Attitudes of Nurse Managers and Assistant Nurse Managers Toward Chemically Impaired Colleagues George Byron Smith

The purpose of this research was to determine attitudes among nurse managers and assistant nurse managers toward impaired colleagues in a descriptive correlational study method, using the Perceptions of Nursing lmpairment Inventory. The study revealed no significant differences in attitudes between groups; assistant nurse managers demonstrated a more disciplinary orientation toward impairment within nursing. Both groups tended to have supportive attitudes toward impaired colleagues. Racial/ ethnic origin had the most influence on nurse managers’ attitudes toward chemically impaired colleagues. ThePhilippine/Orientalgroup demonstrated a stronger need to know when a colleague is impaired or receiving treatment, exhibited less belief in the treatability of impairment and displayed a stronger belief in impairment as a personality weakness. [Keywords: attitudes; impaired practice; supervision/admin istrationl

*

T

he increasing incidence of chemical dependency within nursing required the profession’s immediate concern and attention. Attitudes toward chemical dependency in nursing are important factors that influence institutional and professionalresponses to nurses impaired by chemical abuse (Hughes & Sullivan, 1989).With the shortage of nurses, it has become increasingly important to preserve valuable nurses within the profession. The profession’s focus must be directed equally at preventing chemical dependency and fostering the successful return to practice of the recovering impaired nurse. Negative attitudes toward chemical dependency may act as barriers to the identification, intervention,referral, rehabilitation and re-entry of the impaired nurse into the profession (Hughes & Sullivan, 1989). Nurse managers who understand the process of chemical dependency and are able to form positive attitudes toward chemical abusers will be able to be more supportive and more effective in supervising impaired nurses during their recovery. For a nurse manager to be supportive, there must be some belief that chemical abuse is treatable and that nurses affected by it are worth saving (Cross, 1985).

Review of Literature In the past 10 years, the nursing profession has made steady progress in identifying, intervening in and addressing the problems in nursing practice that result from addictive disease in its members (Haack & Hughes, 1989). The precise number of chemically dependent nurses is difficult to ascertain due to the associated social stigma and to denial which is a characteristic defense. The prevalence of chemical impairment in nursing is on IMAGE: Journal of Nursing Scholarship Volume 24, Number 4, Winter 1992

* the rise. Nurses are disproportionately (two to three times) more likely than the general public to become impaired due to chemical dependency (Caroselli-Karinja & Zboray, 1986). An estimated 40,000 to 75,000 chemically impaired nurses are currently in the work force (O’Connor & Robinson, 1985). A survey of state boards of nursing found that 67 percent of all disciplinary actions in 1985 were related to alcohol or drugs (Sullivan, Bissell &Williams, 1988).The American Nurses’ Association estimates that about six to eight percent (about 120,000 to 160,000)of the registered nurse population has a drug- or alcohol-related problem (Haack & Hughes, 1989). Many believe this to be a conservative figure since many nurses are ignored, fired or asked to resign instead of being reported to their state boards. Sample and Manchester (1985) state that our attitudes, experiences and values have been shaped by the society in which we live and work, as well as by the professional tenets that guide our practice. In 1982 the American Nurses’ Association adopted a resolution urging the states to develop guidelines for peerassistance programs. Endorsement by the nursing organization has provided motivation and support to nurse managers and executives striving for a more enlightened view of chemical dependency within the profession through the development of impaired nurse programs or committees (Naegle, 1989). Although the associations address all forms of impairment, includGeorge Byron Smith, RN, MSN, Alpha Delta, Delta Beta, is Assistant Nurse ManagedProgram Specialist at HCNUniversity of South Florida Psychiatry Center. The author gratefully acknowledges Helen Kee, RN, PhD, Elizabeth Knebel, RN, EdD, Harold Levine, MPA and Jerry Lester, PhD for their assistance in this research project. Correspondence to 1801 Morrison Avenue, Tampa, FL 33606-2829.

