The association between self-reported substance use and work schedule characteristics among nurses: A cross-sectional study

Abstract

Background: Job stress due to adverse work schedules has been associated with negative effects on nurses, including substance use. Nurses' potentially harmful substance use related to adverse schedules amid the COVID-19 pandemic may be of critical concern for nurse wellness and patient safety.

Objective: This study aims to examine relationships between substance use and work schedule characteristics among nurses.

Design: A cross-sectional design was applied.

Setting: This study utilized data from the Nurse Worklife and Wellness Study, which was collected between November 2020 and March 2021. Registered nurses with active licensure status were eligible to participate.

Participants: Nurses were randomly selected from 9 U.S. states, stratified to represent the nurse population per state, with 1170 usable responses.

Methods: The mixed-mode survey (online and mailed questionnaires) contained items regarding adverse work schedules and past year substance use. Adverse work schedules were measured using the Work Schedule Index (0-14 points) and divided into three groups per percentile: low (0-3), medium (4-6), and high levels of adverse work schedules (7 and more). Substance categories included any past year use of illicit drugs, nicotine, high alcohol intake, energy drinks, high caffeine consumption, and prescription drug misuse. Chi-square tests assessed the distribution of nurses' substance use by work schedule characteristics. Logistic regression was performed to estimate the odds of each substance use associated with adverse work schedule levels, and the regression models were adjusted for age.

Results: Almost half of the nurses reported using one or more substance categories listed above in the past year. Adverse work schedules, such as working other than day shifts only, extended work hours, lack of breaks between shifts, and full-time schedules, were positively related to nurses' substance use. In age-adjusted regression models, higher levels of adverse work schedules were related to greater odds of illicit drug use (aOR = 4.08, 95 % CI [1.49, 11.19]), high alcohol intake (aOR = 1.95, 95 % CI [1.27, 3.00]), high caffeine use (aOR = 2.25, 95 % CI [1.40, 3.62]). Higher odds of energy drink consumption were related to medium (aOR = 2.26, 95 % CI [1.13, 4.51]) and highly adverse schedules (aOR = 3.93, 95 % CI [1.96, 7.90]).

Conclusions: Adverse work schedules may encourage nurses' substance use to enhance alertness or cope with adverse work schedules; however, this can have negative implications for nurse health and patient safety. Considering these findings, solutions to reduce adverse schedules are critically needed.

Registration: Not registered.

Keywords: Nurse; Occupational stress; Substance use; Substance-related disorder; Work schedule.