TABLE 2.

Article Characteristics: Design, Methods, Sample, Findings

Author et al. (Year) Title Setting	Aim	Methodology Framework Data collection Data Analysis	Sampling Strategy Sample	Major Alcohol-Related Findings	Key Statistics (Quantitative) Key Themes (Qualitative)
Choflet et al. (2021) A comparative analysis of the substance use and mental health characteristics of nurses who complete suicide Setting: United States using CDC NVDRS	“The aim of this study was to describe the substance use and mental health characteristics of nurses who complete suicide compared to the general population who complete suicide (≥20 years of age).” (p. 1964)	Methodology: Retrospective cohort study Framework: Not described Data collection: CDC NVDRS from 2003–2007 Data Analysis: Descriptive statistics, OR, χ2	Sampling Strategy: Nurses identified from free-text occupation field in the NVDRS Sample: n = 2,306 nurses n = 185,620 non-nurses	Among those who completed suicide, nurses were more likely than non-nurses to use alcohol (42.1% vs. 13%) and to test positive for substances, including alcohol, at time of death.	Alcohol was not statistically significantly linked with completion of suicide when comparing all nurses to others:  • Alcohol tested: OR = 1.17, p = .81  • Alcohol result: OR = 0.92, p = .19  • Crisis alcohol problem: OR = 1.36, p = .26  • Alcohol problem: OR = 0.98, p = .81
Witkoski Stimpfel et al. (2020) Early career nurse reports of work-related substance use Setting: Virtual focus groups in an online platform	“The aim of this study was to explore the culture of substance use among nurses in their first 5 years of practice.” (p. 29)	Methodology: Qualitative descriptive design Framework: Work, Stress, and Health Model (Quick & Tetrick, 2014) Data collection: Participants assigned to one of two private anonymous discussion boards. Data analysis: Content analysis	Sample Strategy: Participants were recruited from the RN Work Project, a national survey study Sample: n = 41 consented n = 23 participated in discussion boards N = 19 competed demographic questionnaires	Nurses reported moderate alcohol use to cope with shift work and work stress.	34.8% of participants reported using alcohol. Participants reported the use of alcohol to promote sleep or relaxation after a long shift to cope with work stress.
Davidson et al. (2021) Job-related problems prior to nurse suicide, 2003–2017: A mixed methods analysis using natural language processing and thematic analysis Setting: United States using secondary data from NVDRS	“To provide context to job-related problems experienced before nurse death by suicide.” (p. 29)	Methodology: Qualitative mixed methods Framework: Interacting Risk and Protective model for understanding suicide Data Collection: NVDRS, which has certified medical examiner/law enforcement reports Data Analysis: Thematic analysis and natural language processing; latent Dirichlet allocation; descriptive statistics	Sampling Strategy: Sample obtained through NVDRS Sample: N = 203 nurse deaths by suicide. Included deaths were those with “job problem” in the law enforcement or certified medical examiner report	Nurses who lose a nursing position related to SUD are at risk for suicide. One-third of nurses who died by suicide had alcohol issues prior to their death.	92% (n = 187) were out of work or in the process of losing their position as a nurse. 38.4% (n = 78) had alcohol issues prior to death by suicide. “Her family stated that she was quite upset by her situation at work and had been drinking more and more over time. Cause of death was alcohol overdose” (p. 34) Common Themes: Peri-job loss; nurse was under investigation for drug and/or alcohol use. History of drug and alcohol addiction; counseled about patient complaint. 10.8% of the nurse suicides were in three states that had no ATD program.