295

Attitudes of Nurse Managers and Assistant Nurse Managers Toward Chemically impaired Colleagues

ing those attributed to psychiatric problems, the majority of referrals are for drug and alcohol abuse (Sullivan, Bissell & Williams, 1988). Surveys of health professionals indicate that most nurses view chemical dependency as a treatable disease unless the abuser is a nurse (Curtin, 1987). Nurses reported strong support of disciplinary measures against nurses for impairment resulting from chemical dependency than for impaired functioning caused by emotional distress (Hendrix, Sabritt, McDaniel & Field, 1987). Nurses have been described in a few studies as being moralistic, pessimistic, stereotypical and authoritarian toward substance abusing patients (Biener, 1983; Cornish and Miller, 1976; Wallston, Wallston & DeVellis, 1976; Wechsler and Rohman, 1982). Despite the current trend of the nursing profession to develop peer-assistance programs for impaired nurses, little is known of nurses’ attitudes toward chemical dependency and impaired nurses. Reisman and Shrader (1984) reported a relationship between industrial nurses’ attitudes toward alcoholism and the rate of referrals made by those nurses for industrial plant employees. Nurse managers and assistant nurse managers can only assist in rehabilitating an impaired colleague to the extent that they understand their own attitudes toward chemical dependency and impaired colleagues. There is a lack of understanding of addictive diseases, the attitude of nurses toward chemical dependent individuals is generally negative. In a study conducted by Sullivan and Hale (1987) nurses indicated that their attitudes toward chemical dependency may now be more positive than those reflected in previous studies. Hughes and Sullivan (1989) found that although most chief nurse executives reported generally positive attitudes toward chemically dependent nurses, their responses to questions on nursing impairment were not strongly correlated with their attitudes. There is very little research of nurse managers’ attitudes toward chemical dependency. Cannon and Brown (1988) found that nurse managers and supervisors have more negative attitudes toward impaired colleagues than staff nurses. Walsh (1989) found staff nurses to be more moralistic than nurse managers or nurse faculty. Nurse managers also held generally more optimistic attitudes than staff nurses. This research is an attempt to expand the current knowledge by examining attitudes of nurse managers toward impaired colleagues.

Theoretical Framework Jellinek’s Disease Model of Alcoholism (1960) was used because alcoholism and related chemical dependencies are primary, chronic and fatal diseases which affect all areas of life: physical, social, cultural, emotional and spiritual. The disease model of alcoholism is a widely accepted model of addiction and chemical dependency (Naegle, 1988). Jellinek demonstrated the correlation of alcoholism with the epidemiologic model of disease as a function of the development of tolerance and physical dependence. Jellinek described the following four phases of alcoholism: prealcoholic phase, early alcoholism, frank addiction and chronic illness. Mello and Mendelsohn (1979) indicated that other forms of chemical dependency are not

different from alcoholism. According to White (19851, only in the last few years has chemical dependency changed from being a moral or ethical problem to a medical problem and a disease that can be treated, resulting in the restoration of health. Green (1989) pointed out that chemical dependency is a primary disease process in and of itself, and not merely a symptom of underlying pathology. Nurses have frequently been misdiagnosed and treated for depression or personality disorderswhile the addictivediseasehas gone untreated (Sullivan, Bissell & Williams, 1988). Stereotypic and stigmatic attitudes toward chemical dependency contribute both directly and indirectly to the lack of response to chemical dependency in the nursing profession (Hughes & Sullivan, 1989).Lacking basic information on chemical dependency as a primary disease process, most nurse managers remain in ignorance, not knowing there is a body of knowledge available on intervening and treating addictive disease (Reed, 1986). Educational exposure to chemical dependency as a primary disease process is lacking in the curricula of nursing schools, resulting in failure to address the needs of patients and colleagues (Murphy, 1989). Negative attitudes associated with chemical dependency may impede recovering nurses’ re-entry into the professional nursing work force (Shaffer, 1988). The successful return to practice and prevention of relapse of the recovering chemically dependent nurse may depend on how well nurse managers can offer support and provide positive leadership for their followers. The specific research study questions were: 1. What are the attitudes of nurse managers and assistant nurse managers toward impaired colleagues? 2. How do selected characteristics (e.g., age, gender, race, education, years in nursing, years in nursing management, institution size and experience with chemical dependency) affect attitudes of nurse managers and assistant nurse managers toward impaired colleagues?

