Nursing under the influence: understanding the situation of Alberta nurses

  • Author / Creator
    Kunyk, Diane
  • Nursing under the influence is a serious professional practice issue as it threatens patient safety and nurse health. Relational ethics, an applied ethic that situates ethical action within relationships while recognizing the interdependent environment, guided questioning regarding moral obligations for public safety and nurse health as well as fitting organizational responses. This ethical reflection guided a literature review that revealed the area lacks in-depth examination, particularly within the Canadian context. As a result, this research studied the prevalence of substance use disorders among Alberta nurses, risks to patient safety and nurse health, nurse perceptions of impaired practice, and nurse perceptions of support from their employer, college and association, and union. Nurses were recruited to an Internet survey through convenience sampling using multiple modalities. The 4,064 responses exceeded the minimum sample size required for statistical analysis to be meaningful. The prevalence of self-identified substance use disorders within the last 12 months among nurses was similar to the general population. Most nurses with self-identified substance dependence were currently practicing in nursing positions. The health of nurses with substance use disorders was compromised on measures of mental health, chronic pain, and smoking when compared with their nurse-peers. They were, in general, practicing among a community of nurse-peers who recognize the treatability of substance use disorders, organizational obligations to help, and who supported confidentiality. Although identifying and restricting impaired practice was acknowledged as necessary, nurses were not confident with their abilities to recognize or intervene when it occurs. Nurses perceived their practice environment as having uncertain support from their employer, and college and association; these perceptions were more pronounced for nurses with substance use disorders. Higher levels of support from the union were perceived by the sample. Study findings question the fit of current organizational responses, based on a hegemonic framework with a primary focus on dealing with and/or disciplining the individual, for dealing well with the situation. It is suggested that organizational policies more closely aligned with nursing ethical values, and that take into account the role of the interdependent environment, hold promise as more fitting responses.

  • Subjects / Keywords
  • Graduation date
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
    • Faculty of Nursing
  • Supervisor / co-supervisor and their department(s)
    • O'Brien, Beverley (Nursing, University of Alberta)
    • Austin, Wendy (Nursing, University of Alberta)
    • Reah, Trish (Business, University of Alberta)
    • Els, Charl (Medicine and Dentistry, University of Alberta)
  • Examining committee members and their departments
    • Mayan, Maria (Extension, University of Alberta)
    • Mill, Judy (Nursing, University of Alberta)
    • Rodney, Patricia (Nursing, University of British Columbia)