Date of Award

January 2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Glenda N. Lindseth

Abstract

The purpose of this grounded theory study was to explicate a substantive theory/model that describes the basic social processes (BSP) operating when a registered nurse (RN) re-enters the workplace following completion of substance use disorder (SUD) treatment. There are a reported 2.6 million RNs employed in the U.S (U.S. Department of Labor, 2014). Over the past 25 years, prevalence studies have found up to 10% of nurses will meet diagnostic criteria for SUD, similar to prevalence rates in the general population. SUDs among nurses present challenges to society and to the nursing profession. State boards of nursing operate primarily to protect the public but also work to preserve the careers of substance dependent nurses by encouraging SUD treatment and recovery. A majority of states now have in place alternative-to-discipline programs to assist nurses during SUD treatment and to provide monitoring afterwards. Little research has been done on work re-entry for nurses following SUD treatment; no qualitative studies have been done that explore work re-entry from the perspective and experiences of the nurse.

The research questions of this study identified the experiences in actualizing workplace re-entry, including what processes helped and what processes hindered work re-entry. Symbolic interactionism and pragmatism provided the theoretical and philosophical foundation for the study. Twenty-two RN participants (4 males, 18 females) who had completed SUD treatment and had a work re-entry experience were interviewed. The audio-taped, transcribed interviews were analyzed using a constant comparative method using the grounded theory approach of Strauss and Corbin (1990, 1998). Open, axial, and theoretical coding led to the emergence of axial and theoretical models that described the processes of work re-entry for participants.

Findings of the study explicate participant experiences from two perspectives: unsuccessful and successful work re-entry as two separate theoretical models emerged during data analysis. All study participants eventually experienced successful work re-entry. The core variable of the unsuccessful work re-entry theoretical model was “lacking self-redefinition” as a person with SUD, an internal process reinforced by stigma, shame and fear, and characterized by limited use of recovery strategies and reluctance to follow monitoring mandates or disclose SUD status. The core variable of the successful work re-entry theoretical model was “self-redefinition,” defined by internalization and acceptance of self as a person and a nurse with a SUD. Properties of self-redefinition included altered (re-defined) definitions of perceptions, values, and priorities, responses to recovery processes, and professional relationships and processes.

The findings of this study have implications for multiple aspects of nursing: regulation, education, and practice, as well as for SUD treatment facilities. Nurses are able to re-enter the nursing workplace successfully but are a unique group among the SUD population. There is a need for increased efforts by regulatory and professional nursing bodies and healthcare systems to explore ways to retain RNs in practice and preserve careers after SUD treatment completion by supporting work re-entry success.

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