This descriptive correlational study attempted to describe attitudes of nurse managers and assistant nurse managers toward impaired colleagues. The demographic characteristics of age, gender, race, education, years in nursing and institution size were examined in relation to attitudes. These variables have been demonstrated in other studies to affect nurses’ attitudes toward chemical dependency and impaired colleagues (Cannon, 1987; Hendrix, et al., 1987; Sullivan & Hale, 1987; Walsh, 1989). In addition, years in nursing management and experience (or lack of experience) with impaired nurses and family members were examined for possible influence in nurse managers’ attitudes. Setting and Sample

The setting for this study was in a large southwestern urban county in Texas. The sample of 400 nurses was selected randomly from a computerized roster of nurse managers and assistant nurse managers from Ihe Texas State Board of Nurse Examiners. Due to the confidentiality of the returned questionnaires, the characteristics of the non-respondents were not possible to determine. The titles of participants were self-defined by the respondents IMACE:/ourna/ofNursing Scholarship. Volume 24, Number 4, Winter 1992

Attitudes of Nurse Managers and Assistant Nurse Managers Toward Chemically Impaired Colleagues

with nurse managers being individuals who held 24-hour accountability and responsibility for a division or unit and assistant nurse managers being individuals who had a shift, or 8-hour, accountability and responsibility for a division or unit. The participants’ demographic data are closely representative of nurses in Texas except that in rural areas of Texas the Philippinel Oriental nurses represented less than one percent of nurse managers and assistant nurse managers and a larger percentage of Texas nurse managers held a Diploma or A.D.N. Degree compared to the sample. The 400 nurses represent two percent of nurses in Harris County, Texas. Instruments

The Perceptions of Nursing Impairment Inventory was the research instrument used to collect information regarding attitudes among nurse managers and assistant nurse managers. This instrument was developed by the Nurses Assisting Nurses project sponsored by the University of Kentucky College of Nursing in cooperation with the Kentucky Nurses’ Association and the Kentucky Board of Nursing. The Perceptions of Nursing Impairment Inventory is a 32-item questionnairepresented in Likert-typewith four response options from “strongly agree” to “strongly disagree” (Hendrix, Sabritt, McDaniel &Field, 1987).The 32 statementsare divided into nine factors without overlapping. Factor 1 (6 items), DiscipZinary Orientation, represented a belief in the necessity or efficacy of action involving the impaired nurses’ employment or licensure status. Factor 2 (6 items), Orientation to Helping Responsibility within the Profession, centered on the responsibility of peers, supervisors and licensure boards to facilitate assistance for impaired nurses. Factor 3 (4 items), Distinctive to Nursing Dimension, represented a perception of impairment as a phenomenon with antecedents specific to nurses’ lives and work. Factor 4 (3 items), Orientation to the Need to Know, represented beliefs in the importance of awareness by peers and supervisors when a nurse is suspectedof impairment or is receiving treatment. Factor 5 (3 items), Treatability Orientation, characterized a belief that impaired nurses can be helped, and that they can be productive and trustworthy after treatment. Factor 6 (4 items), Orientation to the Nurse’s Ability to Help, represented the belief that nurses can assist their impaired colleagues, and that this can be facilitated by insights particular to nursing. Factor 7 (2 items), Perception of Prevalence, involved the belief that impairment is widespread. Factor 8 (2 items), Orientation to Impairment as Illness, represented the rejection of the contrasting view of impairment as a personality weakness. Factor 9 (2 items), Perception of Recognizability, represented the belief that impairment is likely to be reported and that it can be detected through a nurse’s behavior. This instrument has been used in approximately 60 additional studies on different nursing populations throughout the country. It has only face validity since it has not been formally standardized(M.J. Hendrix, personal communication, January 1991). A Cronbach alpha reliability coefficient of .82 has been obtained for this instrument (Hendrix, et al., 1987). The study protocol was reviewed and approved by an University Human Subject Review Committee. After approval for the study, packets consisting of a cover letter explaining the research IMAGE: journal of Nursing Scholarship Volume 24, Number 4, Winter 1992

