Substance use/abuse among nurses is a problem of growing concern. Nurses addicted to legal substances (e.g., tobacco) cannot serve as effective models of healthful behaviors, while impaired nurses represent a potential hazard to their patients, their colleagues and themselves. This proposal describes a study designed to examine factors related to substance use/abuse in female nurses. Our conceptual framework is derived from Marlatt and Gordon's (95, 96) cognitive-behavioral model of relapse prevention. In this model stress is posited to be a direct contributor to substance use/abuse while the individual's coping strategies and sense of self-efficacy are moderators of the contribution of stress. If coping is ineffective and self-efficacy low, then stress is more likely to lead to substance use/abuse. The study employs a prospective cohort design, involving repeated assessments (baseline and 12 months) of 2,585 nurses, to test a conceptual model of interrelationships among stress, coping, self-efficacy and substance use. The model will be tested for work and nonwork situations. A thorough assessment of the psychometric properties of the measures, particularly with regard to the target population of female nurses, and related refinement of constructs and of the model will also be undertaken. Nurses will complete mailed surveys of the variables outlined above. Both waves of data will be organized into higher-order, latent variables and analyzed in a linear panel analysis model. The model will be tested both for contemporaneous effects and time-lagged effects over a 12-month interval. The research outlined in this proposal provides a conceptually derived and methodologically rigorous assessment of variables related to risk for substance use/abuse in nurses. This study has implications for the understanding, preventing and treating of substance abuse in nurses and other health-related professionals who function in high-stress work situations.
