Substance Abuse and Stress in the Nursing Profession

Introduction

The nursing profession is fraught with numerous difficult and burdensome situations. Among the conditions that create stress are heavy workloads, relationships with other healthcare professionals, leadership and management issues, the emotional demands of caring for patients with complex needs, and a perceived lack of adequate reward. Adding to these occupational stressors are the ordinary pressures of daily life and the changing, uncertain state of healthcare in America today. As these situations indicate, nurses face increasingly new challenges, and the profession has become progressively more stressful.

Most nursing professionals find appropriate methods of managing their occupational stress; however, some individuals turn to artificial means such as drugs or alcohol and thereby place their professional status in jeopardy. The purpose of this paper is to review this significant problem and to examine how the nursing profession currently handles those who find themselves facing substance abuse problems.

Literature Review

The fact that substance abuse is a significant problem has been well documented and studied by a number of academic experts (Bell, 1999; Trinkoff, 2000). The existence of these problems within the profession has been portrayed negatively by the mass media, and as a result, the profession has suffered accordingly (Associated Press, 2001; Dembner, 2002). Unfortunately, for too long the profession has denied the existence of such problems within its ranks. As a result, it has done very little to assist those who demonstrate symptoms of substance abuse on the job or to initiate programs for those who may have a tendency to gravitate toward substance use.

Job stress is not unique to the nursing profession. The American Psychological Association conducted a study in 2011 to measure the effect of stress in the workplace. That study found that 75% of all working Americans experience substantial stress (American Psychological Association, 2012). The study identified a series of costs and problems that develop as a result of work-related stress. Absenteeism, decreased productivity, and a multitude of physical problems — ranging from minor issues such as headaches and insomnia to major ones such as heart disease and stroke — were attributed to workplace stress. Those involved in the so-called helping professions, such as doctors, attorneys, accountants, and nurses, were identified as being particularly affected. Among this group, nurses are by far the largest faction, and examining and addressing stress among nurses should therefore be a major societal concern. Stress has been identified as the leading reason nurses leave the profession, which in turn has contributed to the profound nursing shortage that has developed in the United States since the late 1990s (Courchane, 2011).

It is highly likely that when an individual enters a particular profession or career, he or she does so motivated to succeed. This motivation can help one overcome a number of problems and frustrations; however, if the work environment is not supportive, that initial sense of motivation may not be sufficient, and job dissatisfaction, loss of confidence, and diminished enthusiasm can develop. Ultimately, stress is the likely result, and workers can expect to develop feelings of indifference and failure (Spinetta, 2000).

As noted above, nurses are measured to have the highest levels of stress among those engaged in the helping professions. Because the nursing profession encompasses a broad range of responsibilities and settings, stress-related problems are not universal across all specialties. Nevertheless, those who work in oncology, mental health, critical care, and emergency medicine are particularly vulnerable to the effects of stress (Browning, 2007).

What is it about the nursing profession that exposes its members so acutely to stress and early departure from the field? First, nurses spend an inordinate amount of time involved in direct patient care with individuals facing death, life-altering injuries, or extreme pain. They do so during long shifts and are frequently required to work overtime. These conditions are accompanied by high physical and emotional demands that too often leave nurses feeling fatigued and emotionally drained (Jennings, 2008). Second, recent changes in healthcare delivery have fostered a generalized feeling of disillusionment and uncertainty among members of the profession. This uncertainty has caused nurses to more quickly consider alternative options and to leave the profession prematurely (Mastach, 2003). Finally, although the nursing profession includes members of all genders, it remains dominated by women. As a result, the feminist movement has had an effect on increasing stress levels among nurses. One of the most visible effects has been a movement toward greater professional independence at all levels of nursing practice. Historically, nurses served under the authority of physicians and largely did so without resistance. This dynamic is changing as nurses assert greater independence and the nurse–physician relationship is transformed. As this process unfolds, however, it generates additional stress that compounds the stress already inherent in nursing practice.

Conclusion