purpose and the subject’s rights, and the instrument with instructions were mailed to 400 nurse managers and assistant nurse managers. Two weeks after the initial mailing, a reminder letter with extra questionnaires was mailed.

Results Of the 400 nurses contacted, 55 could not be located, had moved out of the countylstate or were no longer nurse managers. A total of 216 nurse managers and assistant nurse managers responded, but two questionnaireswere incomplete and could not be included in data analysis. The remaining 214 questionnaires represented a response rate of 62.6 percent. The demographic data is described with frequency distributions and percentages (Table 1).The sample was divided into two groups with 119 (56 percent) of the respondents holding a nurse

Table 1: Demographic Characteristics of Sampk (N = 24) C haraderistics

Freuuencv

Age 28 - 39 years old 40 - 49 years old 50 - 59 years old 60 69 years old

102 55 41 7

48 26

9

4

147 32 7 21 7

69 15 3 10 3

46 46

22 22 49

-

Missing

Percent

19

3

Race/Ethnic Background Caucasian Black American Hispanic Philippine/Oriental Other

NursingDegree R.N.Diploma A.D.N. B.S.N. M.S.N. Yeanof NursingService Less than 5 years 6 to 10 years 11 to 15 years Over 15 years

105 17

7

6

3

38 53

I8 25 54

117

PdeSiOdPasition NurseManager Assistant Nurse Manager

119

9s

96 64 30

Lessthan 5 years bto10years 11 to 15 years Over 15 years

24

InstiMionSizr Ot0200bedS 201 to400 beds 401 to 600 beds 601 to 800 beds 801 to 1,ooobeds over 1,001 beds

40 45 18 17 27

67

56 44

45 u)

14 11

31 19 21

a 8 13

297

Attitudes of Nurse Managers and Assistant Nurse Managers Toward Chemically Impaired Colleagues

statement that the supervisor has a responsibility to dismiss an individual immediately when he/she has concrete evidence the nurse is impaired. The mean scores for the racidethnic groups on four of the nine factors of the Perceptions of Nursing Impairment Inventory are presented in Table 3. These findings show that as a group, Non-Caucasians were less likely to believe the illness concept of impairment, the treatability of impairment, nursing colleagues’ ability to assist the impaired nurse and the recognizability of the impaired nurse. When racelethnicity was collapsed to Caucasian and NonCaucasian groups, Chi-square analysis revealed a significant statistical difference in the scores on these four factors. One-way ANOVAs were also significantly different for Factor 4, Orientation to the Need to Know; Factor 5, Treatability Orientation; and Factor 8, Orientation to Impairment as Illness with racialfethnic background. For Factor 4, the Philippinel Oriental group (Mean = 4.67) showed a greater need for awareness when a nurse is suspected of impairment or receiving treatment then the Black American group (Mean = 5.97) and the Caucasian group (Mean = 5.77). For Factor 5 , the Philippinel Oriental group showed less belief in the treatability of impairment then the Caucasian group. For Factor 8, the Philippine/ Oriental group (Mean = 4.09) showed a greater belief in impairment as a personality weakness then the Caucasian group. The Black American group did not demonstrate significant differences for Factors 5 to 8 (Table 3). There was a statistically significant correlation between experience with a family member having an alcohol and/or drug problem and racidethnic background (1-=.361,p.05), suggesting that those working in larger institutions may be more likely to believe that impairment in nursing is readily reported and that impairment can be detected through a nurse’s behavior. Other trends and difference in opinions on selected statements are seen in Table 4. The sample believed that the profession has a responsibility to help impaired colleagues: 94 percent agreed that the State Board of Nursing should include referrals and

Table 2: Summary of Mean Scores for the Nine Factors of the Perceptions of Nursing Impairment Inventory Nurse Manaaers FACTORS (RANGE)

Total

Manager

Sample

-

-

x

Assistant Nurse

X

SD

-.

