SUBTANCE ABUSE AMONG REGISTERED NURSES

Subtance Abuse among Registered Nurses

Table of Contents

Chapter 1: Introduction5

Background of the Study5

Problem Statement6

Purpose of the Study6

Significance of the Study7

Research Question7

Theoretical Framework7

Chapter 2: Literature Review9

Key Terms and Concepts10

Levels of Care and Counseling Modalities12

Inpatient and Detoxification13

Residential14

Intensive Outpatient Programs15

Outpatient16

Opiate Replacement Programs17

Components of Counseling in Substance Abuse Settings17

Screening17

Assessment18

Assessing Motivation for Change19

Assessing Problems Related to Substance Use20

Counseling Practices and Approaches21

Recovery Dynamics22

Cognitive-Behavioral Approaches22

Motivational Interviewing and Motivationally Enhanced Treatment23

Social Skills Building24

Co-Occurring Mental Disorders24

Cultural Competency in Counseling for Substance Use Problems25

Risk for substance misuse among health care professionals26

Nurses' use of licit and illicit substances27

Chapter 3: Methodology36

Survey administration and response37

Sample description38

Non-respondents and representativeness of the respondent sample39

Measures40

Substance Use41

Symptoms and negative consequences of drinking41

Results42

Prevalence of substance use as related to type of nurse: RNs versus LPNs42

Use of licit substances42

Use of illicit substances43

Use of prescription drugs44

Use of OTC medications45

Substance use as related to nursing specialty and work setting46

Nursing specialty46

Work setting47

Substance use among nurses of different age groups47

Substance use as related to marital status49

Symptoms and negative consequences of alcohol use50

Chapter 4: Discussion54

Substance use prevalence related to type of nurse (RNs versus LPNs)54

Substance use as related to work setting and nursing specialty56

Substance use as related to age and marital status57

Negative consequences of alcohol use and dependence on substances58

Chapter 5: Conclusion61

Limitations of the Study61

Further Research Recommendations63

References65

Appendices72

Chapter 1: Introduction

Substance abuse among nurses has existed for at least 150 years. Historical research conducted by Church (1985) showed that intoxication on the job existed even during the mid-19th century when Florence Nightingale began her work. Substance abuse is a problem that is still present today.

Background of the Study

No one theory adequately explains the complex phenomenon of substance abuse impairment. Theoretical explanations have been focused on the unique relationship of people to their environment that results in maladaptive responses and impairment. Substance-related disorders are complex and no one identified set of risk factors account for them.

Problem Statement

The problem of nurses with substance-related disorders gained increased awareness in the 1980s when the American Nurses' Association (ANA) first addressed the issue. The ANA (1984) defined an impaired nurse as one who “has impaired functioning which results from alcohol or drug misuse and which interferes with professional judgment and the delivery of safe, high quality care” (p. 18). Research on impairment increased during the 1980s but was focused on identification, attitudes about, effects, and consequences of impairment. Little attention was given to the antecedents leading to impairment or interventions to prevent nurses from becoming impaired. The few studies that have indicated antecedents have not differentiated early from late antecedents.

Purpose of the Study

The purposes of this study were to investigate early risk factors that lead to substance-related disorders and to discriminate between impaired and non-impaired registered nurses based on those risk factors. Many nurses who become impaired are not identified until symptoms are already apparent and patients are at risk. For prevention and early detection of substance-related disorders, nurses must be knowledgeable about risk factors.

Significance of the Study

The ability to identify nurses who have early manifestations of impairment could lead to an increased understanding of when ...