Award Date

December 2015

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Lori Candela

Second Committee Member

Michelle Clark

Third Committee Member

Carolyn Yucha

Fourth Committee Member

LeAnn Putney

Number of Pages



Substance use disorder, defined as the misuse of drugs and/or alcohol, is a major health problem in the United States. Health care providers, including nurses, are at risk for this disorder. Risk factors for substance use disorder (SUD) in nurses include social factors such as family history of the disorder and biological factors such as genetic predisposition. Specific risk factors for nurses include easy access to controlled substances (such as opiates), stressful work environments, the belief that substance use assists with coping and a lack of education related to substance use disorder.

Substance use disorder in nurses is a significant issue because of the potential for impaired practice and patient endangerment. In the 1970s, state boards of nursing developed disciplinary programs for nurses with substance use disorder that protected patients through the removal of nurses from practice. These programs, primarily punitive in nature, provided little advocacy or treatment for nurses and, as a result, nurses hid or denied the disorder, and moved from job to job becoming sicker and sicker in their substance use disorder and further endangering patients. In 1984, the American Nurses’ Association recommended state boards of nursing develop alternative to discipline programs that provided treatment and monitoring of nurses with substance use disorder. The purpose of these programs was to remove nurses from practice during the acute phase of the disorder, provide treatment and then allow the nurse to return to practice in a structured, monitored environment.

Research related to nurses with SUD has addressed characteristics of those nurses, types of substances abused, and area of specialty. It has also addressed characteristics of completers and non-completers of alternative to discipline programs (ADPs), the impact of the programs on stress and life-burden, and the self-integration that occurs during the program. There is a paucity of literature however that addresses the actual lived experience of nurses who complete an ADP.

The purpose of this phenomenological inquiry was to describe, interpret, and gain a deeper understanding of the experience registered nurses have in an alternative to discipline program. Van Manen’s six research activities of interpretive phenomenology guided this inquiry. Colaizzi’s seven step method of data analysis operationalizes van Manen’s activities and was used for analyzing the research data. The question guiding this study was: What is the meaning and significance of the lived experiences of registered nurses with substance use disorder who completed an alternative to discipline program through a state board of nursing?

Three registered nurses participated in this research. The findings of the research resulted in five main themes and four subthemes that provide a rich description of these nurses’ experiences. Findings were validated through participant review and provided the essence of completing an alternative to discipline program- A Transformative Journey.

Understanding the meaning and significance of completing an ADP has implications for both nursing practice and nursing education. Implications for nursing practice include provision of a voice for those nurses who complete ADPs, information for state boards of nursing to enhance ADPs for increased success, and creation of a practice culture that supports the professional responsibility of nurses to intervene with colleagues who have SUD. Implications for nursing education include increased curricular content related to risk factors for SUD that are specific to nurses, the recognition of SUD in students and in graduates, and professional responsibilities in recognizing, and intervening with colleagues and students with SUD.


alternative to discipline program; Registered Nurses; State board of nursing; Substance use disorder



File Format


Degree Grantor

University of Nevada, Las Vegas




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