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An exploration of the role of substance misuse nurses in Scotland
Chapter 4: Motivation, attitudes and beliefs
Key points in this chapter The challenging nature of working with drug misusers was a positive motivating factor for nurses working in this field. Seventy-seven per cent (77%) of nurses considered working with drug misusers to be rewarding. Seventy-nine per cent (79%) considered drug misusers were not easy to deal with. Opinion was split about whether drug misusers could be manipulative in consultations. Nurses believed more strongly than pharmacists that maintenance prescribing could stop the use of illicit drugs. Fewer nurses than pharmacists believed that controlled drug dispensing should take place in central clinics rather than community pharmacies.
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The questionnaire included questions exploring nurses motivation to work in this field, their attitudes to working with this client group and beliefs about the organisation of service. The more general questions were based on a previous study of community pharmacists allowing some comparison of these professional groups.
Nurses were specifically asked to reflect on their motivation to work with drug misusers. They were asked to select up to three (of six) motivation statements provided. The importance of intrinsic motivations (challenge of working with drug misusers and having enjoyed previous work with drug misusers) was apparent (Table 5).
Table 5: Motivation to work with drug misusers
Motivational Statements1 | N | % |
I thought it would be challenging to work with drug misusers | 123 | 64.1 |
I worked with drug misusers in other nursing posts and enjoyed it | 92 | 47.9 |
I felt I lacked knowledge in this field and wished to correct this by becoming a substance misuse nurse | 53 | 27.6 |
The job offers better prospects than other jobs/specialities I have applied for | 37 | 19.3 |
I wanted to change direction in my career | 38 | 19.8 |
My previous employment had terminated and there was a vacancy for a substance misuse nurse | 9 | 4.7 |
1Participants selected up to three statements
In exploring nurses' attitudes to working with this group only 2% agreed with the statement "
I have no sympathy at all for drug misusers" whilst 77% agreed that "
Working with drug misusers is rewarding" and 85% agreed with the statement "
Drug misusers are professionally challenging". This is further explained by the 79% that disagreed that "
Drug misusers are easy to deal with" and the split in opinion about whether drug misusers were manipulative during consultations (44% agreed and 42% disagreed).
Table 6 presents data comparing nurses and pharmacists attitudes to drug misusers and providing services for drug misusers. At a population level a greater proportion of nurses disagreed with the statement
"I have no sympathy for drug misusers" than pharmacists. Nurses appear to be more confident than pharmacists that maintenance prescribing will stop the use of street drugs. Perhaps not surprisingly there was a slightly higher proportion of pharmacists than nurses agreeing that controlled drugs should be dispensed through a central clinic than community pharmacies.
Table 6 Nurse and pharmacist attitudes to drug misusers and treatment approach (n=187 nurses and n= 969 pharmacists).
Comparative attitude statements | Respondent | Strongly agree
% | Agree
% | Disagree
% | Strongly disagree
% | Uncertain
% | Missing value
% |
Providing drug misusers with a maintenance dose of a controlled drug can stop them using street drugs
1 | Nurse | 22.6 | 61.6 | 12.6 | 1.6 | 1.6 | 1.0 |
Pharmacist | 1.3 | 15.1 | 43.9 | 10.5 | 26.3 | 2.9 |
Controlled drugs should be dispensed to drug misusers through a central clinic rather than a community pharmacy | Nurse | 2.1 | 11.6 | 45.3 | 30.0 | 11.1 | 1.0 |
Pharmacist | 16.3 | 22.2 | 31.9 | 6.0 | 20.7 | 2.9 |
I have no sympathy at all for drug misusers | Nurse | 0.5 | 1.6 | 26.8 | 71.1 | 0 | 1.0 |
Pharmacist | 3.5 | 10.9 | 49.8 | 18.4 | 17.0 | 0.3 |
Providing problem drug misusers with a maintenance dose of a controlled drug is a waste of NHS resources | Nurse | 1.6 | 3.7 | 42.2 | 49.7 | 2.7 | 2.6 |
Pharmacist | 4.7 | 13.7 | 47.4 | 7.4 | 23.6 | 3.1 |
1Pharmacist question was worded as "I believe providing drug misusers with a maintenance dose of a controlled drug will stop them using street drugs." (Matheson
et al., 2002).
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