 1-year prevalence of nurses newly enrolled in substance abuse monitoring programs in the United States and its territories was 12,060 or 0.36%. Although every National Council of State Boards of Nursing jurisdiction has a disciplinary monitoring program, only 73% (n = 43) of these jurisdictions have alternative programs. Despite this, on average, alternative programs had nearly 75% more new enrollees (9,715) when compared with disciplinary programs (2,345). The prevalence of nurses identified with a substance use problem requiring an intervention (and likely treatment) is lower than the prevalence of those who report receiving substance abuse treatment in the general population (0.51% vs. 1.0%).

CONCLUSIONS

The ATD programs potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more nurses with substance use problems, thereby initially removing more nurses with substance use problems from direct patient care.

Nurses recovering from substance use disorders: a review of policies and position statements

The authors review policy initiatives and professional organization position statements that hospital and nursing administrators should be familiar with to respond effectively to public and policy-maker concerns about substance use in healthcare settings. Detecting and addressing substance use disorders proactively and systematically are essential for 2 reasons: to protect patient safety and to enable healthcare professionals to recognize problems early and intervene swiftly. The authors identify key points and gaps in existing policy statements.