.

SP. X

SD

14.67 *

2.30

14.93*

2.05

14.79

2.20

8.84

2.04

9.14

2.13

8.97

2.08

8.70

1.24

8.81

1.65

8.75

1.43

Factor4 13-12) Need to Know

5.65

1.38

5.67

1.41

5.66

1 -39

Fitdm 5

8.94

1.14

8.85

1.?5

8.90

1.15

9.74

1.60

9.82

1.45

9.77

1.53

5.69

0.81

5.70

0.84

5.69

0.82

4.63

0.89

4.70

0.81

4.46

0.86

4.94

1.00

4.87

1.02

4.91

1.01

Factor1

(6-241

Disciplinary

Fador 2

16-24)

Help Responsibilily

Factor 3

(4- 16)

NursingDimension

(3-1 2 ) Treatability

Factor 6

14-16)

NursingHelping

Factor 7

12-8)

Prevalence

Factor8 Lz-8) Illness

Factor9

12.8)

Reccgnizability

‘R2.045

Pc .05

manager position and 95 (44 percent) holding an assistant nurse manager position. In the total sample, 45 percent of participants had been in their positions for less than five years. Two-thirds (65 percent) of the respondents indicated past experience in working where a co-worker had a drug and/or alcohol problem. Half (52 percent) reported past experience with a family member who had a drug and/or alcohol problem. Seventy-one percent indicated they knew about the state’s Peer Assistance Program for Impaired Nurses. The mean scores for the nurse managers, assistant nurse managers and the total sample on the nine factors of the Perception of Nursing Impairment Inventory are presented in Table 2. Although the management groups differed significantly in the perceived need for discipline (Factor l), neither group demonstrated a belief in punishment of the impaired colleague. As a group, 19 percent of the respondents agreed with the statement that public safety should require that impaired nurses’ licenses be revoked; 65 percent of the respondents disagreed with the

Table 3: Mean Scores by Racialfithnic Background for Factor 5,6,8

and 9 of the PerCeptimuf Nursing lmpahnent Inventory

Philippine Caucasian

FACTORS Fa& 5 [TreatabililyOientatiim)

Factor 6

x

Non-Caucasian -

-. SD

. .

!&&

Oriental

X

SD

X -

_.

Other

HisDanic

SD

x

SD

-

x

SD

-

X -- SD ._I_-. -

9.01

1.12

8.66

1.17

am

1.30

8.91

1.09

9.14

0.90

8.71

0.95

9.95

1.38

9.39

1.77

9.00

1.82

9.50

1.76

9.86

1.95

9.57

1.62

4.77

0.79

4.42

0.95

4.10

0.83

4.39

1.02

5.14

0.69

4.86

0.69

5.06

0.93

4.60

1.10

4.38

1.20

4.76

0.94

4.71

1.1 1

4.29

1.50

[Nurse’sAbility to Help1

Factor a [ImpairmentarIllness)

Factor 9 Recognizability)

298

1MAGE:lournalofNursingScholarship. Volume 24, Number 4, Winter 1992

Attitudes of Nurse Managers and Assistant Nurse Managers Toward Chemically Impaired Colleagues

Table 4: Selected Statements about Nursing Impaimrent Statement

Aaree

WhiIe receivingtreatment, most impaired nurses are capableof continuingtowork as registered nurses.'

51.9%

When a nursing supervisor suspects that a nu= is impaired,ho/she hara responsibilityto helpthatperson receiveassistance."