Hurley et al. (2018) Nurses’ perceptions of self as role models of health Setting: Online survey of nurses in Tennessee	“To determine the relationship between nurses’ personal health practices and their perceptions of themselves as role models for health promotion, and assess the relationship of personal and professional characteristics both on perception of self as role model and on the practice of healthy behaviors” (p. 1131)	Methodology: Cross-sectional study Framework: Social cognitive theory Data Collection: Anonymous online questionnaire Data Analysis: Pearson’s r correlational matrix; Multiple regression; ANOVA	Sampling Strategy: Random sample of all registered nurses in Tennessee (n = 61,829) Sample: N = 804 RNs with active license in Tennessee and valid email address	Caucasian race and working in academia were predictive of alcohol use among nurses. There was a significant relationship between alcohol use and lack of exercise among those working in academic settings.	24.9% of respondents drank alcohol. Two predictor variables that contributed significantly to alcohol use:  • Caucasian race (β = 0.87, p < .016)  • Academia as area of employment (β = 0.105, p < .004)
Foli, Forster, et al. (2021) Voices from the COVID-19 frontline: Nurses’ trauma and coping Setting: Online survey of U.S. nurses working during the COVID-19 pandemic	“To describe the experiences of frontline nurses who are working in critical care areas during the COVID-19 pandemic with a focus on trauma and the use of substances as a coping mechanism” (p. 3853)	Methodology: Qualitative Framework: Middle-range theory of nurses’ psychological trauma Data Collection: Online survey with two open-ended questions Data Analysis: Qualitative content analysis	Sampling Strategy: Nurses recruited through American Association of Critical Care Nurses, alumni list of large university Sample: N = 73 nurses who contributed to either or both open-ended questions	Nurses used alcohol and other substances to cope with stress from work during the COVID-19 pandemic.	Turning to substances (alcohol, tobacco, food, drugs) to cope. Normalization of use among colleagues and backing away from alcohol use for fear of health and developing dependency.
Stovall et al. (2021) Personality traits and traumatic outcome symptoms in registered nurses in the aftermath of a patient safety incident Setting: Online survey of nurses in New York and Oregon	“To investigate the relationship between personality traits (perfectionism and neuroticism) and the traumatic outcomes of reexperience, avoidance, and alcohol abuse severity of [RNs] involved with a patient safety incident” (p. 1652)	Methodology: Cross-sectional study Framework: Not described Data Collection: Electronic surveys sent via email Data Analysis: Multiple linear regression	Sampling Strategy: RNs electronically recruited from the NewYork and Oregon BONs Sample: N = 216 nurses who working in a clinical setting within the past 5 years and were involved in a patient safety incident; currently an RN in NewYork or Oregon	Negative linear relationship between perfectionism-order and alcohol abuse severity.	Perfectionism-order (p < .01) had a protecting effect against alcohol severity symptoms (r2 = 13.56%; f(19, 183)) when controlling for sociodemographic and experience variables, which explained 5% of the variance in the model. Per authors, perfectionist-discrepancy subscales use in isolation is recommended against; they should be taken with caution.
Foli, Zhang, et al. (2021) Predictors of substance use in registered nurses: The role of psychological trauma Setting: Online and postal mail survey of nurses in Indiana	“The purpose of this study was to (a) reveal risk scores of SUD; and (b) determine predictors of nurses’ risk for tobacco, alcohol, and other SU” (p. 1025)	Methodology: Cross-sectional study Framework: Not described Data Collection: Online multiple single-item questions and validated tools survey Data Analysis: Bivariate analysis (χ2, Fisher exact test); multivariate regression; one-way ANOVA	Sampling Strategy: Targeted 4,000 Indiana RNs via BON registry via postal mail and email. Sample: N = 1,478 RNs in Indiana	Nurses are at moderate risk for alcohol use (11.6%). Depression, anxiety, and GAD level of difficulty item were predictive of risk for alcohol use. Life events and lateral violence were predictive of alcohol use. Current nursing position associated with increased alcohol use. Protective to the risk for alcohol use included religiosity and resilience.	