Disciplining virtue: investigating the discourses of opioid addiction in nursing

Abstract

Two nurses diagnosed with opioid addiction launched legal action after being found guilty of unprofessional conduct due to addiction-related behaviors. When covered by the media, their cases sparked both public and legal controversies. We are curious about the broader discursive framings that led to these strong reactions, and analyze the underlying structures of knowledge and power that shape the issue of opioid addiction in the profession of nursing through a critical discourse analysis of popular media, legal blogs and hearing tribunals. We argue that addiction in nursing is framed as personal choice, as a failure in the moral character of the nurses, as decontextualized from addiction as disease arguments, and as an individualized issue devoid of contextual factors leading to addiction. Our investigation offers a critical case study of a nursing regulatory body that upheld popular assumptions of addiction as an autonomous, rational choice replete with individual-based consequences - a framing that is inconsistent with evidence-based practice in health-care. We put forth this critical interrogation to open up possibilities for counterdiscourses that may promote more nuanced and effective responses to the issue of addiction in nursing.

“A Two Glass of Wine Shift”: Dominant Discourses and the Social Organization of Nurses’ Substance Use

“…These current discursive representations of nurses readily bring to mind the historical Christian and Victorian, gendered, moralistic stereotypes of “good” women (and nurses) as temperate, uncomplaining, endlessly altruistic “angels” ( Heise, 2002 ; Turkoski, 1995 ). Our data supported others’ findings that vestiges of such virtue-based ideologies persist in current nursing discourse ( Gordon & Nelson, 2006 ; Kunyk, Milner, & Overend, 2016 ). Our study also revealed how substance-use problems were discursively organized as character flaws that “good nurses” simply do not have.…”

“…These discourses are also consistent with those found in the scholarly nursing literature, in which a highly individuated ( Ross et al, 2018 ), neoliberal ( Kunyk, Milner, & Overend, 2016 ) perspective exists toward nurses’ substance-use problems, which pays little heed to the institutional context of nurses’ work lives. For instance, Burton (2014) concluded a common characteristic of nurses who had problems with substance use was that “they did not know how to effectively cope” (p. 157).…”

“…We also felt a disjuncture 3 arising from what we saw as the decontextualization of the issue in the extant scholarly works. Nurses’ problems with substance use have been principally framed in neoliberal terms of individual shortcomings ( Kunyk, Milner, & Overend, 2016 ), whereas broader institutional and organizational conditions have neither been critiqued nor researched ( Ross et al, 2018 ). This trend conflicted with what we knew experientially about the interconnections between nurses’ substance-use practices and their workplaces.…”

Individualized approach to primary prevention of substance use disorder: age-related risks

“…Healthcare professionals (e.g., pharmacists, nurses, dentists, and anesthesiologists) have a higher risk of opioid misuse primarily due to the access and availability of substances in their professions, as well as the risk of work-related injury [ 36 , 79 ]. Long work shifts and physical injury on the job were specifically identified as SUD risk factors for nurses [ 80 ]. Among all healthcare workers, the lack of SUD awareness education in school translated into increased risk in the profession, as did the tendency to view SUD as a personal and moral failure within the profession, despite all evidence to the contrary [ 36 , 80 , 81 ].…”

Discourse analysis of health providers' experiences using service design

“…Over the last 20 years, discourse analysis has gradually been accepted as an important method in healthcare research (Buus, ). Discourses authorize and encourage inquiry into the framing and understanding of prevailing structures of knowledge and power (Kunyk, Milner, & Overend, ). While the approaches to discourse analysis differ, they all study language and meaning.…”