97.7%

"Impairednurwscanh beunderstoodas peoplewho suffer from an illness."

95.3%

"When made aware of a co-worker's impairment, fellow num are often abletoofferassistance."

53.8%

36.9% 'Impaimnt isawidespreadproblem amongnurses."

31.7%

'Impairment is generally a result ofa weakness in the nurse'spersonality."

19.6%

'I could probably recognize an impaired nurse in the work setting by hisher appearance or behavior.'

M.WO

lmpainnent, when it occurs, is more likely to be reported in nursingthan in other health related fields."

51 .o%

sources of assistance to impaired colleagues and 91 percent agreed that the State Board of Nursing should provide resources to support research on the prevention and treatment of impaired colleagues. In addition, the respondents believed that impairment is treatable with 95 percent of the respondents disagreeing with the statement that even after treatment it is unusual for an impaired nurse to be productive and trustworthy and 97 percent disagreeing with the statement that there is little that can be done to help nurses who are impaired. The response to the Perception of Prevalence Factor indicated a trend toward the belief that impairment occurs in nursing with the same frequency as in other health-related fields with 85 percent disagreeing that impairment occurs less frequently in nursing than in other health-related fields.

Discussion The purpose of this research was to investigate and determine nurse managers' and assistant nurse managers' attitudes toward chemically impaired colleagues by comparing their attitudes and by examining the attitudes as a group. Results indicated no significant difference in attitudes among nurse managers and assistant nurse managers toward impaired colleagues except assistant nurse managers tend to have a more disciplinary orientation toward impairmentwithin nursing than do nurse managers. However, neither group seemed directed toward the punishment of their impaired colleagues. The finding on disciplinary orientation in previous studies on attitudes of nurses and nurse managers toward impaired colleagues are mixed. Walsh (1989) IMAGE: /ourna/ of Nursing Scholarship Volume 24, Number 4, Winter 1992

found that nurse managers and nurse faculty were less moralistic and less oriented toward disciplinary action than staff nurses. Hendrix, et al., (1987) demonstrated that nurse managers were more likely than staff nurses to perceive a need for disciplinary action in responding to nursing impairment. On the basis of the data obtained, it appeared that nurse managers as a group generally had supportive attitudes toward impaired colleagues. This generally supportive attitude toward the chemically dependent nurse supports findings from perceived studies (Walsh, 1989; Cannon, 1987; Cannon & Brown, 1988; Hendrix, et al., 1987; Sullivan & Hale, 1987). The group tended to favor the profession's responsibility to help impaired nurses, the treatability of chemical impairment in nursing, and the concept of chemical dependency as an illness. These findings are consistent with Cannon and Brown's study (1988) of registered nurses in Oregon. The groups collectively disagreed on two of the factors. These factors were the Perception of the Prevalence of Impairment within nursing and the Ability to Recognize Impairment in colleagues. This finding lends strong support to increasing education in institutions and nursing schools on chemical dependency and impairment within nursing. Nurse managers and assistant nurse managers have not effectively been trained to deal with impaired nurse colleagues. Education and training is an important factor in providing nurse managers with the skills to effectively work with and support impaired nurses under their supervision. Analysis of the relationships between demographic variables and attitudes revealed some unexpected findings. The variable raciaYethnicbackground had the most effect on the attitudes held by the respondents. The Philippine/Orientalgroup demonstrated a strong need to know when a colleague is impaired or receiving treatment, exhibited a lesser belief in the treatability of impairment and displayed a strong belief of impairment as a personality weakness. These findings may be indicative of the strong values held by the Philippine/Oriental culture of chemical dependency being a moral and personality weakness, instead of a disease (Akutsu, Sue, Zane and Nakamora, 1989; Bennett and Ames, 1985). The Black group also was less likely to believe in the illness concept and treatability of impairment. Studies have shown that Blacks believe alcoholism and chemical dependency are personality weaknesses (Harve, 1985) and that alcoholics and drug addicts are morally weak (Blum, Roman & Bennett, 1989). Education about chemical dependency in nursing will need to take cultural differences into account. Knowledge of the state's Peer Assistance Program for Impaired Nurses positively influenced the respondents' attitudes toward impaired colleagues. Nurse managers and assistant nurse managers who knew about the state's Peer Assistance Program had a strong orientation toward helping the impaired nurse and toward the profession's ability to help the recovering chemically dependent nurse. This trend could be construed as an indication that the peer assistance program is accomplishing its goal of educating nurses about the disease of chemical dependency and the role of the program in the nursing profession. Respondents working in larger institutions tended to believe they could recognize impairment in colleagues more readily then their counterparts.This may be a result of peer assistance and chemical - 299