Multivariate regression with predictive variable for alcohol use (r2 = 0.09): Depression score/PHQ-9 (p = .000), anxiety/GAD-7 (p = .30), GAD level of difficulty item (p = .001), current nursing position (p = .000); predictive of alcohol use: Life Events Checklist (p = .000). Potential buffers to alcohol use were religiosity (p = .000), resilience (p = .04), perceived organizational support (p ≤ .001). Bivariate associations: ACE (p = .005), Life Events Checklist (p ≤ .001), Lateral Violence Question 37 (p ≤ .001), Lateral Violence Question 38 (p ≤ .001), Lateral Violence Question 39 (p ≤ .001), Depression: PHQ-9 (p ≤ .001), Anxiety: GAD-7 (p ≤ .001), GAD Level of Difficulty (p ≤ .001)
Collins et al. (1999) Substance use among a regional sample of female nurses Setting: Western NewYork	“[To assess] the prevalence of licit (e.g. alcohol) and illicit (e.g. cocaine) drug use ... in a regional sample of female nurses” in the context of nursing-related factors and demographic characteristics (p. 145)	Methodology: Cross-sectional study Framework: Not described Data Collection: Postal mail surveys Data Analysis: Descriptive statistics, χ2	Sampling Strategy: Random sample of nurses from Western NewYork obtained through BON Sample: N = 1,951 RNs and LPNs in Western NewYork	Compared to non-hospital colleagues, nurses who worked in hospitals reported using alcohol at greater rates.	Hospital vs. non-hospital nurses: χ2 (1) = 5.74, p ≤ .02 Ages 18–44 vs. 54+ past month use of alcohol: χ2 (4) = 39.39, p ≤ .001 Almost 13% reported being drunk from alcohol in the past month of use, suggesting excessive intake. Of nurses who reported being drunk, most were married and worked in a hospital setting. 5.7% reported feeling dependent on alcohol; most in this group were married and worked in hospitals. Very few (1.1%) reported blackouts related to alcohol use in the past month.
Trinkoff & Storr (1998a) Substance use among nurses: Differences between specialties Setting: Nationwide survey	To “report on the prevalence of substance use among nurses and expand on previous research by providing substance-specific use rates for a comprehensive array of nursing specialties obtained from a nationwide survey of nurses” (pp. 581–582)	Methodology: Cross-sectional study Framework: Not described Data Collection: Postal mail survey Data Analysis: Descriptive statistics, χ2, logistic regression	Sampling Strategy: Balanced stratified sampling Sample: N = 4,438 RNs in the United States	Total prevalence of binge drinking was 16% in this study. Working in oncology, administration, emergency, or adult critical care increased odds of having engaged in binge drinking by 1.7–2.1.	Binge drinking by specialty:  • Oncology: OR = 2.1 (95% CI 1.2–3.6)  • Administration: OR = 2.1 (95% CI 1.3–3.6)  • Emergency: OR = 1.9 (95% CI 1.2–30)  • Adult Critical Care: OR = 1.7 (95% CI 1.2–2.4).
Foli et al. (2020) Substance use in registered nurses: “I heard about a nurse who...” Setting: Online survey of nurses in Indiana	“To ascertain an accurate description of nurses’ SU in the State of Indiana, we sought to expand our understanding of SU (including alcohol) in RNs through qualitative data collected via online survey, (p. 66)	Methodology: Mixed method: Cross-sectional and descriptive content analysis Framework: Not described Data Collection: Online survey with open-ended responses Data Analysis: Descriptive content analysis, χ2	Sampling Strategy: Stratified random selection Sample: N = 1478 nurses overall n = 373 contributed to open-ended responses	Clear narratives that tie nurses’ use of alcohol to cope with professional stress.	Four themes:  • “Differing Social Network Proximity to SU.” Nurses mostly described information about a peer, for example, “I heard about a nurse who...” (p. 69)  • “Individual Process—From Vulnerability to Outcomes” (p. 70). Professional and job-related factors created a “perfect storm” (p. 70) of vulnerability: “I used alcohol as a coping mechanism for the trauma, death, and dying I was experiencing at work” (p. 70); “I do, however, truly believe that the experiences bedside nursing staff live on a day to day basis can cause post-traumatic stress disorder (myself being one of them) dependency on alcohol and drugs as a means of coping” (p. 70)  • “Bedside, System and Organizational Space and Effects” (p. 71). Ripple effects after nurses are found to have diverted  • “No exposure to substance use in the profession” (p. 72).
