An institutional ethnography of substance-use practices among nurses and related management intervention practices in a province in Western Canada

When nurses have problems with substance use and are reluctant to seek treatment, their health and wellness are put at risk and their care provision to the public is potentially compromised. Nurses’ substance-use problems and their management through professional organizations’ treatment programs are underresearched and poorly understood overall, and particularly from a Canadian perspective. The disjuncture I experienced between my own embodied experiential knowledge as a nurse and the conceptually based, decontextualized, individuated “official accounts” of the issue I found in the professional and scholarly literature became the problematic that I explored in a multiphase, manuscript-based doctoral study. I carried out a critical integrative review of the literature on nurses’ substance-use problems, followed by an institutional ethnographic inquiry, in which I aimed to discover (a) how dominant discourses in nurses’ talk about their everyday worlds organized their substance-use practices and (b) how nurses’ experiences were managed in a regulatory treatment program. I utilized data from interviews with 12 standpoint informants (nurses in a regulatory program for substance-use problems) and six secondary informants from different standpoints in the institution, as well as analyses of relevant institutional texts. This work yielded significant original findings. Dominant individuated, moralistic, decontextualized discourses in nurses’ talk about their everyday worlds and in professional and scholarly texts silenced nurses’ experiences of work stress. Employers’ roles in nurses’ working conditions were obscured. Nurses’ substance-use practices, particularly alcohol, were organized in ways that enabled them to silently manage their distress and keep working. Nurses gaining capacities to self-advocate for improved working conditions was linked to their recovery from substance-use problems. The standardized regulatory treatment program studied was not based on current norms of practice; did not afford nurses the right to choose treatments; privileged physicians while silencing and subordinating nurses; and was rife with conflicts of interest, power imbalances, and private corporate benefits—all acritically accepted by the regulatory body. The important new nursing knowledge gained informs prevention, treatment, regulatory, and education processes aimed to address nurses’ substance-use problems. It does so from nurses’ everyday knowledge and standpoint, furthering their interests and those of other disciplines concerned with professional power and domination.