Attitudes of Nurse Managers and Assistant Nurse Managers Toward Chemically Impaired Colleagues

dependency inservices offered more freely in larger institutions than in smaller ones; however, further research is needed to explore this finding. Age, years of nursing experience and education were not significant in this study as has been found in other studies on attitudes of nurses toward nursing impairment (Cannon, 1987;Walsh, 1989;Cannon andBrown, 1988;Hendrix, et al, 1987). Recommendations for further study would include increasing the sample size and replication of the study in various areas of the country. In future studies, a comparison between attitudes of nurse managers who work in states with peer assistance programs and those nurse managers who work in states without peer assistance programs should be investigated. The possible cultural influences on nurse managers’ and assistant nurse managers’ attitudes deserve further exploration. Additions to the demographic data may include asking the subjects if they are recovering from chemical dependency; if they have experienced a friend with an alcohol and/or drug problem; and if their experiences with chemical dependency have been positive or negative. Future studies might include demographic data on the attendance at inservices and courses offered in the subject’s nursing school curriculum on chemical impairment in nursing and peer assistance. In conclusion, this study demonstrated that nurse managers and assistant nurse managers have generally supportive attitudes toward impaired colleagues. Nurse managers should be cognizant of their attitudes toward impaired colleagues to adjust appropriately their leadership to meet the needs of the impaired nurses under their supervision. Attitude changes cannot occur without proper education in the nursing school cumcula at all levels and in health care organizations. Educational programs must include addictive diseases generally and chemical dependency in nursing specifically. Nurse managers and assistant nurse managers with supportive attitudes can assist in helping impaired colleagues through identification, intervention, referrals, rehabilitation and reentry into the work force. As nursing management and the nursing profession are able to develop more compassionate attitudes toward impaired colleagues, more chemically dependent nurses will be able to obtain help instead of leaving the profession, being prosecuted or dying from addiction. @$Q

References

Akutsu, P.D., Sue, S., Zane, N.W.S. & Nakamora, C.Y. (1989). Ethnic differences in alcohol consumption among Asians and Caucasians in the United States: An investigation of cultural and physiological factors. Journal of Studies on Alcohol, 50,261-267. American Nurses’ Association (1984). Addictions and psychological dysfunc-