Jordan et al. (2016) The impact of perceived stress and coping adequacy on the health of nurses: A pilot investigation Setting: Midwestern US hospital	“To assess nurses’ health status, health behaviors, self-reported stress levels, coping techniques, perceived coping effectiveness, and situation specific self-efficacy to cope with workplace related stress” (p. 2)	Methodology: Cross-sectional study Framework: Not described Data Collection: Postal mailing of 65-item survey Data Analysis: χ2 tests, ANOVA, t tests	Sampling Strategy: Surveys mailed to all part-time and full-time nurse employees (n = 177) Sample: N = 120 nurses employed by a hospital in the Midwestern United States	More than 1 in 5 nurses (22%) met criteria for binge drinking. Nurses who had high stress and poor coping were more likely to binge drink (more than 5 drinks on any occasion).	High stress poor coping with 5 or more drinks on any occasion in the last 30 days: 24% (p = .07).
Trinkoff et al. (2022) The prevalence of substance use and substance use problems in registered nurses: Estimates from the Nurse Worklife and Wellness Study Setting: RNs in the United States	“To generate population-based prevalence estimates for SU and related problems, including SUDs, among registered nurses and to examine other personal and work characteristics related to nurse SU” (p. 35)	Methodology: Cross-sectional observational study Framework: Balance theory from human factors and systems engineering Data Collection: Online and mailed questionnaires during November 2020 and March 2021 Data Analysis: Descriptive statistics, χ2 tests (Fisher exact as appropriate), logistic regression, ORs	Sampling Strategy: Balanced stratified sampling to select sample representative of the U.S. RN population Sample: N = 1,170 RNs and APRNs	Risk for SUD was significantly higher among nurses in certain positions and specialties.	Alcohol use prevalence 30.9%. Alcohol use higher among charge nurses coordinators/nurse managers (32.8%; SE = 2.9) and other administrators (34.4%; SE = 4.7). Alcohol use highest among nurses in nursing homes/assisted living (42.9%; SE = 6.4). Alcohol use higher for administration (45.8%; SE = 7.1), emergency (38.6%; SE = 5.7), critical care (35.5%; SE = 4.5), and total multispecialty nurses (373%; SE = 4.2). 34.3% of nurses demonstrated a low to moderate risk of alcohol use problem.
Trinkoff & Storr (1998b) Work schedule characteristics and substance use in nurses Setting: US nationwide postal mail survey	To “examine the relationship of a broad array of work schedule characteristics (shift, shift length, overtime, and weekends) to drug and alcohol use in a national sample of nurses” (p. 267)	Methodology: Quantitative cross-sectional observational study Framework: Not described Data Collection: Postal mail surveys Data Analysis: OR	Sampling Strategy: Balanced stratified sampling Sample: N = 3,917 nurses employed either full or part time	Nurses working night shifts longer than 8 h had the highest likelihood of alcohol use. Nurses working rotating shifts longer than 8 hours were more likely to use alcohol. Working a few days of overtime in the past month, working shifts longer than 8 h, and working one or two weekends per month increased the likelihood of using alcohol.	Prevalence of drinking 5 or more drinks on one occasion in the past year was 17%. Nurses on rotating shifts were 50% more likely to drink alcohol (OR = 1.54, p < .05).

Note. ACE = Adverse Childhood Experience; ANOVA = analysis of variance; APRN = advanced practice registered nurse; ATD = alternative to discipline; BON = board of nursing, CDC = Centers for Disease Control and Prevention; GAD = generalized anxiety disorder; LPN = licensed practical nurse; NVDRS = National Violent Death Reporting System; PHQ-9 = Patient Health Questionnaire-9; RN = registered nurse; SE = standard error; SU = substance use; SUD = substance use disorder.