ORCID Identifier(s)


Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Susan M Baxley


There are approximately 3.1 million nurses in the Unites States (US Census Bureau, 2016) and approximately 8% of them suffer from chemical dependency and substance use disorders (Kunyk, 2015). In Texas, nurses with impaired practice are referred to peer assistance programs such as the Texas Peer Assistance Program for nurses (TPAPN), a monitoring program for nurses as they seek rehabilitation and recovery. Nurses are referred for various reasons including diversion of medications from patients and impairment at work. Currently, 348 nurses in TPAPN are actively participating in the program for substance abuse related offenses. Many nurses are also referred to the program are for dual diagnoses. Of all the nurses that were referred to TPAPN over the last six years, 1553 were specifically for substance abuse related problems. These represent two percent of the population of nurses in Texas. The average age of participants in this study was 40.1 years, and approximately half of them were under the age of 40. Females represented 75% of participants and 76% were registered nurses. About 32% relapsed while they were in the program, and about 41% successfully completed the program. Nurses with impaired practice abuse variety of substances including prescription drugs and illegal drugs. Opioids were the most frequently abuse class of drugs, followed by alcohol, and then stimulants. The majority of nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical-surgical units, and home health care had the highest prevalence of impaired practice. In this study, psychiatric comorbidity was not significantly associated with relapse. Self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of days abstinent. Men were also more likely to be employed while in the program compared to their female counterparts. Of the twelve-predictor variables used in Cox Regression analysis, only two were significant predictors of relapse among nurses with impaired practice in TPAPN. These two predictors were (a) having substance use disorder as the referral type and (b) having alcohol as the primary drug of choice. The findings of this will help develop interventions that promote recovery, reduce relapse rates, and ultimately protect the public from impaired practice.


Substance abuse, Nurses, Peer assistance program


Medicine and Health Sciences | Nursing


Degree granted by The University of Texas at Arlington

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Nursing Commons