300

tions in nursing: The profession’s response to the problem. Kansas City, MO. Author. Bennett, LA. & Ames, G.M. (1985) The American experience with alcohol: Contrasting cultural perspectives. New York: Plenum Press. Biener, L. (1983). Perceptions of patients by emergency room staff Substanceabusers versus non-substance abusers. Journal of Health and Social Behavior, 24,264-275. Blum, T.C., Roman, P.M. & Bennett, N. (1989). Public images of alcoholism: Data from a Georgia survey. Journal of Studies on Alcohol, 50,5-14. Cannon, B.L. (1987). Attitudes of registered nurses toward suhstance abuse and impaired nurses. Unpublished master’s thesis, The Oregon Health Sciences University, Portland, OR. Cannon, B.L. & Brown, J.S. (1988). Nurses’ attitudes toward impaired colleagues. Image: Journal of Nursing Scholarship, 20,96-101. Caroselli-Kariqja,M.F. & Zboray, S.D. (1986).The impaired nurse. Journal of Psychosocial Nursing, 24(6), 14-19. Cornish, RD. & Miller, MeV. (1976). Attitudes of registered nurses toward the alcoholic. Journal of Psychiatric Nursing and Mental Health Services, 14(12), 19-22. Cross, L. (1985). Chemical dependency in our ranks: Managing a nurse in crisis. Nurshg Management, 16(11), 15-16. Curtin, L.L. (1987). Throw-away nurses? Nursing Management, 18(7), 7-8. Donaldson,M A C . (1983).A comparisonof attitudes of nurse managersand staff nurses toward nurses who are chemical abusers. Unpublished master’s thesis, University of Southern Mississippi, Hattiesburg, MS. Green, P. (1989). The chemically dependent nurse. Nursing Clinics of North America, 24(1), 81-94. Haack,M.R. & Hughes, T.L. ( 1989).Addictionin the nursingprofession.New York Springer Publishing Co. Harve, W.B. (1985). Alcohol abuse and the black community: A contemporary analysis. Journal of Drug Issues, 15,81-91. Hendrix, MJ., Sabritt, D., MeDaniel, A. & Field, B. (1987). Perceptions and attitudes toward nursing impairment. Research in Nursing and Health, 10, 323-333. Hughes, T.L. & Sullivan, EJ. (1989). Attitudes toward chemically dependent nurses: Care or curse? In M.R. Haack & T.L. Hughes (Eds.), Addition in the nursing profession, 20-34, New York: Springer Publishing Co. Jellinek,E.(1968). Thediseaseconceptofalcoholism.NewBrunswick: Hillhouse Press. MeUo, J. & Mendehhn, J. (1979).In the diagnosis and treatment of alcoholism. New York: McGraw-Hill. Murphy, S.A. (1989). The urgency of substance abuse education in schools of nursing. Journal of Nursing Education, 28,247-25 1. Naegle, M.A. (1988).Theoretical perspectives on the etiology of substanceabuse. Holistic Nursing Practice, 2(4) 1-13. Naegle (1989). Professionalissues, ethical constraintsand legal considerations.In M.R. Haack&T.L. Hughes (Eds.),Addictioninthenursingprofession,1-19. New York: Springer Publishing Co. O’Conner, P. & Robinson, R.S. (1985). Managing impaired nurses. Nursing Administration Quarterly, 9(2), 1-9. Reed, M. (1986).Descriptivestudy of chemicallydependentnurses: Psychiatric nursing research. New York John Wiley and Sons. Reisman,B. & Shrader,R. (1984).Effects of nurses’ attitudestoward alcoholism on their referralrate fortreatment. OccupationalHealthNursing,32,273-275. Sample, S. & Manchester, E. (1985).Addictions and psychologicaldysfunction in nursing. Nursing Administration Quarterly, 9(3), 30-31. Shaffer, S. (1988). Attitudes and perceptions held by impaired nurses. Nursing Management, 19(4), 46-50. Sullivan, EJ. & Hale, R.E. (1987). Nurses’ beliefs about the etiology and treatment of alcohol abuse: A national study. Journal of Studies on Alcohol, 48,456-460. Wallston, K., Wallston, B.S. & DeVellis, B.M. (1976). Effect of negative stereotype on nurses’ attitudes toward an alcoholic patient. Journal of Studies on Alcohol, 37, 659-665. Walsh, I.F.Y. (1989). Attitudes among nurses toward substance abuse. Unpublished master’s thesis, University of Texas Medical Branch, Galveston, TX. White, M.S. (1985). The disease of chemical dependency: Recovery to restoration. Nursing Administration Quarterly, 9(2), 38-41.

IMAGE:JournalofNursingScholarship. Volume 24, Number 4, Winter 1992

Attitudes of nurse managers and assistant nurse managers toward chemically impaired colleagues.

The purpose of this research was to determine attitudes among nurse managers and assistant nurse managers toward impaired colleagues in a descriptive ...
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